You wouldn’t be alone if you’ve never heard of azelaic acid. Despite having a plethora of skincare benefits, the ingredient is a bit of an unsung hero. Dr Denning is here to discuss how azelaic acid can help you and where to find the best products on the market.
What is it?
Azelaic Acid a naturally occurring compound found in whole grains, and is also produced by the skin’s natural yeasts. Extensive studies of this acid have shown it to be beneficial for a number of conditions; from acne to melasma.
How does it work?
Azelaic acid works actively in the skin targeting many cells in both the dermis and epidermis. It has anti-inflammatory effects on the skin and so is excellent at reducing redness and swelling in flare-ups of acne and rosacea. As well as a good on-the spot treatment, when used everyday it is also an effective acne preventer. In fact, for my fellow science geeks, studies suggest it’s as effective as other topical treatments such as tretinoin, antibiotic cream and benzoyl peroxide but has fewer side effects. It works as a natural exfoliant, has antibacterial properties and reduces the production of keratin – a protein which can block pores and lead to acne.
Another key property of azelaic acid is its ability to even out pigmentation and skin tone by inhibiting tyrosinase, an enzyme responsible for pigment (melanin) production. I commonly prescribe it for people suffering with skin marks left after acne (post inflammatory hyperpigmentation) and excess pigmentation (melasma). It has been shown in some studies to be as effective as 4% hydroquinone when used daily over several months.
How do I use it?
Use about a fingertip’s worth of Azelaic Acid for the whole face after cleansing. If you find you are experiencing some irritation from it, try using it after applying your moisturiser. Unlike some topical treatment, this won’t decrease its effectiveness and is a good way of avoiding unnecessary irritation.
Whenever starting a new skin product, I recommend introducing it into your regime slowly and patch test first. With azelaic acid, more isn’t necessarily better. One study found that applying 20% Azelaic Acid cream once daily was just as effective as applying it two times a day after three months
Azelaic acid is a natural exfoliant and it is important that it is used alongside a high SPF (greater than SPF 20) on a daily basis to avoid sensitisation and further pigmentation of the skin.
As with any topical skin treatment, due to the skin's cell cycle, results aren't often seen until after a couple of months.
Where can I find it?
Unlike many conventional acne and hyperpigmentation treatments, azelaic acid can be used safely by nearly everyone. Your doctor can prescribe you Finacea gel 15% or Skinoren 20% following a consultation if you you need prescription strength but the great thing about azelaic acid is that there are some great over the counter products you buy from your local department store or online (see below).
Dr Denning recommends these over the counter formulations of azelaic acid
 Katsambas A1, Graupe K, Stratigos J. Clinical studies of 20% azelaic acid cream in the treatment of acne vulgaris. Comparison with vehicle and topical tretinoin. Acta Derm Venereol Suppl (Stockh). 1989;143:35-9
Gollnick H , Graupe K , Zaumseil R. Azelaic acid 15% gel in the treatment of acne vulgaris. Combined results of two double-blind clinical comparative studies. Journal of the German Society of Dermatology. 01 Oct 2004, 2(10):841-847
 Baliña LM1, Graupe K. The treatment of melasma. 20% azelaic acid versus 4% hydroquinone cream. Int J Dermatol. 1991 Dec;30(12):893-5
 Thiboutot D et.al. Azelaic acid 15% gel once daily versus twice daily in papulopustular rosacea. Journal of Drugs in Dermatology : JDD [01 Jun 2008, 7(6):541-546]