Azelaic acid: what it treats and how it works
Azelaic acid is an over-the-counter and prescription skincare ingredient used for rosacea, acne, and hyperpigmentation. Here's what the evidence shows.
Azelaic acid is a naturally occurring compound found in grains like barley and rye. It's available both over-the-counter and by prescription, and dermatologists use it to treat three main skin conditions: rosacea, acne, and hyperpigmentation.
How azelaic acid works
Azelaic acid works by reducing inflammation and killing acne-causing bacteria. It also appears to regulate melanin production, which is why it's used for dark spots and discoloration.
What azelaic acid treats
The evidence is strongest for rosacea. Studies show it reduces redness, pustules, and bumps associated with the condition. It's also effective for mild to moderate acne, particularly in people who can't tolerate other treatments like benzoyl peroxide or retinoids.
For hyperpigmentation and melasma, azelaic acid shows promise but works more slowly than some alternatives.
Strength and formulation
Over-the-counter versions typically contain 10 to 20 per cent azelaic acid. Prescription formulations go up to 20 per cent and sometimes higher in combination products.
Side effects
Azelaic acid is generally well tolerated. Common side effects include mild itching, stinging, and temporary redness at the application site. It's safe for most skin types, including sensitive skin.
Considerations
Results take time. Most people need 4 to 12 weeks of consistent use before seeing meaningful improvement. If you're pregnant, consult your doctor before starting azelaic acid, though topical use is considered low-risk.