Everything Dermatologists Want to Know About Azelaic Acid




Doctors evaluate the efficacy of azelaic acid in skin care products and how it works. If you struggle with acne, you've probably researched face washes, moisturizers, and spot treatments containing active ingredients like benzoyl peroxide and vitamin C. 

When it comes to reducing blemishes and keeping skin clear, a better solution is azelaic acid, an ingredient on Dr.'s radar. Dr. Rachel Westbay is a board-certified esthetician and general dermatologist at Marmur Medical, but she's often overlooked. 

In addition to clearing pores and preventing acne, azelaic acid helps even skin tone and fade dark spots and acne scars. Skip Buying the Best Azelaic Acid Products | Who Should Use Azelaic Acid? How to use azelaic acid | How long does it take for azelaic acid to work? 

We asked dermatologists how this ingredient works and how you can incorporate it into your skincare routine. We've also collected some expert-recommended azelaic acid products based on your doctor's guidance. 

How does azelaic acid work? Westbay tells us that azelaic acid is a tyrosinase inhibitor, which means it helps even out skin tone and prevent and treat hyperpigmentation caused by conditions like melasma. 

According to Westbay, it can also reduce post-inflammatory hyperpigmentation caused by acne, including dark spots (most common in people with darker skin tones) and red scars (most common in people with lighter skin tones). 

It does this by acting as an inhibitor of tyrosinase, the enzyme responsible for producing melanin. Azelaic acid is also an antibacterial antioxidant that can unclog pores, reduce inflammation, and treat acne. 

It's gentler than other acne-fighting ingredients like salicylic acid and adapalene, making it better for people with sensitive skin, acne and rosacea, says Dr. Lindsey Bordone, board-certified dermatologist and assistant professor of dermatology at Columbia University Medical Center. 

Prescription azelaic acid is available in 15% and 20% concentrations (with more research supporting its effectiveness), but you can also find over-the-counter versions in concentrations as high as 10%. Try combining low-strength over-the-counter products with other acne-fighting ingredients "which may be more effective than [azelaic acid] alone," Westerby says. Here's How We Picked the Best Azelaic Acid Products of October 2023. When purchasing over-the-counter products containing azelaic acid, our experts recommend paying attention to the following factors: 

Concentration: Our experts tell us that while prescription products are generally better than over-the-counter products because they contain higher concentrations of azelaic acid, over-the-counter products with concentrations of 10% or less are still effective. 

Formula: While it's usually available as a serum, it can also be found in cleansers, masks, creams, and gels. Other Ingredients: Depending on the specific skin concerns you're targeting, consider products that combine azelaic acid with skin-brightening ingredients like niacinamide and vitamin C, and moisturizing ingredients like hyaluronic acid. 

Best Azelaic Acid Products of October 2023. Below, we've rounded up some experts' favorite azelaic acid products, as well as some highly rated products containing azelaic acid. 

1. Common azelaic acid essence
Ordinary Azelaic Acid Serum is our experts' favorite because it can help improve blemishes and dark spots. 

According to the brand, the serum contains 10% azelaic acid, is cruelty-free, vegan, and gentle enough to be used up to two times a day. 

2. Paula's Choice Azelaic Acid Booster. 

According to Dr. According to Joshua Zeichner director of cosmetic and clinical research at Mount Sinai Hospital, this facial serum with 10% azelaic acid effectively fades dark spots, evens skin tone and improves hyperpigmentation caused by acne According to Paula's Choice, it's non-comedogenic and hypoallergenic and can be used once or twice a day. She said Westbay also recommended the brand's Niacinamide + Azelaic Acid 2-in-1, a two-in-one product that fights acne, shrinks pores, improves dull skin, and softens uneven skin tone and texture. 

3. Sesderma Azelac Ru Facial Serum. 

According to Westbay, this serum is one of her "favorite products for fighting hyperpigmentation" because it targets melasma and post-inflammatory hyperpigmentation to fight. 

This serum is a combination of active ingredients including azelaic acid, retinol, and vitamin C. The formula also contains tranexamic acid, a topical treatment "particularly suitable for treating UV-induced discoloration," says Westbay. 

4. Tula Clear It Up Acne Cleansing and Toning Gel. 

PhD. Hadley King, a board-certified dermatologist in New York City, recommends this azelaic acid gel because its ingredients are combined with niacinamide, which experts say can help lighten skin tone and texture. 

It also contains 2% salicylic acid to combat acne, probiotics to soothe and calm inflammation, and hyaluronic acid to help hydrate, according to the brand. 

