Acne is one of the most common and widely spread chronic skin disorders affecting millions of people around the globe. In the United States alone, it affects 17 million people every year. It affects people irrespective of their race, gender or age though it is more common in women than in men. However, it acquires a more severe form in men as per a survey.

The symptoms of acne include the breakout of pimples, whiteheads and blackheads along with inflammation and redness or scarring of the skin. At times these inflammations reach deep down under the skin developing cysts and nodules and causing a more severe form of cystic or nodular acne respectively.

The primary cause of acne breakout is the rise in the level of androgens. Higher androgen level induces the sebaceous glands to produce more sebum. Sebum is the oil like substance secreted by the sebaceous glands that are used to moisturize the hair follicles and surface of the skin.

However, its overproduction along with the accumulation of dead skin cells on the surface which leads to clogging of the skin pores prevents the sebum from coming out as it gets trapped under the surface of the skin creating an environment congenial to the growth of microbes.

It is these microbes that cause acne breakouts. This is the main reason why acne breakouts usually occur during or after puberty and it may or may not persist into the adult life of these people. According to a survey, at any one point in time approximately 85% to 90% teenagers face the problem of acne breakouts.

There are also other factors which can contribute towards the frequency and intensity of these breakouts which includes exposure to local pollution, naturally occurring oily skin and stress. Persisting acne often causes psychological morbidity resulting in anxiety, depression and stress.

A lot of methods and medications have been introduced with time which ranges from anti biotic to various herbal and home remedies. This article shall discuss the effectiveness of Azelaic acid in the treatment of acne along with its various benefits and side effects.

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What is Azelaic Acid

Azelaic acid is basically an organic compound which exists as a white powder in form of saturated dicarboxylic acid. It is naturally found in wheat, rice and barley and is used in a number of hair and skin conditioners.

This medication is used for the treatment of comedonal or inflammatory acne. It is a form of dicarboxyl acid and kills the acne-causing bacteria thereby unclogging the pores that they otherwise keep occupied, to trap the excess sebum.

It also tends to inhibit the manufacture of keratin that would otherwise support the growth and survival of these bacteria and microbes.

It is used for correcting a number of skin conditions like rosacea, acne, skin pigmentation, melasma, post inflammatory hyper-pigmentation. Azelaic acid further facilitates a reduction in the production of melanin, as it also tends to function as a tyrosinase inhibitor.

How Azelaic Acid can Help in Acne Treatment

How is Azelaic Acid used to Treat Acne?

Azelaic acid has been a widely popular topical treatment for acne. It is often combined with oral antibiotic or hormonal therapy.

Azelaic acid tends to exhibit antibacterial properties which help in killing and thereby reducing the P.acne bacteria and inhibit their growth in the follicle. It also shows keradolytic and comedolytic properties which reduce the disordered growth of skin cells lining the follicle.

It further functions as an antioxidant reducing the oxidative stress due to the presence of free radicals which further helps in the reduction of inflammation.


Before it is applied to the affected area, the area should be washed and pat dry. After this, a thin layer can be applied and massaged gently. In order to get maximum benefits, it should be used regularly. Improvement is seen mostly only after a month of using it. No bandage should be placed over the cream unless otherwise directed by the doctor.


This can be applied twice daily usually in the morning and evening if not otherwise directed by the doctor concerned. In order to facilitate regularity, it is usually advised that you apply it at the same time every day.

Any contact with the eyes, ears or mucous membranes should be avoided as it is only meant for external use. Large amount of this medication should not be applied as it would only increase the risks of side effects and will not contribute towards speeding up the healing process in any way.


It should be stored at room temperature between 59 degrees F to 86 degrees F (15 degrees Celsius o 30 degrees Celsius). It should strictly not be frozen. Its proper disposal should be discussed with the doctor or pharmacists.

Side effects

Azelaic acid is not known to cause very severe and frequent side effects especially when used topically. However, some of the side effects it might result in are enumerated below

  • Azelaic acid, when used topically, might cause stinging and burning of the area on which it is applied.
  • It may cause itching and tingling of the skin post application.
  • It might result in worsening of cold sores and fever blisters (oral herpes), though very rarely.
  • It might result in unwanted hair growth.
  • Hypopigmentation or lightening of the skin colour might develop after the treatment. This usually happens to people who have dark skin.
  • It might also cause a worsening of the asthma symptom like shortness of breath or wheezing.
  • Though allergic reactions are rare, it might cause rash, itching or respiratory issues.

In case of any of these symptoms being persistent, the doctor must be informed and consulted and if the situation requires, this medication should be put on a hold.


In order to avoid any risks of side effects, the following precautions must be maintained:

  • The doctor must be informed about any medication that you are taking whether prescriptive, non-prescriptive, herbal or any other vitamin or mineral supplement.
  • You must inform the doctor if you are allergic to Azelaic acid or any other substance contained in the medicine.
  • It tends to make you sensitive to sun light and therefore exposure must be avoided as much as possible. Also, whenever you go out, you must use a sun screen or a protective covering.
  • The doctor must be informed if you have suffered from any other medical condition earlier.
  • If you are pregnant or breastfeeding or even plan to become pregnant, you must inform the doctor about it.

Drug interaction

Azelaic acid is not known to react adversely with any medication. However, you should try avoiding any such cream or lotion that might cause further dryness or irritation of the skin. These include cleansers or creams that might contain alcohol, astringent, abrasive and peeling agents.

Brand names

Azelaic acid is available for the following brands:

  • AzClear action: It is a lotion containing 20% Azelaic acid.
  • Azelex : This also contains 20% Azelaic acid.
  • White action cream: It contains 20% Azelaic acid and 2% glycolic acid.
  • Finacea: It contains 15% Azelaic acid and comes in a gel form.

Customer review

We did an online analysis of consumers who had used Azelaic acid for treating their acne breakouts. Here is a summary of what they liked or disliked about it:

What they liked about Azelaic acid

Gentle: Most consumers were of the view that Azelaic acid was rather gentle on their skin as opposed to other treatments that make their skin rough. It was not harsh at all and did not cause any scabbing.

Very effective: A lot of consumers found this treatment extremely effective. Some saw an improvement rate of 90% in two months and more than 50% in a week. The difference, after application, is visible over one night.

Inexpensive: The cost of any Azelaic acid product is relatively cheaper. One tube/lotion of the usual quantity costs not more than 10$. It is therefore not a burden on your pocket.

What they did not like about it

Dryness: Some consumers were of the view that Azelaic acid had caused extreme dryness on their skin. This might be due to the use of excess amounts of the cream.

Burns: A few consumers complained that application of Azelaic acid made their skin burn and they had a stingy feeling.

This again can be attributed to its excessive use. However, it has been suggested that this sensation tends to fade away with time as your face gets used to the treatment.


Azelaic acid is one of the most popular forms of topical treatment which is widely used by people around the globe. Its antibacterial, antioxidant and anti-inflammatory properties attack the problem of acne breakouts from all four sides.

Furthermore, it is also effective in fading away from the scars and has one of the lowest risks of hyper or hypopigmentation. What more, it is not at all expensive. If you have long been suffering from these breakouts then you might as well try this out. Additionally, it also has a very high safety rate as it rarely causes any side effects.


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