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Azelaic Acid for Acne and Hyperpigmentation

Kristin Hall

Medically reviewed by Kristin Hall, FNP

Written by Our Editorial Team

Last updated 10/09/2020

Living with a skin problem is no walk in the park. You can slather it with creams and medications, wash it with cleansers and soaps or hide it with makeup — but you know it’s there, even when you manage to gain ground or conceal it. 

For women living with acne, the problem is more than skin-deep. It can affect your quality of life and even your social relationships. If you’ve ever cancelled a date because of a breakout, you know what we mean. 

Fortunately, there are solutions out there. Azelaic acid is one such solution. 

We know, you’ve tried “all of the things.” But if you’ve yet to chat with a dermatologist or healthcare professional about your skincare problems, there’s likely more that you can do. 

Azelaic acid may be a solution for you. 

Acne: Some Background

To understand how solutions against acne might work, it’s helpful to understand acne. 

Acne vulgaris is a very common skin disease, increasingly seen in adult women. As a matter of fact, one-third of medical office visits for acne are made by women over the age of twenty-five.

Acne lesions are caused when sebum, or oil, becomes trapped in your pores due to dead skin cells. There, bacteria can cause inflammation, and a pimple is formed.

Several things can heighten your risk of developing acne, including: lack of sleep, poor diet, stress, genetics, hormonal imbalance, cosmetics, obesity and certain medications.

There are several different types of acne lesions — comedones (whiteheads and blackheads), papules, pustules, cysts and nodules. 

The type of acne you’re prone to and just how frequent and severe your breakouts are can help your healthcare provider  determine your acne severity and the right line of treatment for you. 

Azelaic Acid: What Is It? 

Azelaic acid is a topical product, sold in both prescription and over-the-counter formulas. It may  be used in the treatment of rosacea, acne and sometimes off-label for hyperpigmentation.

Azelaic acid is a naturally occurring acid derived from grains such as barley, wheat and rye. It’s believed its effectiveness is due to several mechanisms, including its ability to destroy damaging oxygen and reduce inflammatory proteins. 

It also works to reduce an enzyme that creates pigment (discoloration) known as tyrosinase, and may reduce the rate at which skin cells shed, helping manage blocked pores.

Azelaic Acid in Acne

Several studies have affirmed the effectiveness of azelaic acid in the treatment of acne. 

Both 15 percent and 20 percent formulas have proven helpful in reducing acne blemishes, either alone or in conjunction with other medications. 

It’s effectiveness is said to be on par with other topical therapies used in the treatment of mild to moderate acne.

In addition to reducing the severity of acne, it’s been found to improve the Dermatology Quality of Life Index, a measurement that assesses the quality of life of people living with a skin disease.

Generally, azelaic acid is recommended as a first-line treatment in both inflammatory and non-inflammatory acne. 

What that means is your healthcare provider may suggest you try this topical solution before bringing out bigger guns like systemic antibiotics. 

adult acne is cancelled

put acne in its place with a prescription-strength cream

Azelaic Acid in Hyperpigmentation

Azelaic acid has also been proven effective in treating post-inflammatory hyperpigmentation (PIH), a concern among many women suffering from or having suffered from acne. 

PIH creates dark spots on your skin, where acne lesions once were. It’s more common in women of color, though it can affect anyone. 

A few smaller studies have affirmed the medication’s ability to lessen PIH without significant side effects. As a matter of fact, in one study of 20 patients, 92 percent of them saw two-point improvements on a seven-point scale.

For women suffering from both acne and hyperpigmentation, azelaic acid could be a doubly beneficial treatment

Precautions and Side Effects

One reason azelaic acid is a popular choice among women is the relatively safe profile. Side effects are minimal and may include burning, stinging and peeling of irritated skin, as well as severe itchiness.

Also, azelaic acid is safe for pregnant and breastfeeding women, or women who may become pregnant.

Azelaic Acid: The Bottom Line

Azelaic acid is a topical skin care product that’s sold in both over-the-counter and prescription-only formulas.

It’s a naturally occurring acid derived from grains like wheat, rye and barley. 

If you’re looking for a possibly effective treatment in your fight against acne and/or the signs of aging, it may be worth having a conversation with your healthcare provider about azelaic acid.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.