Azelaic Acid for Acne: A Gentle and Effective Treatment for All Skin Types

Many acne treatments are known for being harsh and difficult to stick with if you have sensitive skin. If you have been looking for an active ingredient that can address breakouts while remaining gentle, it’s time you learned about azelaic acid for acne.

What is Azelaic Acid?

Azelaic acid is a naturally occurring compound that is found in small amounts on your skin. It can be derived from grains such as wheat, barley, and rye, and can also be produced synthetically for use in skincare products. It belongs to a class of acids called dicarboxylic acids, and it is widely used in dermatology for its beneficial effects on the skin.


Low risk high reward skincare ingredient – azelaic acid. It’s a great acne medication during pregnancy as well. You can get it over the counter or as a prescription! #dermatology #dermatologist #derm #residency #doctor #skincare #azelaicacid #retinoid #melasma #acnetreatment #fy #fyp

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Azelaic acid is often used in treatments for acne, hyperpigmentation, and rosacea. 

How Does Azelaic Acid Help with Acne?

The combined antimicrobial, anti-inflammatory, and exfoliating properties of azelaic acid make it an effective treatment option for acne: 

  • Antimicrobial: Azelaic acid naturally has antimicrobial effects, meaning it can help prevent the growth of certain bacteria on the skin, including Cutibactrium acnes, the bacteria associated with acne. By reducing the amount of acne-causing bacteria, azelaic acid can help to keep new breakouts from forming.
  • Anti-inflammatory: The anti-inflammatory properties of azelaic acid help to calm the skin, reduce redness, and alleviate the inflammation and physical discomfort that often goes along with acne, particularly cystic acne
  • Exfoliation: By encouraging a more regular cell turnover, azelaic acid helps prevent the buildup of dead skin cells that can clog pores and contribute to the formation of acne lesions. Although azelaic acid’s primary way of preventing acne is not through exfoliation, which is relatively mild compared to other exfoliating ingredients like alpha-hydroxy acids (AHAs) or beta-hydroxy acids (BHAs), it can contribute to a smoother skin texture and help prevent comedones

Azelaic Acid for Hyperpigmentation

Azelaic acid can also help to fade the red or dark marks called post-inflammatory hyperpigmentation that acne can leave behind. 

This hyperpigmentation is made by an increase in melanin production where acne has caused inflammation. This excess melanin accumulates, resulting in the darkening of that spot. Hyperpigmentation can occur in all skin types, but it is more common and lasts longer in people with darker skin tones.

Azelaic acid can help fade hyperpigmentation by inhibiting tyrosinase, which is an enzyme used in melanin production. This can help give you a more even skin tone and reduce the appearance of these post-acne marks.

Azelaic Acid for Rosacea

Rosacea is a chronic skin condition that causes persistent redness, flushing, visible blood vessels, and bumps that can often be mistaken for acne.

Azelaic acid is effective in managing rosacea due to its potent anti-inflammatory properties. By calming the skin’s inflammatory response, azelaic acid helps alleviate redness and soothe the associated discomfort. Certain microorganisms are also present in rosacea and azelaic acid is able to inhibit their growth thanks to its antimicrobial properties. Additionally, azelaic acid can help with regulating cell turnover to decrease the acne-like bumps.

By addressing inflammation, inhibiting microorganisms and regulating cell turnover, azelaic acid can play a beneficial role in managing the symptoms of rosacea.

How to Get Azelaic Acid for Acne?

Azelaic acid is available in topical formulations such as creams, gels, and serums, and it is typically applied directly to the affected areas of the skin. 

It is available both by prescription or over the counter. However, it’s always recommended to consult with a dermatologist or healthcare professional to determine the most appropriate and effective use of azelaic acid for your specific skin concerns.

The main difference between prescription and over-the-counter azelaic acid is the concentration of the active ingredient. Prescription azelaic acid is available in strengths of 15% and 20%, while over-the-counter azelaic acid is typically only available in strengths of 10% or less, although Dermatica has a cream with 15% azelaic acid.

What is Prescription Strength Azelaic Acid?

