Azelaic acid has developed a cult following on Instagram, beauty forums, and skincare blogs — for good reason.

This quiet overachiever is an absolute hero in the fight against acne — in fact, it might be one of the most effective treatments available on the market today and it works during all stages of acne.

It reduces active breakouts, helps clear up the redness, scarring, and hyperpigmentation that acne can cause, and keeps bacteria at bay once your skin has healed [1]. It’s also a pro at clearing up rosacea, and unlike some other acids, it’s gentle enough to use on sensitive skin [2].

Azelaic acid is available as a foam, lotion, gel, and serum. As an over-the-counter product, it can often be mixed with other products to form a multi-purpose serum, exfoliant, or gel, and is usually available at a concentration anywhere from 5-20%.

Usually, when used to treat uneven skin tone and for light exfoliation, lower concentrations are sufficient. However, stronger prescription concentrations are often required when used to treat acne. 

How does azelaic acid work?

The word “acid” is bound to make your eyebrows raise if you’ve never used one on your skin before, but don’t worry, this isn’t going to turn your face bright red. On the contrary, azelaic acid can improve your skin in many ways.

As we mentioned before, it helps fight against acne, and it does so by killing bacteria, preventing follicular keratinization, and reducing inflammation [3]. But what does that all mean?

Bacteria

There are 2 forms of bacteria that contribute to acne: propionibacterium acnes and staphylococcus epidermidis. We’ll call them p. acnes and s. epidermidis for short.

These bacteria are found on everyone’s skin normally but tend to multiply and breed in sebum, meaning that if you have an excess of oil on your skin, you can often end up with acne because the acne-producing bacteria have so much space to reproduce.

Azelaic acid doesn’t stop sebum production, but it does kill the bacteria that multiply in it. It seeks out p. acnes and s. epidermidis and attacks them directly, beginning to inhibit their reproduction after only one application to the skin [4].

With repeated use, it continues to kill remaining bacteria and some studies have even suggested that it can kill some antibiotic-resistant bacterial strains as well [5]. By continually doing so, azelaic acid helps prevent acne from recurring.

Follicular keratinization

One of the many abilities of azelaic acid is that it can prevent clogged pores.

Acne begins with 2 main changes to the sebaceous (hair) follicles on the skin. The first is a process called follicular hyperkeratinization, which is an excessive shedding of skin cells into the hair follicles. The second is caused by excess sebum being produced by the skin, which is usually under the control of hormones.

Together, these processes lead to clogged pores, which then are known as comedo or pimples. 

Follicular keratinization occurs when the cells that line the inside of our hair follicles stick together. Ordinarily, the cells would shed and be expelled onto the skin’s surface [6]. 

While it’s not known precisely how azelaic acid stops this, we do know that it does. It normalises the cells within the follicle and prevents them from sticking to each other, meaning they can be carried out of the follicle by the sebum without issue [1].

Inflammation

Azelaic acid works as an acne treatment by reducing inflammation, and it can do the same for rosacea as well. While rosacea isn’t related to acne, it can look similar, as those experiencing it will often see a reddening of the face and some papules and pustules as well [7].

Within acne, inflammation looks like redness and swelling around the affected areas. These symptoms can often last after the pimples themselves have healed, which is why it is important to keep treating acne even as it becomes less apparent.

Azelaic acid does just that, and while there are a few theories as to exactly how, it has been suggested that this ingredient has antioxidant properties [8] [9]. Just like niacinamide, azelaic acid is capable of tackling free radicals and preventing the effect of oxidative stress that they have on the skin [10].

But that’s not all...

Azelaic acid is a great treatment for acne because it doesn’t only stop it, it assists with the healing process as well. 

There are 2 main types of damage you might notice on your skin post-acne: scars from the pimples and acne lesions themselves, and damage done to the skin by picking or popping pimples.

As tempting as it might be to pick on a pimple, the resulting trauma caused to the skin around it can lead to broken capillaries and redness even after the pimple itself has healed. 

