Azelaic acid is a chemical compound found naturally in some grains as well as in a fungus called Malassezia furfur that grows on your skin. It’s also a skin care ingredient. It comes in prescription strength, but you can also find it in in some over-the-counter products.
It treats common skin conditions like acne and rosacea.
Forms of Azelaic Acid
You can get azelaic acid as a:
- Gel
- Foam
- Cream
- Pill
Prescription forms have 15% to 20% azelaic acid, but over-the-counter versions have much less.
How Azelaic Acid Works
The acid has antibacterial and anti-inflammatory properties. Here's how it can help your skin.
Azelaic acid kills bacteria on your skin that causes acne. Experts aren’t exactly sure how this happens, but using a 15% to 20% cream can lower the amount of bacteria on the skin.
It's also an antioxidant that can counter the effects of, or neutralize, free radicals. These are compounds in your body that can cause inflammation in your skin and trigger acne. Neutralizing free radicals with azelaic acid can lower inflammation.
Acne is made partly by skin cells that don’t shed normally. Dead cells build up, and pimples are the result. Azelaic acid can slow down skin protein production, which can help lower buildup.
Azelaic acid can break the connection between testosterone and the body's production of oil. This can be helpful for a person going through puberty, when hormone changes lead to acne.
Certain skin cells make pigment when you expose your skin to sunlight. That pigment may show up as dark patches, called hyperpigmentation, on your skin. Azelaic acid can block the process and prevent dark patches from showing up.
You can find over-the-counter products and creams with 10% or less azelaic acid, but it’s a good idea to talk to your doctor about using these products on your skin.
Most of the research is on prescription-strength azelaic acid.
How to Use Azelaic Acid
Follow these steps when using azelaic acid:
- Wash your skin with a gentle or mild cleanser, and pat dry.
- Apply a thin layer of your foam, cream, or gel to the affected areas. Gently massage it in.
- Wash your hands with soap and water. Once the medication is dry, put on sunscreen.
- Apply makeup, if you wish.
You should follow your doctor’s instructions closely. Don’t use it more often or in a larger amount than directed. Only use it on your skin. If it gets in your eyes, nose, mouth, or vagina, rinse it off with water and call your doctor right away (especially if your eyes become red and sore).
Side Effects of Azelaic Acid
It’s common to have some side effects from azelaic acid. This normally happens when you start using the medication, and it usually goes away after 2 to 4 weeks of treatment. Talk to your doctor or dermatologist if it doesn’t.
Common side effects of azelaic acid can include:
- Burning or stinging
- Itchiness
- Dryness
- Peeling skin
- Redness
One reason for these side effects is that by slowing down the production of skin protein, azelaic acid also affects your skin barrier. It can break down and reduce the thickness of the outer layer of the skin, which can lead to skin irritation and dryness.
You may make the situation worse if you use extra astringents, peels, alcohol cleansers, tinctures, or abrasives on your skin while you’re using azelaic acid.
Be extra careful with azelaic acid if you have dark skin, because it can cause changes in skin color. Talk to your doctor right away if your skin becomes lighter in some areas.
Azelaic acid might make asthma worse. If you have asthma, talk to your doctor if you notice changes in your condition.
Other, stronger side effects include:
- Crusting
- Soreness
- Severe redness
- Swelling
- Scaliness
Things to Look Out For With Azelaic Acid
Don’t use azelaic acid on children unless your doctor tells you to. There haven’t been any studies on the effects of azelaic acid on children under 12 years old, so safety information isn't clear.
There also aren’t any human studies on azelaic acid during pregnancy and breastfeeding. Your body absorbs only a small amount of it, so it appears to be safe, but you’ll need to discuss it with your doctor.
Azelaic acid foam can catch fire, so you need to avoid fires, flames, and smoking right after you put it on.
Some foods and drinks might make your skin red or flushed-looking while you’re using azelaic acid gel. Your doctor may tell you to avoid things like:
- Spicy foods
- Hot drinks, like coffee and tea
- Alcohol
In general, if you’re using azelaic acid, follow up with your doctor so they can make sure your treatment is going well.