Azelaic acid is a dicarboxylic acid naturally found in grains. This active ingredient has proven efficacy in the treatment of acne, rosacea, and hyperpigmentation, and is a versatile dermatological agent with antimicrobial, anti-inflammatory, and tyrosinase-inhibiting properties.
Mechanism of Action
Azelaic acid acts through multiple mechanisms. Its bactericidal effect reduces the population of Cutibacterium acnes (formerly P. acnes), it normalizes keratinocyte proliferation to prevent comedogenesis, and it regulates pigmentation by inhibiting the tyrosinase enzyme in melanocytes.
Its anti-inflammatory effect is associated with the reduction of reactive oxygen species (ROS) and the regulation of neutrophil function. These properties make it particularly valuable in the treatment of rosacea.
Use in Acne Treatment
Azelaic acid is an effective option for the treatment of mild-to-moderate acne. Prescription formulations at 15–20% concentrations show efficacy comparable to benzoyl peroxide and topical antibiotics for both inflammatory and non-inflammatory acne lesions.
Azelaic acid, classified as pregnancy category B, is one of the few active ingredients that can be safely used for acne treatment during pregnancy.
Rosacea Treatment
In the treatment of rosacea, azelaic acid is among the FDA-approved therapeutic options. Its 15% gel formulation is recommended as a first-line treatment for papulopustular rosacea. It reduces inflammatory lesions, alleviates erythema, and improves skin texture.
Hyperpigmentation and Pigmentation Treatment
The anti-pigmentary effect of azelaic acid is achieved through tyrosinase inhibition and selective cytotoxicity against abnormal melanocytes. It is effective in the treatment of melasma, post-inflammatory hyperpigmentation, and post-acne pigmentation. It is considered a safe alternative among hydroquinone substitutes.
- Does not carry the risk of ochronosis associated with long-term hydroquinone use
- Can be safely used on darker skin tones
- Can be combined with vitamin C and niacinamide
Usage and Side Effects
Azelaic acid is applied twice daily, morning and evening, in a thin layer. During the first weeks, mild burning, tingling, and redness may occur; these effects are generally transient. It is recommended to start with a low concentration and increase as tolerance develops. The fact that it does not cause sun sensitivity is an important advantage.
This article is for informational purposes only. Please consult a qualified physician for treatment decisions.