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What Does Azelaic Acid Actually Do and Should You Start Using it?

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Main image – Annatabakova/Stocksy

With so many skincare acids out there, it can be hard to differentiate between them. Each one is beneficial to the skin in its own way, but sometimes it feels like you need an acid encyclopedia to figure out which one is right for you.

Here, we’ve decided to focus on one acid in particular – azelaic acid.

This is your guide to what it actually is, what it does for the skin, its downsides (if any) and how to use it.

There are tips from founder of Em Skin, Erica Marie Gatt, dermatologist Dr Nowell Solish, GP and aesthetician Dr Ahmed El Muntasar, and Beverly Hills facial plastic surgeon, Dr Patrick Davis. And I too share my personal experience with azelaic acid, having recently used it on my adult acne. 

So, settle in and discover how azelaic acid might just be the answer to your skincare prayers.

 


What is azelaic acid?

This skincare acid, “is an extract derived from both animal products and grains like wheat, barley and rye,” explains Dr Davis. “Depending on the strength, it can be purchased over the counter or via prescription.” 

What’s more, azelaic is one of the gentler acids compared to some of the better-known names like glycolic acid or salicylic acid

 

Image – Ivanhaidutski/Stocksy

 

“It’s naturally occurring and is safe even for pregnant women unlike many other products that contain harsh chemicals,” Dr Davis confirms. “It is an anti-inflammatory agent and unlike other creams we use is not very irritating,” says Dr Solish.

Gatt adds, “azelaic acid is amazing for sensitive skin and it exfoliates more gently than AHAs and BHAs.”

 


What does it do?

Azelaic acid is, “a pretty versatile product that has proven effective in treating acne, skin anomalies like rosacea, melasma, psoriasis and even hair loss,” Dr Davis says. 

Studies have confirmed its effectiveness on the following skin issues:

  • Acne:

One 2023 study found that azelaic acid was an effective treatment for mild to moderate adult female acne.

And I can personally attest to that. After a year of trying ingredients like salicylic acid, glycolic acid, silver chitoderm and retinol for my own acne, my doctor prescribed me some azelaic acid along with a 12-week course of antibiotics and, since finishing, I haven’t had a breakout for three months. My skin is also less oily and looks noticeably more even. 

It’s important to note that whilst azelaic acid worked brilliantly on my acne though, it’s not always the case for everyone. “Although it is helpful in these conditions, it is not a cure and can be more moderately effective,” says Dr Solish.

  • Redness and rosacea:

Another study found that 15% azelaic acid was an effective treatment for mild to moderate rosacea cases (a chronic skin condition that can present as redness, irritation and acne-like breakouts) over a period of 15 weeks. 

  • Hyperpigmentation:

Studies have shown that 20% azelaic acid can help treat pigmentation spots safely on all skin tones.

Dr El Muntasar explains, “it’s great for treating pigmented lesions because it kind of inhibits tyrosine” [which is what contributes to the production of melanin].

  • Melasma:

For the same reason, melasma, another common form of pigmentation where dark patches are typically larger and found on the forehead, cheeks or upper lip, can also be helped by azelaic acid, according to one study, but is more effective when used in conjunction with other ingredients like tretinoin (a prescription form of retinol).

Dr Solish agrees. “On its own, it is helpful but not very effective,” he says. “Melasma is extremely hard to treat so using different types of treatments usually leads to better results.”

  • Rough skin texture:

Bumpy, rough skin can be a common- and pretty annoying- problem, but azelaic acid can help here too since it can break down dead, dull skin cells

 


Are there any downsides?

As a gentler acid, azelaic acid can be used on almost all skin types. However, it can cause dryness and peeling while skin adjusts to using it and those with sensitive or broken and cracked skin should avoid.

There is also some risk of causing pigmentation issues, according to the experts. “For some people it might work a bit too well and cause hyperpigmentation but that’s quite rare,” Dr El Muntasar confirms. 

 

Image – Ohlamourstudio/Stocksy

 


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

Dr El Muntasar says results times may vary. “It might take a bit of time for you to see a difference in your skin generally for acne – about four weeks,” he says. 

Ok, but what about for other skin issues? “Generally we say you need to use it for at least 12 weeks before you see a difference,” he confirms. 

Personally, it took me around 6 weeks to notice my acne spots were getting smaller and less frequent, and they were completely gone by the 12-week mark. 

 


Will you see skin ‘purging’ with azelaic acid?

And what about purging (where a new skincare ingredient in your routine increases your cell turnover, bringing any waiting breakouts to the surface over a short period of time)?

“It doesn’t particularly cause purging but you might get a bit of sensitivity initially because it’s still an active ingredient,” Dr Solish warns. 

The only side effect I noticed was a slight itchiness around my chin and jawline.

