Is Azelaic Acid Good for Your Skin?

Medically Reviewed by Zilpah Sheikh, MD on March 01, 2024
8 min read

Azelaic acid is a type of acid that's found in some grains like rye, wheat, and barley. It's naturally produced by Malassezia furfur (also known as Pityrosporum ovale), a yeast found on healthy skin. Azelaic acid is a potent skin care ingredient because it can help treat common issues such as acne and rosacea.

Your doctor can prescribe azelaic acid, while weaker versions are also found in some over-the-counter products.

Azelaic acid vs. salicylic acid

Many skin care products contain salicylic acid, which is a different type of acid.

Salicylic acid softens a protein in your skin called keratin. This can help keep your pores from getting clogged, reducing the occurrence of pimples.

Azelaic acid not only unclogs pores but also helps kill acne-causing bacteria on your skin. It can also even out your skin tone by getting rid of free radicals, toxins that can damage your cells.

Generally speaking, salicylic acid works deep inside your pores, while azelaic acid largely works on the surface of your skin.

Azelaic acid can be prescribed in a few different forms.

  • Azelaic acid cream: Your doctor might suggest this type to help clear up your acne. You'll probably be told to wash and gently dry your skin, then apply a thin layer to the affected area, twice a day. Kids younger than 12 will get different instructions.
  • Azelaic acid gel: A gel or jelly form is typically prescribed to improve rosacea. Like the cream, it's often also applied twice a day, and children under 12 usually need a smaller, safer dose.
  • Azelaic acid serum: You can find azelaic acid in some skin care products, such as face serums. These are designed to be used before moisturizers. They contain high amounts of azelaic acid and can sink into your skin quickly.

Other forms of azelaic acid

You could also find azelaic acid in some soaps or get it prescribed as a foam. The foam is often used to treat rosacea. Because it's flammable, you'll need to avoid smoking and open flames after you apply it.

Prescription products usually have 15%-20% azelaic acid, while over-the-counter versions have less.

Here's how azelaic acid can help your skin:

  • It kills bacteria that cause acne. Experts aren’t exactly sure how this happens, but using a cream with 15%-20% azelaic acid has been found to be effective.
  • It protects your skin. Free radicals can damage cells, leading to skin inflammation and acne. Because azelaic acid is an antioxidant, it can defend your body against the harmful effects of these toxins.
  • It keeps your pores from getting clogged. Acne is caused by a buildup of dead skin cells and sebum (oil). Azelaic acid can help keep your pores open, making your skin less inflamed and new pimples less likely to form.
  • It can prevent dark patches. 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 this process.
  • It can reduce redness. Azelaic acid can also help prevent the widening of your blood vessels, thereby minimizing the redness of your skin.

Most research focuses on prescription-strength azelaic acid. You can find over-the-counter products and creams with 10% or less azelaic acid, but it’s still a good idea to check with your doctor before using these products.

Rosacea is a common skin condition. In the early stages, your face may flush. Over time, you can start to have more symptoms, and your skin can get very sensitive. For instance, it could burn or sting when you use a skin care product, or you could get acne-like breakouts. Rosacea can also start to affect your eyes.

Researchers haven't yet found the exact cause of rosacea, but several factors are likely involved, including an overactive immune system and an issue with your nerves and blood vessels.

You can get rosacea no matter what your skin tone is. Once you have it, there's no cure. Instead, you'll need to take steps to prevent flare-ups of your symptoms.

Azelaic acid cream, gel, foam, or lotion can help with the red bumps and pimples that are caused by rosacea. This treatment doesn't start working right away. Some people don't see results for weeks. But multiple studies have shown that about 70%-80% of people see their rosacea symptoms improve.

To help improve your skin, your doctor might also prescribe another medicine at the same time.

Usually, adults and kids over the age of 12 are told to apply azelaic acid twice a day. But read the prescription label carefully in case your doctor has different advice.

Follow these steps when using azelaic acid:

  1. Wash your hands before using this medicine.
  2. Wash your skin with a gentle cleanser. Rinse well and pat dry.
  3. Apply a thin layer of your foam, cream, or gel to the affected areas. (Shake a can of foam.)
  4. Gently massage it in.
  5. Wash your hands again with soap and water. Once the medication is dry, put on sunscreen.
  6. If you wear makeup, you can apply it now.

