Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 2/17/2021
Search for proven, science-based acne treatments and you’ll quickly find recommendations for azelaic acid.
Azelaic acid is a type of dicarboxylic acid. It has a variety of benefits for your skin, including the ability to reduce swelling, prevent redness and kill the bacteria that can grow inside your pores and contribute to acne breakouts.
Because of these numerous benefits, it’s become a popular ingredient for skin care treatments, including our Customized Acne Cream.
Using azelaic acid is simple, but there are a few things that you should know before adding this ingredient to your skin care routine.
Below, we’ve explained what azelaic acid is, how it works and the benefits you may experience by using azelaic acid to treat acne, rosacea and other skin issues.
We’ve also talked about how you can use azelaic acid alongside other skin care products for optimal results.
Azelaic acid is a dicarboxylic acid that’s found in a variety of natural sources, including barley, wheat and other whole grains.
While the idea of applying an acid to your skin might sound scary, the azelaic acid used in skin care products isn’t dangerous.
Instead, it can offer several benefits for your skin, from stopping the growth of acne-causing bacteria to controlling redness and inflammation.
You can find azelaic acid in a variety of over-the-counter and prescription skin care treatments, including creams, gels and foams.
Azelaic acid works in several ways to improve your skin. First, it reduces swelling and redness, giving your skin a smoother, more consistent appearance.
Second, it has the ability to destroy certain types of bacteria, including those that can contribute to acne and skin infections.
Some research has found that azelaic acid is even effective against certain antibiotic-resistant strains of bacteria.
Third, it can decrease your skin’s production of keratin — a natural substance that’s associated with acne breakouts.
Fourth, azelaic acid has an antioxidative effect, allowing it to control oxidative damage that can affect your skin.
Fifth, it may also stop something called epidermal melanogenesis — a process in which your skin produces excess melanin, giving it an uneven, discolored appearance.
Azelaic acid’s broad range of effects on your skin give it several benefits, from controlling acne to treating skin conditions that cause inflammation and changes in your skin’s color tone.
We’ve listed these benefits below, along with the science behind how each benefit works.
Azelaic acid treats acne from several angles. First, it decreases your skin’s production of keratin — a fibrous structural protein.
Keratinocytes, or keratin-producing cells, are a key factor in acne breakouts. As your skin sheds old cells and replaces them with new ones, keratinocytes rise to the outermost layer of your skin before detaching from your body.
Sometimes, keratinocytes can mix with sebum on the surface of your skin. When this happens, the substance created by the keratinocytes and sebum can form plugs inside your hair follicles, leading to acne breakouts.
We’ve explained this process in more detail in our complete guide to the factors that cause acne breakouts.
By controlling your skin’s keratin production, azelaic acid can lower your risk of developing acne breakouts.
Azelaic acid also targets the bacteria that can contribute to acne breakouts. Although bacteria isn’t a root cause of acne, some types of bacteria can infect blocked hair follicles and contribute to swelling, inflammation and discomfort, making your acne breakouts significantly worse.
Research has found that azelaic acid is very effective at killing some types of bacteria. In fact, it’s even effective against some antibiotic-resistant strains of bacteria that are hard to treat using conventional medications.
Numerous studies have found that azelaic acid is effective at getting rid of acne. For example, a study involving more than 280 people with inflammatory acne found that azelaic acid led to a significant reduction in acne lesions over the course of six months of use.
A more recent study published in the Journal of Drugs in Dermatology found that a topical foam containing 15% azelaic acid produced a noticeable reduction in acne lesions and inflammatory acne over the course of 16 weeks, all with only mild side effects.
While azelaic acid is best known as an acne treatment, it also offers benefits for skin conditions such as rosacea.
Rosacea is a common, non-contagious skin condition that can cause your skin to develop a red, flushed appearance. It usually begins at your nose but can often spread to other parts of your face and body.
In addition to redness, some forms of rosacea can produce swelling, acne-like breakouts, visible blood vessels and thickening of your skin.
Because of its anti-inflammatory benefits, azelaic acid is used to control the breakouts, swelling and redness that can affect people prone to rosacea.
Research shows that regular use of azelaic acid can reduce the number of inflammatory lesions that develop during rosacea flare-ups, all while controlling symptoms such as redness.
In addition to treating acne and rosacea, azelaic acid can also help to control melasma — a skin pigmentation disorder that can cause brown or gray-brown patches to develop on your face and body.
Azelaic acid treats melasma by blocking the effects of tyrosinase, an enzyme that’s responsible for producing the skin pigment melanin.
This prevents the patchy, uneven pigmentation that’s common in people with melasma.
This effect also makes azelaic acid one of several effective treatments for removing dark spots left behind by acne breakouts.
Products containing azelaic acid are available over the counter and with a prescription. Azelaic acid products available over the counter usually have a lower concentration of azelaic acid than prescription treatments.
Using azelaic acid is easy. If you’ve bought an over-the-counter skin care product that contains azelaic acid, follow the instructions provided with the product.
If your healthcare provider has prescribed an azelaic acid cream, gel or foam, closely follow the instructions provided with your prescription.
Before applying any topical products that contain azelaic acid, wash the target area using warm water and a mild soap.
Gently pat the skin dry using a towel, taking care not to scrub your skin firmly or aggressively.
After you’ve applied azelaic acid cream, gel or foam, allow it to dry before applying any makeup or other skin care products.
Most azelaic acid products are designed for use up to two times per day. To avoid forgetting to use your azelaic acid treatment, try to apply your skin care products or medications at about the same time every day.
Azelaic acid creams, gels and other products are safe and effective for most people. However, like other active ingredients used in skin care products, azelaic acid has the potential to cause side effects.
Common side effects of azelaic acid include dryness and feelings of itching, stinging, burning and/or tingling that may affect your skin.
If any of these side effects are severe or persistent, it’s important to contact your healthcare provider for assistance.
Although uncommon, azelaic acid may cause more severe side effects such as swelling, rash, hives, hoarseness and difficulty swallowing and/or breathing.
If you develop any of these side effects, contact your healthcare provider immediately or seek emergency medical care.
From getting rid of acne to treating rosacea, melasma and dark spots left behind by inflamed acne, azelaic acid offers a variety of benefits for your skin.
You can add azelaic acid to your skin care routine by using an over-the-counter azelaic acid product.
For more noticeable effects, you may want to consider a prescription acne product that’s formulated with azelaic acid.
From azelaic acid to tretinoin, clindamycin and even the birth control pill, a variety of different medications can help you to keep acne under control.