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The Different Skin Benefits of Azelaic Acid

Whether you’re trying to treat acne, have sensitive skin or you simply want to better understand what you’re putting on your skin, it can sometimes feel like you need a Ph.D. to decipher the ingredients of some skincare products. People often say to avoid ingredients you can’t pronounce, but there are some ingredients with different-sounding names that are beneficial and help promote healthy skin. 

You’ve probably seen glycolic acid and salicylic acid, but azelaic acid is another safe skin care ingredient that’s been around for decades that you may have overlooked. 

Azelaic acid, pronounced ay-zuh-lay-uhk, is touted by dermatologists and is an ingredient definitely worth knowing about. To thoroughly explain its full range of benefits and uses, we turned to Rebecca Thiede, MD, a dermatologist with Banner – University Medical Center Tucson.

What is azelaic acid?

It has been used for more than 30 years and has quite a range of uses due to its antimicrobial and anti-inflammatory properties. 

“Azelaic acid is a naturally occurring dicarboxylic acid found in cereal grains like wheat, rye and barley and animal products,” Dr. Thiede said. “It is produced by Malassezia furfur, a yeast that lives on normal skin.”

Azelaic acid can be found in gel, foam and cream forms both by prescription (Azelex and Finacea) or in lower strengths in over-the-counter products. Azelaic acid strengths range from 10% to 12% for over the counter and more than 15% for prescription.

What are the benefits of azelaic acid?

“Azelaic acid is effective against a number of skin conditions, such as mild to moderate acne, melasma and rosacea,” Dr. Thiede said. “More recent research shows it may even help with hidradenitis suppurativa, alopecia, keratosis pilaris and psoriasis vulgaris.”

It is very safe and gentle, with minimal side effects. Azelaic acid is one of the few treatment options that can be used in children and people who are pregnant or breastfeeding. 

“This is great for pregnant people as many options we typically use for acne treatment aren’t safe in pregnancy,” Dr. Thiede said.

Here’s how azelaic acid products help your skin:

  • Reduces inflammation. Azelaic acid can counter or neutralize free radicals that cause inflammation. It has significant skin-calming effects and helps to improve redness.
  • Evens skin tone. It decreases pigmentation, inhibiting an enzyme called tyrosinase that leads to hyperpigmentation, or dark patches of skin. This is why azelaic acid is great for acne breakouts, post-acne scarring and melasma.
  • Fights acne. Azelaic acid kills bacteria on your skin that cause acne. “It decreases the activity of bacteria called Propionibacterium, the bacteria found in acne, due to its bacteriostatic (limits the production of bacteria) and bactericidal properties (kills bacteria),” Thiede said.

Dr. Thiede noted that while azelaic can benefit those with mild to moderate acne, it shouldn’t be used as a first-line treatment for those with cystic acne. “It isn’t going to penetrate deep enough to be beneficial,” she said. “These patients will need to be seen by a board-certified dermatologist for care.”

How does azelaic acid differ from glycolic and salicylic acids?

Glycolic and salicylic acids are typically what you think of when it comes to skin care and belong to the hydroxy acid family. Although azelaic is also an acid, it doesn’t belong to the hydroxy acid family and is gentler.

“Glycolic is a type of alpha-hydroxy acid, or AHA, while salicylic acid is a beta-hydroxy acid or BHA,” Dr. Thiede said. “Both are used in topicals and peels as a moisturizing exfoliant and to enhance penetration for such conditions as photodamaged skin, xerosis (dry skin), acne and actinic keratoses (pre-skin cancerous tumors).”

There is some overlap in conditions that both hydroxy acids and azelaic acid treat but they can be used in different ways. 

“For instance, azelaic acid is a first-line therapy for patients with melasma as a daily treatment whereas glycolic and salicylic are typically the second line and in the form of chemical peels every four to six weeks,” Dr. Thiede said. 

What are the cautions for and side effects of azelaic acid?

Azelaic is a mild type of acid, but it is possible to experience some irritation when first using it. 

“Up to 10% of patients may report itching, burning or scaling, which may last up to four weeks,” Dr. Thiede said. “Local reactions may be reduced by starting the treatment once a day  and using a small amount for the first one to two weeks of treatment.”

It’s always important to wear sunscreen when you go outside—especially while using azelaic acid. Conditions such as hyperpigmentation from acne or melasma can worsen with sun exposure, so you will have the added benefits if you protect your skin and use this product.  

How do you use azelaic acid?

Azelaic acid plays well with others and can be used on its own or with other products and ingredients, such as hydroxy acids, retinoids, niacinamide, hyaluronic acid, benzoyl peroxide and antioxidants like vitamin C. 

“However, use caution when using azelaic, hydroxy acids, benzoyl peroxide and retinoids together as they can be irritating and drying,” Thiede said.

Typically, azelaic acid cream is applied once or twice a day to clean, dry skin. For those with sensitive skin, you may start with once daily and go up to twice daily if you aren’t experiencing irritation.

“For best results, apply a pea-sized amount evenly over your skin after cleansing,” Dr. Thiede said. “Then follow with a hydrating moisturizer and sunscreen with SPF of at least 30.”

Results can vary depending on the skin condition. “For acne, you should see improvements after one to two months and maximum benefits after four months with prescription strength and longer with over-the-counter strength,” Dr. Thiede said. 


Azelaic acid is a skin-friendly dicarboxylic acid that can treat rosacea, help with acne, melasma and a number of other skin conditions. Due to the gentle nature of the acid, it’s great for almost all skin types and safe for those who are pregnant or breastfeeding.

Talk to your health care provider or dermatologist before starting azelaic acid topical treatment or if you have concerns about a skin condition. They may recommend other treatment options or a prescription-strength dose of azelaic acid. 

To find a Banner Health specialist near you, visit bannerhealth.com. 

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