 

Image – Ohlamourstudio/Stocksy

 


What strength should you get?

Gatt says it depends on the skin issue you’re wanting to tackle. 

“If you are dealing with a couple of blemishes a lot of products have a 10% or lower that’s perfect for you to try out,” she says. These concentrations can often be found in over-the-counter formulations like The Ordinary’s Azelaic Acid Suspension 10% (£11.10 from Cult Beauty UK /$12.20 from The Ordinary US).

For more serious skin issues you may want to go prescription though. “If it’s not working or if you are experiencing inflamed acne or moderate rosacea you may want to go higher to get better results. I suggest 15% to 20%.” Your dermatologist, GP or even an online dermatology service like Dermatica in the UK or DirectDerm in the US should be able to help you work out whether prescription-strength azelaic acid is right for you.

I knew it was time to visit a doctor when nothing over the counter was making any difference and my acne was getting more angry and painful. It was beginning to make me feel very low and helpless and enough was enough.

 


How do you use azelaic acid?

You’ll want to apply it to clean, dry skin. “Wash your face, dry your face then apply it to dry skin,” confirms Dr El Muntasar. 

It’s important to make sure you’re not applying any other serums or treatments before your azelaic acid, according to the experts. “As this is a medicine, it should go on first.  A light moisturiser, if needed, can be applied on top,” recommends Dr Solish.

 

Image – Studiofirma/Stocksy

 

Ok, but how much should you be applying? “A good pea sized amount,” according to Dr El Muntasar.

And of course, you’ll want to finish by applying an SPF during the day.

When I was using azelaic acid, I would use a gel cleanser and pat my face with a towel until it was completely dry. 

Then I’d squeeze a pea sized blob onto my fingers and apply it all over my face, just like I would with any face cream. I would then wait a few minutes before applying my moisturiser.

 


How often should you use it?

“Twice a day is recommended. Excessive use is not going to work any better and can be irritating if used too much,” says Dr Solish.

 


Layering azelaic acid with other actives

According to Dr El Muntasar, you can use azelaic acid with almost everything. “I combine it with tretinoin, I combine it with benzoyl peroxide, which is for acne and I combine it with various different cleansers and moisturisers,” he says. 

Although you can use azelaic acid alongside retinol, you don’t want to overdo it though, according to Dr El Muntasar.

He suggests alternating. “Some of my patients are on both at the same time and it’s never really been a problem, but you can use azelaic acid in the morning and then retinol in the evening,” he says. 

Personally, I didn’t want to overload my skin with too many active ingredients as I’d had such a difficult year with my skin and was worried that I would irritate it further. So, I applied it twice a day and just pared down my usual routine so that it just included a salicylic acid cleanser and moisturiser, with no other products, acids or retinols.

 


The takeaway

Azelaic acid is one of the kinder-to-skin acids that has very few side effects. It is mostly used to treat acne and pigmentation. 

Whilst it is an effective ingredient though, its gentle nature can mean it is less so when used alone so you can combine retinols and other acids with it in moderation, either together or alternated.

Apply it to dry skin, up to twice a day, and make sure the strength of the one you’re using tallies with the expert advice above. If the problem persists and you feel you need extra help, talk to your GP. My acne began to really get me down after almost a year of nothing working and speaking to my doctor really helped.

 

Meet the experts

Erica Marie Gatt is an aesthetician and founder of EM Skin. Erica honed her talent and channeled her passion under the tutelage of celebrated Los Angeles aesthetician Gina Mari after having spent years as a makeup artist. She’s worked on the face of Vanessa Hudgens, Sofia Vergara, Kim, Khloe, and Kourtney Kardashian, and many more.  

 

Dr. Nowell Solish is Indeed Labs Dermatologist. He is a world-renowned expert in cosmetic dermatology with 20+ years of experience, co-director of Dermatologic surgery at The University of Toronto, and advisor for skincare brands including Indeed Labs. He continues to work with patients in his Toronto practice.

 

Dr Ahmed El Muntasar is a GP and award winning aesthetician.

 

Dr. Patrick K. Davis is a renowned facial plastic and reconstructive surgeon delivering a highly personalised treatment experience in Beverly Hills, California.

 

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Beauty Editor

The former Beauty Editor of Glamour UK, Philippa has been a beauty and lifestyle journalist for over 16 years, picking up countless tips and tricks from makeup artists, hair stylists, dermatologists and celebrities. In that time she’s written for names like Cosmopolitan, The Sunday Times Style, The Telegraph, Grazia, Refinery 29 and Byrdie. Philippa lives in the UK with her husband, two children and their hyperactive cockapoo, Paddy.

Expertise: Makeup, hair care
Education: Oxford Brookes University
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