Another thing you may notice is hyperpigmentation: dark spots and patches on the skin. This occurs when damage to the skin causes the release of inflammatory cells, which then lead to the release of pigment cells that darken the skin [11].

While hyperpigmentation and scarring aren’t necessarily harmful, it’s common to want to get rid of them, and azelaic acid’s anti-inflammatory properties help manage skin texture and tone issues [12].

Who can use azelaic acid?

Azelaic acid is suitable for practically everyone. It’s ideal for anyone with sensitive skin and may be a good choice for anyone whose skin is not compatible with stronger anti-acne treatments.

Studies have shown that, when compared to over-the-counter ingredient benzoyl peroxide, azelaic acid is just as effective but with fewer side effects [13]. It was also shown to be as effective as tretinoin but better tolerated by the skin [14][15]. 

To find out if azelaic acid is right for you, you can simply take our online consult. Our Australian health practitioners will analyse your skin concerns and needs and, if appropriate, include azelaic acid in your prescription treatment for acne, pigmentation, or ageing.

Are there any side effects?

Side effects are possible with any medication and skin treatment, but azelaic acid is often suggested as the ideal product for those with sensitive skin, so it’s unlikely (but not impossible) that it can cause a reaction.

Immediately after applying the treatment, you may notice a slight tingling sensation. This is normal, but if you experience any redness, burning, peeling, or itching, you should cease using the product and speak to your practitioner.

How to use azelaic acid

Azelaic acid products are often used once a day, either in the morning or evening and as part of a skincare regime to get the best results:

• Wash your hands. This will prevent you from transferring bacteria onto your skin and counteract the benefits of azelaic acid.
• Cleanse and tone your skin. Go for hypo-allergenic, non-comedogenic, and oil-free products to reduce the possibility of them causing a negative reaction on your face and promoting comedone growth.
• Apply a small amount of azelaic acid. Something the size of your fingernail will do the trick unless you’re advised otherwise by your healthcare provider or dermatologist. Avoid the sensitive skin of your eyes and lips, but apply it everywhere else on the affected area.
• Moisturise. A gel or serum moisturiser may work best for people with oilier skin, while a lotion or cream may be better for people with drier skin. Software's Ceramide Repair Balm is suitable for all skin types and it helps maintain the integrity of the skin to keep it healthy, soft and supple.

If it’s daytime, make sure you finish by applying sunscreen with SPF50+ protection. Software's Daily Sun Defence SPF50+ is non-comedogenic and non-greasy, provides UVA/UVB broad-spectrum protection and is fragrance-free, making it safe for sensitive and acne-prone skin.

Can I use azelaic acid with other skincare ingredients?

Azelaic acid is powerful on its own, but combining it with other ingredients can help maximise its benefits:

• Niacinamide. Azelaic acid and niacinamide work extremely well together to minimise pigmentation issues.
• Hyaluronic acid. This strong humectant balances out the potential drying effects of azelaic acid, pumping your skin with extra moisture.
• Gentle retinoids. They boost the benefits of azelaic acid, helping to treat acne scarring and dark spots.
• Antibiotics for skin. Azelaic acid can be used in conjunction with antibiotics that target acne, or in its place for those who can’t take the antibiotic [16]. 

What results can I expect?

Topical azelaic acid begins working on the skin immediately, but its effects may not be visible for a month or so. During this time you should continue using the treatment as directed.

Once it starts to work, you can expect to notice a decrease in redness and inflammation, fewer clogged pores, a reduction in acne size and frequency, and — over time — a lessening of scars and hyperpigmentation.

Can I use azelaic acid in the long term?

Azelaic acid is definitely an ingredient you can keep in your skincare routine for months or even years. Over time, you may choose to switch to a product with a lower concentration or continue using the same dosage.

Keen to learn more about the ingredients we use in our powerful formulas? Check out our A to Z of skincare ingredients, including guides to salicylic acid, vitamin C, hyaluronic acid, and more.