Treating Acne with Azelaic Acid

Azelaic acid is a prescription medication used to treat mild to moderate acne vulgaris.  It comes in a gel, lotion, and cream.

Azelaic acid is sold under the brand names Azelex, Finacea, and Finevin.  You can also get generic azelaic acid.

How Azelaic Acid Works

Azelaic acid works to clear up acne in several ways.  First, it kills propionibacteria acne, the bacteria that's responsible for inflamed acne breakouts.

Azelaic acid is a comedolytic.  This means it reduces the amount of comedones, or pore blockages.  This medication also helps your skin shed cells more effectively.  This also helps keep the pores clear.  Less pore blockages ultimately leads to less inflamed pimples. 

Speaking of inflamed pimples, azelaic is good for those too.  It helps reduce inflammation of acne blemishes.

Another benefit of azelaic acid its it's ability to improve post-inflammatory hyperpigmentation, or those discolored spots pimples leave behind.  Complexions that are prone to hyperpigmentation will especially benefit from azelaic acid.

Make sure you're applying your azelaic acid over all areas where you know you break out.  Don’t just spot treat existing blemishes.  This will help keep new pimples from forming.

Azelaic Acid Is Best in Specific Situations

Azelaic acid typically isn't used as a first line treatment in most cases, and that's because it's a very slow worker compared to other acne medications.

  If you're using azelaic acid, try to be patient. 

You might notice some improvement after a month or so.  But it can take several months more to really get acne under control.  Just keep using your medication as consistently as you can.

Even with the months-long wait for clearing, there are good reasons to use azelaic acid in favor of other acne treatments.


Does tretinoin leave your skin completely irritated?  Is benzoyl peroxide just too drying?  Compared to other acne medications, azelaic acid is fairly gentle.   So, if your skin is especially sensitive and you can't handle some of the the other topical acne medications, azelaic acid is a very good option. 

And, since all topical retinoids and many oral acne medications are off-limits during pregnancy, azelaic acid makes a good acne treatment choice for pregnant and nursing moms. 

Possible Side Effects of Azelaic Acid

While this is a fairly gentle treatment, there's still a possibility of side effects.  The most common:

  • Itching, burning, or stinging
  • Redness
  • Dryness or peeling

For those with darker complexions, be on the lookout for lightening of the skin in areas where the medication is used.  This happens only rarely, but you should let your doctor know right away if you notice any changes in your skin color.

As always, if you have any questions or concerns about your acne treatment, ask your dermatologist.


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Vargas-Diez E, Hofmann MA, Bravo B, et. al. "Azelaic acid in the treatment of acne in adult females: case reports."  Skin Pharmacol Physiol.  2014;27 Suppl 1:18-25.

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