Acne Treatment Review Azelaic Acid

Azelaic acid occurs naturally in animal products and whole grain cereals. It is said to help the skin renew itself rapidly and stops cell buildup that causes clogged pores. Hence, azelaic acid is used in the treatment of acne for it can reduce the formation of blackheads and zits and kill P.acnes bacteria, which causes inflammatory acne.  Azelaic acid belongs to the dicarboxylic acid group of medications.

How should Azelaic Acid be used?

Azelaic acid for acne is usually used as a topical cream under the brand name ‘Azelex’. ‘Azelex’ cream contains 20% of this azelaic acid.   As a topical gel / jelly or cream, azelaic acid clears lesions, swelling and bumps caused by acne and acne rosacea. The gel or cream is applied directly to affected areas twice a day. For best results, try and apply the medications at the same time every morning and evening. Use azelaic acid carefully, following instructions printed on the label and getting further clarifications if needed from your doctor or pharmacist. The full benefits can be realized only after at least 4 weeks or more of applications.

The affected areas must be washed and cleansed with mild soap or cleansing lotion and patted dry gently using a soft towel. Always avoid cleansers or soaps that contain harsh chemicals, alcohol, tinctures, and astringents, peeling agents or abrasive products. Once cleaned, apply a thin layer of the gel or cream and massage it into the skin. Try not to get the cream into your eyes, mouth or nose and if you do so, wash thoroughly. Bandages or other dressings need not be used and non-comedogenic makeup can be used after the medication has been completely absorbed. Wash your hands thoroughly after each application.

Benefits of Azelaic Acid

Azelaic acid for acne is as effective as other topical creams like tretinoin, topical antibiotics and benzoyl peroxide in treating acne.  It is beneficial in treating mild or moderate acne outbreaks by reducing the P.acnes bacteria that attack the skin, keeping pores unclogged and therefore reducing acne outbreaks.  Azelaic acid is also said to help in treating dark spots that some patients develop due to the color of their skin. Most people are able to tolerate this medication, even with prolonged use and hence it is widely prescribed as a topical treatment for acne.

Limitations and Possible side effects of Azelaic Acidacne treatment

Azelaic acid can control acne outbreaks but not cure them.  Azelaic acid is not suitable for everyone and hence, do not share this medication or take it without consulting a doctor. It is not meant for children below the age of 12. Some people can develop resistance with prolonged use.  It provides good results only for acne that occurs due to bacterial infections. 

Side effects

A few side effects can be experienced when using azelaic acid such as:

  • Increased redness of the skin
  • Severe skin rash
  • Swelling
  • Itching
  • Burning
  • Peeling
  • Stinging
  • Dryness
  • Skin color changes in dark-skinned people

If you notice any of these or other side effects when using azelaic acid, then consult your doctor at once.  These side effects usually affect only 1-5% of users and these symptoms are usually mild and disappear soon.

If you get unusual hair growth or already have cold sores, oral herpes or fever and these conditions worsen then inform your doctor.


Those who have asthma, sensitive skin or are allergic to azelaic acid cannot use this cream or gel. Always inform your doctors if you are pregnant or nursing and they will then decide if you can use this medicine or not.

If you accidentally swallow azelaic acid, go to a hospital emergency room at once. Never share this medication with others for you do not know the effect on them. If you do miss a dose, apply it as soon as you can or wait till the next dose.  Avoid cosmetics that peel off such as facial masks, exfoliating products or abrasive products. If you have any other skin problem, do not use azelaic acid unless a doctor recommends it.

You need not use large quantities of azelaic acid or use it more often than your doctor tells you. Extra medication will not improve acne conditions faster. On the other hand, your side effects could worsen. The medication must be used for the full duration – at least a month. If the condition does not improve after this, you can inform your doctor who will consider other courses of action.

Drug interaction and Storage

There are no known interactions of any food or alcohol with azelaic acid for acne. Some medicines can interact with vitamins and complementary preparations. Make sure you inform your doctor about all medications you take.  Always ask your doctor before using any cosmetics on the treated area.


Store this medication at room temperature away from direct heat and light. It does not have to be frozen. Always throw out unused medicine, which has passed the expiry date and after you have finished using it. All medicines must be kept out of reach of children.


Azelaic is an excellent topical microbial that can inhibit the growth of P.acnes populations. It is beneficial in treating mild to moderate acne either alone or in combination with other medications. Always consult your dermatologist who can guide you about proper usage and such.