Follow your doctor’s instructions closely. Don’t use azelaic acid more often or in a larger amount than directed. 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).

If you miss a dose

Try to apply the product at the same time every day. If you forget to apply azelaic acid, put it on as soon as you can. Only skip the missed dose if it's too close to the next scheduled application.

It’s common for your skin to react when you first start using azelaic acid. For instance, you could notice:

  • Burning or stinging
  • Itchiness
  • Dryness
  • Peeling skin
  • Redness

One reason for these side effects is that azelaic acid slows down the production of a type of skin protein. That can result in the breakdown of the outer layer of your skin, which then leads to skin irritation and dryness.

You could make the situation worse if you use astringents, peels, alcohol-based cleansers, tinctures, or scrubs.

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.

Other, stronger side effects include:

  • Crusting
  • Soreness
  • Severe redness
  • Swelling
  • Scaliness

Azelaic acid might also make asthma worse. Talk to your doctor if you notice changes in your condition. If you have chest tightness or trouble breathing or swallowing, call 911 or go to a hospital.

You might be able to tolerate some side effects of azelaic acid, particularly if they're temporary or if the pros outweigh the cons. Talk to your dermatologist for more information about side effects.

Any skin care product that contains acid can cause "skin purging." This isn't a clinical term, but you may have heard about it online. It's when your skin looks like it's breaking out and getting worse. What's happening is that your skin cells are being sloughed off and replaced faster than usual.

Although you might not like how your skin looks during this time, purging should only last a short time. Once it stops, your skin should start to look clearer.

Don’t use azelaic acid on children unless your doctor tells you to and gives you clear instructions. There haven’t been any studies on the effects of azelaic acid on children under 12, so its safety 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 appear red or flushed while you’re using azelaic acid gel. Your doctor may tell you to avoid things such as:

  • Spicy foods
  • Hot drinks, such as 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.

Your doctor could suggest that you use azelaic acid along with another product to improve your skin. For instance, retinol is a form of vitamin A. It also speeds up how fast your body sheds skin cells and makes new ones. That helps keep your pores from getting clogged. Retinol also boosts the collagen in your skin, which can help it look smoother.

You can find retinol in many skin care products you buy at the store, or your doctor can prescribe a stronger product. Common retinol creams that come in prescription strength include tretinoin (Atralin, Avita, Refissa, Renova, Retin-A, and Tretin-X) and adapalene (Differin, Epiduo).

If your acne hasn't responded to other treatments, your doctor may want you to try a strong retinol such as tretinoin and azelaic acid at the same time. Some early data suggests that this duo can be helpful.

One reason your doctor could want you to use azelaic acid and tretinoin or another type of retinol together is if you have melasma. Azelaic acid can gently improve your skin, while retinol can even out your skin tone.

Because retinol, especially prescription strength products, can cause your skin to easily sunburn, it's important that you wear SPF during the day while using it.

Prescription-strength retinol products aren't recommended if you have rosacea. And they're not safe to use if you're pregnant because they can cause birth defects.

Vitamin C contains a different type of acid than azelaic acid, but it's also an antioxidant. Some research shows that over time, skin products containing vitamin C can improve wrinkles, protect your skin from sun damage, help control acne, and reduce dark spots. One small study showed that treatments that included vitamin C and azelaic acid helped improve skin moisture and firmness. It also evened out skin tone.

Talk to your doctor if you'd like to try vitamin C. Many different types and strengths exist. Your doctor can suggest a product that may work well for you. Make sure you know when to apply vitamin C and azelaic acid products, and the right order to put them on your skin.

Vitamin C skin products aren't recommended for kids. It's unclear how safe they are for children to use or how well they would work.

Azelaic acid is a natural acid that can help improve mild acne and rosacea. Use it exactly as directed, and be patient — it may be weeks before you see a difference. Some burning or stinging at first is common, but if you have any other side effects, let your doctor know right away.

How long will it take to see results from azelaic acid?

Azelaic acid doesn't start working right away. If you're taking it to clear up acne, it may be a month before your skin improves. If your doctor has prescribed azelaic acid for rosacea, you may not see a positive change for 3 months. If your skin stays the same or gets worse, let your doctor know. You may need a different treatment.