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When you think of acne treatments, azelaic acid might not be the first ingredient to come to mind—or, let's be honest, even the fifth ingredient—but it should be. A favorite of dermatologists for its gentleness and versatility (it helps with way more than just acne breakouts), this skincare ingredient deserves a little more respect and recognition than it gets in the beauty world. To thoroughly explain the full range of benefits of using this overachieving skincare ingredient, we turned to the pros. Ahead, NYC-based dermatologists Francesa Fusco, MD, and Gervaise Gerstner, MD, dive into what azelaic acid even is in the first place, what makes it so good, and how you should use it. Keep reading to discover the skincare ingredient you're about to be obsessed with that you didn't even know you needed.
Type of ingredient: Exfoliant
Main benefits: Fights acne, treats rosacea, lightens dark spots, and removes dead skin cells.
Who should use it: In general, anyone with acne-prone, rosacea-prone skin and hyperpigmentation. Fusco says azelaic acid is recommended for all skin types and is even safe for those who are pregnant.
How often can you use it: It is safe to use twice a day (morning and night) or once every other day for those with sensitive skin.
Works well with: Alpha-hydroxy acids (AHA), beta-hydroxy acid (BHA), and retinol.
Don't use with: Azelaic acid is safe to use in conjunction with most, if not all, ingredients.
What Is Azelaic Acid?
In short, Gerstner says azelaic acid is a dicarboxylic acid that helps exfoliate the skin and is synthesized by yeast naturally—but it can be derived from a number of places. "Azelaic acid is produced naturally on your own skin by your own yeast, but you can also make it in a laboratory, and it can come from grains and cereals," Fusco says. In addition to being comedolytic (meaning it prevents comedones) and working to exfoliate deep within the pores, Fusco says azelaic acid is also keratolytic (decreases keratin), anti-inflammatory, and has antioxidant properties. Like we said, it's an overachiever.
Though Fusco and Gerstner recommend a prescription form of azelaic acid to their patients (either Finacea or Azelex) in a strength of 15 percent to 20 percent respectively, it's also available over the counter in a lower strength of 10 percent or less. Azelaic acid can be found in leave-on topical treatments and comes in gel, foam, and cream forms, which are designed to be used on different areas of the body. For instance, the foam version is better suited to cover a larger area like the back than a small cream or gel would be.
Benefits of Azelaic Acid for Skin
Azelaic acid is a multifunctional skincare ingredient that tackles a multitude of concerns related to breakouts and inflammation.
- Exfoliates gently: It goes deep within the pores and removes dead skin cells that cause dull skin tone and clogged pores.
- Fights acne: It has antibacterial properties, and according to Fusco, it's reported to be bactericidal to P. acnes, which leads to acne.
- Reduces inflammation: It soothes irritation and helps to improve red bumps caused by inflammation.
- Evens skin tone: It inhibits tyrosinase, which is an enzyme that leads to hyperpigmentation. It's effective on post-inflammatory hyperpigmentation from acne breakouts and can possibly have an effect on melasma as well.
- Treats rosacea: Azelaic acid could help with pore-clogging, inflammation, and secondary infections caused by rosacea. "It’s a less irritating option, which is why we use it for rosacea because the skin tends to be very sensitive," Gerstner says.
- Is safe for pregnant women: Fusco says azelaic acid is one of the few treatment options for acne, rosacea, clogged pores, or pigmentation that is generally safe for pregnant women.
- Is gluten-free: Despite being wheat-derived, Fusco says most gastroenterologists agree that it can’t be absorbed significantly enough through your skin to trigger a gluten sensitivity or reaction.
- Could be helpful with alopecia: "There have been some reports suggesting that it could be helpful in treating alopecia or hair loss," Fusco says. "Some doctors are having pharmacists incorporate it into their hair products because it might help to grow hair."
Side Effects of Azelaic Acid
Although it is possible to experience slight irritation, Fusco and Gerstner say they do not find that their patients have adverse reactions to it and that by and large, it's a mild type of acid.
How to Use It
Whether you're using an OTC formula or a prescription, Gerstner suggests applying a thin layer of the product to clean, dry skin twice a day, morning and night. For someone with sensitive skin, she recommends using it once every other day. If you're applying the product to your face and neck, use a pea- or marble-size amount spread evenly over the area. To help the azelaic acid absorb and perform even more effectively, Fusco recommends applying your AHA (like glycolic or lactic acid), BHA (salicylic acid), or retinol first to open up the skin and accept the azelaic acid more readily. Then, follow with a hydrating moisturizer and a sunscreen with an SPF of at least 30 in the morning.
The Best Products With Azelaic Acid
Fusco and Gerstner both favor this prescription formula, which contains 15 percent azelaic acid and yet is still gentle, safe, and easy to use. It's so mild that Gerstner says she's never had a patient experience a reaction or intolerance to using it. If that alone isn't reason enough to consult your doctor about giving it a try, it's effectiveness against rosacea will have you convinced.
The packaging of this formula isn't anything to get excited about, but the ingredients inside such as azelaic, tannic, and kojic acids 100 percent are. The application process is slightly different than the other product recommendations (lather it up and let it sit for a few minutes before removing) but you still get the same calming and complexion-clearing results.
This leave-on peel comes highly recommended by Gerstner for those interested in the organic variety. The combination of azelaic acid with salicylic and lactic acids makes this a super-effective exfoliant for addressing large pores and acne.
This affordable alternative comes highly recommended by Fusco—and the 30k reviewers on Sephora who gave it a "love." Formulated with 10 percent azelaic acid, this gel-cream minimizes breakouts and addresses uneven skin tone and texture.
Hailed by Byrdie's editorial director as the only acne treatment that actually gets rid of pimples overnight, this best-selling gel formula is packed with a triple threat of acne-fighting ingredients: azelaic acid, salicylic acid, and niacinamide.
This formula also contains azelaic acid, salicylic acid, and niacinamide, but with the added benefits of hyaluronic acid for hydration and sea buckthorn berry to soothe and soften the skin, which is why it's another Byrdie-editor favorite.
If you have particularly oily skin or are looking for a way to tone down a shiny T-zone in the sweatier summer months, this Byrdie editor-approved mattifying gel formula moisturizes without going overboard. A combination of ceramide and lecithin restore and replenish the moisture in your skin, while licorice root extract (which has antioxidant properties) and azelaic acid soothe redness in an acne-prone complexion.
Up next: Your ultimate acne treatment cheat sheet.
National Center for Biotechnology Information. PubChem Compound Summary for CID 2266, Azelaic acid. Updated Oct 3, 2020.
M, Sharad J, Kadhe G, Ahirrao P, et al. Evidence-based treatment for melasma: expert opinion and a review. Dermatol Ther (Heidelb). 2014;4(2):165-186. doi: 10.1007/s13555-014-0064-z