5. Urban Skin Rx Evening Skin Cleansing Bar. 

This 3-in-1 cleanser, mask, and scrub contains azelaic acid, niacinamide, and kojic acid, another tyrosinase inhibitor that can fade dark spots. According to the brand, you can apply the cleanser directly or massage it into your skin with the included exfoliating sponge and leave it on for a few minutes. 

According to Urban Skin Rx, you can also use it as a brightening mask, leaving it on for 3-5 minutes and then rinsing off with cold water. 

6. Glytone Enhanced Brightening Complex. 

Recommended by the experts in our guide to retinol alternatives 



this cream contains 12% azelaic acid and 3% glycolic acid (a chemical peel) to target dark spots, exfoliate dead skin cells and smooth out inflamed skin. Evens skin tone, as stated on the brand's website. According to Glytone, it can be used in the morning and evening. 



7. The Inkey List Azelaic Acid Serum. This azelaic acid serum was developed by Dr. Recommended by board-certified dermatologist Erum Ilyas of Schweiger Dermatology. Similar to The Ordinary's serum, it contains 10% azelaic acid and can be used twice daily, according to the brand. 



If redness is a major concern, The Inkey List serum contains microfine green particles that can help mask redness, as well as 0.3% allantoin, a compound that can help soothe skin, as described on the Inkey List website Show. 

Who should use azelaic acid—and who should avoid it? 

According to our experts, azelaic acid is a safe and gentle option for people with sensitive skin, in their teens, during pregnancy, or while breastfeeding.

Although it's a gentle option, people with very sensitive skin should still use this ingredient "with great caution," as it can cause stinging, burning, and even hyperpigmentation, says Dr. Ronda Farah is a board-certified dermatologist at the University of Minnesota Medical School and M Health Fairview. "That's probably the biggest problem because when you get a rash, it leaves dark spots instead of the lightening and lightening of the skin that you want," says Farah.

Azelaic acid may also be less helpful for patients with severe cystic acne. "It might help a little bit with the pigment that's left behind after the acne lesions clear up, but for people with deeper cystic acne, [azelaic acid] doesn't penetrate as deeply into the skin," says Beaudone. 

To combat cystic acne, our experts have previously recommended stronger ingredients, like benzoyl peroxide to inhibit bacterial growth, and retinol gels like adapalene to reduce congestion.

How to use azelaic acid
You can use azelaic acid once or twice a day, but you should start using it once a night, says Dr. Amy Witt, board-certified dermatologist at Derrow Dermatology. If your skin tolerates it well for a few weeks, you can start using it twice daily. Our experts tell us to pair it with a gentle cleanser and a good moisturizer and sunscreen every morning.

Although azelaic acid won't make you more sensitive to the sun like other acids, Zeichner still recommends wearing sunscreen if you incorporate this ingredient into your daily routine. "If you use azelaic acid, be careful when applying sunscreen—even small amounts of UV rays can promote pigmentation and reverse the effects of the treatment," he says. 

 If you're incorporating azelaic acid into your daily routine, most ingredients are safe to continue using: alone or with other soothing and brightening options like niacinamide (a natural anti-inflammatory) and hyaluronic acid, according to Zeichner The ingredients are safe when used together. Locks in moisture. However, our experts generally recommend against layering ingredients such as beta-hydroxy acids (BHA) (including salicylic acid) and alpha-hydroxy acids (AHAs) (such as glycolic acid), as this increases the risk of dryness and irritation .

"I wouldn't use [azelaic acid] in addition to other products that contain salicylic acid or glycolic acid because that can increase irritation," says Farah. "Typically, you want to remove other irritants from your regimen, or at least separate them so you can use one in the morning and another at night." 

How long does it take for azelaic acid to work? 

After you start taking prescription azelaic acid, you should see some improvement within six weeks to three months, Farah says. For over-the-counter products, it may take longer to see improvement — about three to four months, Witt said. When it comes to whitening your skin and lightening dark spots and pigmentation, you have to wait for the results. It's likely to be "very slow and very weak - it will take about six months to a year before you see a real effect, and it will be very small," Farah said. 

Although azelaic acid is great for sensitive skin types due to its mildness, it can also be a drawback. "The biggest problem I hear from patients is that it simply doesn't work," says Dr. Aaron Secrest, board-certified dermatologist and assistant professor of dermatology at the University of Utah. "It's one of the weaker acids, which is good because it will reduce side effects or dryness, but it also doesn't help clear the skin as well as the stronger anti-acne ingredients," he says.

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