AZELAIC ACID
Also known as: Azelaic acid, Nonanedioic acid, 1,7-heptanedicarboxylic acid
Overview
Azelaic acid is a naturally occurring dicarboxylic acid found in grains like barley, wheat, and rye. It is widely used topically for dermatological conditions such as acne, rosacea, melasma, and skin aging. Its key characteristics include anti-inflammatory, antimicrobial, and keratolytic properties. Research supports its efficacy and safety, with numerous randomized controlled trials (RCTs) and systematic reviews confirming its benefits. It is available in various formulations, including creams, gels, and foams, with concentrations ranging from 15% to 20%. Azelaic acid works by reducing inflammation, normalizing keratinization, and inhibiting melanin synthesis, making it effective for a range of skin issues. It is generally well-tolerated, with mild local irritation being the most common side effect.
Benefits
Azelaic acid is effective in treating several skin conditions. For acne, it significantly reduces inflammatory lesion counts and overall severity, proving beneficial in mild to moderate cases. In rosacea, it reduces erythema and inflammatory lesions, improving overall symptoms. Meta-analyses support these findings with statistically significant outcomes. For melasma, azelaic acid reduces severity, potentially outperforming hydroquinone in some studies, while maintaining comparable safety. Some evidence suggests it may improve skin texture and pigmentation related to aging, although this is less substantiated than its benefits for acne, rosacea, and melasma. Improvements are often observed within weeks to months of consistent treatment.
How it works
Azelaic acid exerts its effects through multiple mechanisms. It exhibits antimicrobial activity against *Propionibacterium acnes* and *Staphylococcus epidermidis*, reducing bacterial colonization in acne. Its anti-inflammatory properties stem from inhibiting reactive oxygen species and neutrophil-mediated inflammation. Azelaic acid also normalizes keratinization, reducing follicular plugging. Furthermore, it inhibits tyrosinase, an enzyme crucial in melanin synthesis, which explains its efficacy in treating hyperpigmentation disorders like melasma. Topical absorption is moderate, and the formulation vehicle significantly impacts bioavailability and skin penetration, influencing its overall effectiveness.
Side effects
Azelaic acid is generally well-tolerated when used topically. Common side effects, occurring in more than 5% of users, include mild local irritation, burning, stinging, and dryness at the application site. Uncommon side effects, affecting 1-5% of users, involve erythema, itching, and peeling. Rare side effects, seen in less than 1% of users, include allergic contact dermatitis. Due to minimal systemic absorption, drug interactions are rare; however, caution is advised when combining it with other potentially irritating topical agents. It is contraindicated in individuals with known hypersensitivity to azelaic acid or any of the formulation's excipients. While data are limited, it is generally considered low risk for pregnant women, but consultation with a healthcare provider is recommended.
Dosage
The minimum effective dose is typically a 15% topical azelaic acid cream or gel. Optimal dosage ranges are between 15-20%, applied twice daily for acne and rosacea. For melasma, 20% formulations may be used. There is no established maximum safe dose; usage is guided by individual tolerability. Twice-daily application is generally recommended, and consistent use over 8-12 weeks is needed for visible effects. The choice of cream, gel, or foam formulation depends on skin type and tolerance, with foam and gel formulations potentially enhancing delivery. No specific cofactors are required, but moisturizing agents may improve tolerability.
FAQs
Is azelaic acid safe for sensitive skin?
Generally, yes, but mild irritation can occur initially. Starting with once-daily application may improve tolerance. Monitor for any adverse reactions and adjust frequency accordingly.
How long until results appear?
Improvements in acne and rosacea are typically seen within 4-8 weeks. Melasma may require longer treatment durations for optimal results. Consistent use is key.
Can it be combined with other treatments?
Yes, azelaic acid is often combined with other topical agents or oral medications under dermatological supervision. Consult a healthcare provider for personalized advice.
Does it bleach the skin like hydroquinone?
No, azelaic acid lightens pigmentation by inhibiting melanin synthesis without the bleaching effect associated with hydroquinone. It's a gentler alternative.
Is it safe during pregnancy?
Limited data suggest it is low risk, but consult a healthcare provider before use during pregnancy to ensure it is appropriate for your specific situation.
Research Sources
- https://pubmed.ncbi.nlm.nih.gov/37550898/ – A systematic review and meta-analysis including 20 studies on rosacea and acne showed significant reductions in erythema severity and inflammatory lesions with azelaic acid (p < 0.05). The review also covered melasma and skin aging applications, highlighting the versatility of azelaic acid in dermatology. However, the study noted variability in study designs and outcome measures as a limitation.
- https://pubmed.ncbi.nlm.nih.gov/37457606/ – A systematic review and meta-analysis compared azelaic acid to hydroquinone in 6 RCTs with 673 melasma patients. The study found azelaic acid superior in reducing MASI scores (MD = -1.23, 95% CI [-2.05, -0.40], p=0.004) with similar safety profiles. The authors noted that while the methodology was robust, the moderate sample size and need for longer follow-up were limitations.
- https://www.actasdermo.org/en-efficacy-widely-used-topical-drugs-articulo-resumen-S0001731025002820 – A meta-analysis analyzed 9 studies on azelaic acid for rosacea, showing higher success rates compared to placebo or comparators in some scoring systems (MD 1.26, 95% CI 1.10–1.45, p=0.001). The study focused on rosacea with multiple RCTs, confirming azelaic acid's efficacy. However, some heterogeneity in outcome measures was noted as a limitation.
- https://m.x-mol.net/paper/detail/1689895990993899520 – This paper provides detailed insights into the mechanisms of action of azelaic acid, particularly its role in inhibiting tyrosinase and reducing melanin synthesis. It highlights the importance of azelaic acid in treating hyperpigmentation disorders and its impact on melanocyte activity. The research contributes to a deeper understanding of azelaic acid's therapeutic effects on skin pigmentation.
- https://academic.oup.com/bjd/article/187/5/639/6966388 – This article discusses the efficacy and safety of azelaic acid in treating various dermatological conditions, including acne and rosacea. It emphasizes the anti-inflammatory and antimicrobial properties of azelaic acid, which contribute to its therapeutic benefits. The study supports the use of azelaic acid as a valuable topical agent in dermatology.