Azelaic acid: The skincare ingredient that fights acne and calms rosacea

If you suffer from mild to moderate acne and rosacea, have sensitive skin or an uneven skin tone, chances are you're looking for a solution to help.

You might have heard of azelaic acid as a possible solution — but what exactly does it do and how can it help treat acne? We'll get into that as we break down exactly how this skincare ingredient helps fight acne and calm your rosacea.

Let's start by determining whether you do have rosacea. Rosacea is a common and chronic skin condition on your face that displays noticeably broken capillaries, pink or red patches or even acne-like bumps [1].

Rosacea commonly occurs in people with fair skin and often starts as frequent blushing, which becomes ongoing facial redness.

The word 'acid' can make you do a double-take before putting it on your skin, but there's no need to panic. Azelaic acid combats acne and rosacea by reducing inflammation and actually helping with the healing process. More on that later.

What is azelaic acid?

Azelaic acid is an active ingredient that can be packaged as a topical cream, foam or gel that works to reduce the redness, hyperpigmentation and scarring caused by acne.

It is considered to be a naturally occurring dicarboxylic acid that can also help reduce moderate acne and is often favoured by those with acne-prone skin [2]. Topical azelaic acid also has the benefit of helping to clear up rosacea.

So, how does it work? Well, azelaic acid helps reduce the occurrence of your pores becoming clogged from excessive skin cell shedding, which is a process called keratinization.

And, once azelaic acid has helped clear up your acne, you can continue using it to prevent future breakouts. It's also worth noting that in Australia, azelaic acid products are not approved for patients under the age of 17 [3].

Azelaic acid is classified as a pharmacy-only drug, meaning it can only be sold as a clinical-strength product, or as an over-the-counter product from a chemist only.

What are the skin benefits of azelaic acid?

We all know that bacteria contributes to acne, especially if you have an excess of sebum. Azelaic acid works to kill the bacteria that reproduces in sebum and some research suggests it can even kill the antibiotic-resistant strains of bacteria too [4].

Azelaic acid has anti-inflammatory properties that can also reduce redness, improve inflammation and help to heal acne and blackheads, while also working to unclog pores from dead skin cells.

It's able to do this as azelaic acid is a natural keratolytic agent, which means it breaks down the layers of dead skin cells, dirt and debris that often cause pimples [5].

Not only is it great for treating acne, but azelaic acid is a powerful skincare ingredient that can help combat hyperpigmentation or melasma, including post-inflammatory hyperpigmentation that is caused by acne scarring or prolonged sun exposure.

You should be able to see results of consistent use of azelaic acid within four to six weeks.

What is the best way to use azelaic acid?

If you're going to include azelaic acid as a topical treatment or as part of your skin routine, there are a few steps to keep in mind [6].

Before using azelaic acid, be sure to thoroughly wash your hands with soap and water. Start by cleansing your face with a mild soap or cleanser and gently pat it dry.

The azelaic acid gel, cream or foam should be applied topically in a thin layer to the affected area. Massage the azelaic acid into your skin until it is dry. You can then apply sunscreen followed by makeup.

Like any new product, it is worth doing a small patch test and waiting 24-48 hours in case of any adverse reactions. The amount and frequency you use azelaic acid will depend on what skin conditions you are hoping to treat.

For acne treatment in adults, use an azelaic acid cream twice a day, morning and night. Apply sparingly to the affected area — do not put it over your entire face.

To soothe redness and treat rosacea, a gel or cream enriched with azelaic acid is best.

What are the side effects of azelaic acid?

Like any acid treatment, there can be several common and less common side effects. The most common can include redness, stinging or tingling, dryness, itching, and even burning when first applied.

Less common side effects are blistering or swelling caused by the breakdown of your outer skin layer.

Those with darker skin tones need to be careful when using azelaic acid as in some cases, it can cause skin lightening. If you notice patches of skin that have changed tone due to azelaic acid, get in touch with your doctor immediately.

Is azelaic acid safe for pregnant women?

Azelaic acid can work well for those with sensitive skin (who can't tolerate stronger ingredients like benzoyl peroxide or retinoids) and is also safe for those trying for a baby, pregnant or breastfeeding.

You may experience some mild irritation when first using azelaic acid — if symptoms persist, consult your doctor.

Can you use vitamin C and azelaic acid together?

Yes! Azelaic acid can be safely used with vitamin C. The best method is to apply vitamin C in the morning, so it has time to work its magic on neutralising free radicals throughout the day, before using azelaic acid in the evening.

Both are potent ingredients, so it's best to space them out in your skincare routine.

What else should not be mixed with azelaic acid?

Azelaic acid is a mild acid and it's also one of the most compatible skincare ingredients [7]. It pairs well with most AHA and PHA products including salicylic acid, lactic acid and glycolic acid and also works well with vitamin B3 to give your skin a clarifying boost or TLC.

Azelaic acid is great to pair with retinol or vitamin A products to help even out your skin tone while also treating acne scarring and hyperpigmentation.

It also pairs well with hyaluronic acid for added hydration.

How does azelaic acid compare to AHAs or BHAs?

Azelaic acid has similar properties to some AHAs and BHAs. While they are both exfoliants, azelaic acid is far more gentle and not as effective at exfoliating as an AHA.

The real benefit of azelaic acid is its anti-inflammatory and anti-bacterial properties, while AHAs and BHAs are great for their ability to rid the skin of dead skin cells. You can use azelaic acid with AHAs and BHAs but be sure to use them on alternative days to minimise the risk of irritation.

If you want to reduce inflammation, improve skin texture and treat acne and rosacea, azelaic acid is your best bet.

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