A Prescription Guide to Azelaic Acid

In the recent past, azelaic acid has developed a cult following on beauty forums, Instagram, and skincare blogs, and for a good reason. It might be one of the most effective acne treatments available on the market today.

Azelaic acid is effective in treating acne at every stage. It helps to reduce active acne while clearing up the hyperpigmentation, redness, and scarring that acne can leave behind. It also aids in keeping acne bacteria at bay after your skin heals. Azelaic acid is also highly effective in clearing up rosacea, and it is gentle enough to use on sensitive skin, unlike most other skincare acids.

Azelaic acid is available as a gel, lotion, foam, or serum. It is also mixed with other products to form exfoliants, multi-purpose serums, or gels sold over the counter.

How does it work?

Azelaic acid fights acne by preventing follicular keratinization, killing bacteria, and reducing inflammation.


Two types of bacteria contribute to acne; staphylococcus epidermidis and propionibacterium acnes. These bacteria are naturally found on everyone’s skin, but they tend to breed and multiply in the presence of sebum. That is why people with excess sebum production often end up with acne. Although azelaic acid doesn’t stop sebum production, it helps kill the bacteria that reproduce in it, therefore helping to prevent acne from recurring.

Follicular Keratinization

Another significant ability of Azelaic acid is that it can prevent clogged pores. Acne occurs as a result of two main changes to the sebaceous follicles on the skin. The first is follicular hyperkeratinization, where skins cells are shed into the fair follicles in excess, and the second is excess sebum production, which is controlled by hormones. Together, these processes clog pores, leading to a pimple or comedo.

Azelaic acid helps to normalize the skin cells within the follicle, preventing them from sticking together. They can then be carried out of the follicle by sebum without any blockages.


Azelaic acid helps to combat rosacea and acne by reducing inflammation. It does this through its antioxidant properties and ability to track free radicals just like niacinamide, therefore preventing oxidative stress on the skin. It also helps to fade the scarring and hyperpigmentation that occurs as a result of acne.

Who can use it?

Azelaic acid is suitable for anyone, including people whose skin can’t tolerate more potent anti-acne treatments due to sensitivity. It is often combined with niacinamide since both treatments work exceptionally well together.

What are the side effects of Azelaic acid?

Like with any other skin treatment or medication, it is possible to get a reaction from using Azelaic acid. However, it is an ideal product for sensitive skin, so most people are unlikely to experience a reaction.

It is normal to experience a slight tingling sensation immediately after you apply the treatment. However, seek the counsel of a doctor if you experience any peeling, redness, itching, or burning.

How is it used?

For best results, incorporate Azelaic acid into your daily skincare routine. It is often used once a day, either in the morning or evening.

What can I expect?

Azelaic acid starts working on the skin after the first application, but its effects may not be visible for a month of use. After it starts to work, you can expect a significant decrease in the number of clogged pores, decreased inflammation and redness, and reduced acne frequency and size. Over time, you will notice less hyperpigmentation and acne scars.


  1. DermNet NZ, Azelaic acid, <https://dermnetnz.org/topics/azelaic-acid/>, accessed 16th June 2020.
  2. Graupe, K., Cunliffe, W. J., Gollnick, H. P., Zaumseil, R. P. 1996, ‘Efficacy and safety of topical azelaic acid (20 percent cream): an overview of results from European clinical trials and experimental reports’, Cutis, vol. 57, no. 1, pp. 20—35. <http://europepmc.org/article/med/8654128>, accessed 16th June 2020.
  3. Passi, S., Picardo, M., de Luca, C., Nazzaro-Porro, M. 1989, ‘Mechanism of azelaic acid action in acne’, G Ital Dermatol Venereol, vol. 124, no. 10, pp. 455—463. <https://pubmed.ncbi.nlm.nih.gov/2534550/>, accessed 16th June 2020.
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