Azelaic acid in strengths of 15-20% are available by prescription from your doctor. The higher concentration of prescription azelaic acid means that it is more effective at treating skin acne. However, it also means that it is more likely to cause side effects, such as dryness, redness, and peeling.

It usually comes in two forms: a gel and a cream. The gel is more lightweight and absorbs more quickly into the skin, while the cream is more moisturizing. Both forms are effective at treating acne and rosacea, but the gel may be a better choice for people with oily skin, while the cream may be a better choice for people with dry skin. There is also an azelaic acid foam made by the brand Finacea that is available by prescription for the treatment of rosacea. 

What is Over-the-Counter Azelaic Acid?

If you would like to try a more mild version of azelaic acid, it is available in over-the-counter products in up to 10% strength in the United States. You can find it in serums, toners, creams, and silicone-based gels

Over-the-counter azelaic acid is less effective than prescription azelaic acid, but it is also less likely to cause side effects. This makes it a good option for people who are looking for a gentler treatment for acne

Can You Use Azelaic Acid with Other Acne Treatments?

Azelaic acid for acne can be used in combination with other acne treatments. In fact, it is often incorporated into acne treatment regimens with other topical and oral medications to enhance effectiveness.

Generally you should only add one topical acne treatment at a time and give it time to take effect. If your current acne treatment is not enough to keep your skin consistently clear, you can consider slowly adding azelaic acid. For example you could continue to use your retinoid treatment at night and add azelaic acid every other morning to see how your skin reacts before using it every morning.

It can also be used alongside oral treatments such as spironolactone or as maintenance after a round of isotretinoin.

Azelaic Acid During Pregnancy

Azelaic acid is a good acne treatment option for pregnant women as it is considered to be safe for pregnancy and breastfeeding.


Azelaic acid is pretty versatile and well tolerated by most. 15-20% is going to most helpful and usually as a prescription. Check my recs for otc formulations #azelaicacid #acnetreatment #melasmatreatment #rosaceaskincare #perioraldermatitis #dermatologist #skincareinfo #skincaretips #greenscreen

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In addition to helping with acne during pregnancy, its ability to fight hyperpigmentation can also make it a great ingredient to fade melasma, sometimes called pregnancy mask, which can be triggered by hormones during pregnancy. 

Side Effects of Azelaic Acid

Azelaic acid is generally well-tolerated, but some people may experience side effects, such as:

  • Dryness
  • Redness
  • Peeling
  • Irritation

If you experience any side effects from azelaic acid, you should stop using it and talk to your doctor.

Does Azelaic Acid Cause Purging?

Purging is a temporary worsening of breakouts that can occur when you start using a new acne treatment that increases cell turnover. This can bring up clogged pores that were previously hidden below the skin’s surface.

Azelaic acid is a relatively gentle treatment, and it is not as likely to cause purging as other acne treatments, such as retinoids. However, it is still possible to experience purging with azelaic acid. To minimize purging with azelaic acid you can start by using it just a few times a week and then gradually increase the frequency of use as your skin gets used to it.

How Long Does Azelaic Acid Take to Work?

Azelaic acid for acne can take several weeks to start working, so be patient. It can vary greatly depending on the strength of azelaic acid that you are using, the condition you are trying to treat, and your individual skin type.

If you are not seeing any results after a couple of months you should contact your doctor.

Who Should Try Azelaic Acid for Acne?

Azelaic acid is a great product to test if you are trying to balance acne treatments with sensitive skin. Azelaic acid is more gentle than many treatments, but it can still lead to some side effects so add it slowly and use it to replace harsher acne products. 

If you tend to get post-inflammatory hyperpigmentation that lasts a while after a pimple is gone, azelaic acid could also be a great addition to your routine. It will help fight the breakouts as well as aid in fading the dark marks left behind.

Azelaic acid would also be a wonderful option if you struggle with a combination of rosacea and acne, as it could help to address both skin conditions. 

Using azelaic acid for acne is a gentle and effective treatment that is safe for all skin types. Unlike many harsh acne treatments, azelaic acid offers a milder approach while still delivering powerful results. Its antimicrobial, anti-inflammatory, and exfoliating properties make it a versatile treatment option for acne and other skin concerns.

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