Azelaic Acid Is the Under-the-Radar Acne Ingredient You Should Know About

It helps calm rosacea and redness, too.

Azelaic Acid
Photo: Leandro Crespi/Stocksy

As someone who's struggled with stubborn breakouts for most of my adult life, I've tried almost every over-the-counter acne-fighting ingredient I could get my hands on — or so I thought. Even though, as a beauty editor, I'm tuned into the latest products and "it" ingredients on the market, the benefits of azelaic acid for pimples and rosacea somehow slipped under my radar.

I was first turned onto azelaic acid when I saw a viral post from a Facebook skincare group about how well it works for acne. This led me down a deep Reddit hole where I found entire threads dedicated to the ingredient.

The reason why so many people on the internet swear by azelaic acid is twofold. The ingredient has antibacterial proprieties that help calm and prevent pimples and inflammation. Plus, it's an exfoliant that can lighten up dark spots from old breakouts over time, so your skin tone appears more even.

To get the complete lowdown on this overlooked skincare ingredient, I turned to board-certified cosmetic and medical dermatologist Lily Talakoub, MD, and board-certified dermatologist and Mohs surgeon at the Shafer Clinic Fifth Avenue Dendy Engelman, MD, to find out how and why azelaic acid works, what skin types it's best for, and more.

What Is Azelaic Acid?

"Azelaic acid is called a dicarboxylic acid, which is derived from yeast in wheat, rye, and barley," says Dr. Talakoub. "It is also produced by yeast on the skin."

The Benefits of Azelaic Acid

While it is also an exfoliant like AHA and BHA acids — two common ingredients in acne products that are usually derived from fruit acids or made synthetically — azelaic acid has anti-inflammatory and anti-microbial properties, too. This means it can be extremely effective at keeping the bacteria that cause acne under control. Plus, it helps calm inflammation and redness. "Azelaic acid works by killing bacteria on the skin, as well as decreasing keratin which clogs pores," confirms Dr. Talakoub. "It has an anti-inflammatory property which will decrease redness and swelling associated with rosacea."

Who Can Use Azelaic Acid?

This ingredient is safe for all skin types, including expectant mothers. Dr. Talakoub adds that those with acne-prone skin, rosacea, or hyperpigmentation would benefit most from using azelaic acid.

Dr. Engelman agrees but cautions those with sensitive skin to tread carefully. She says you may experience unwanted side effects like irritation or a stinging sensation. As with any skin concern, ask a professional if this ingredient works for you and your routine. “Always consult your dermatologist if you have questions about how to use this ingredient, as they can make accurate recommendations based on your skin type, concerns, and the products you’re using,” she explains. 

How Often Should You Use It? What Are the Side Effects?

Dr. Talakoub says that azelaic acid should only be used once daily: "It can have a slight tingle when applied to the skin and should be used cautiously in sensitive or inflamed skin. If overused, azelaic acid can lead to irritated, red skin." To prevent any side effects, start using it once every other day for a few weeks to see how your skin reacts to it, and then work your way up every day.

Like with AHA and BHA acids, if you use azelaic acid in the morning, it's best to apply sunscreen afterward because the ingredient can make your skin more sensitive to sunlight.

Dr. Talakoub recommends avoiding AHA and BHA acids when you're using azelaic acids because, together, these ingredients could be too harsh for your skin. As for retinol, she says the two ingredients can be used in combination with oily and acne-prone skin but should be avoided if you have rosacea or inflamed skin.

Prescription vs. Over-the-Counter Azelaic Acid

According to Dr. Engelman, prescription azelaic acid contains about 15 percent concentration or more. She adds that the prescription option is stronger than over-the-counter options and is suitable for more serious skin conditions. For example, a systematic review of the clinical trials of both concentrations published in JAMA Dermatology in 2006 found that both concentrations effectively treated rosacea symptoms, specifically papules and pustules.

As for over-the-counter options, she says they'll have a lower ingredient concentration, which will work, but may not be as effective as a prescription formula. “OTC azelaic acid is usually used for cosmetic purposes (e.g., gently brightening or evening out skin tone) and treating mild acne and/or inflammation,” she explains. 

In terms of azelaic acid products, two cult favorites show up again and again on skincare Reddit and Facebook. The first, The Ordinary's Azelaic Acid Suspension 10%, is a gel cream with a high acid concentration that can be applied in the morning or at night. It works to brighten skin while improving texture and minimizing blemishes. Oh, and a tube of it will only set you back only $8.

Alternatively, Paula's Choice Azelaic Acid Booster contains 10% azelaic acid, among other exfoliating extracts and hydrators. The gel cream can be used alone or added to your favorite moisturizer or serum.

Dr. Engelman also recommends the Glo Skin Beauty Hydra-Bright Alpha Arbutin Drops. “This brightening [and] gently exfoliating serum is clinically proven to improve skin texture, evenness, and clarity, and reduce hyperpigmentation and dullness,” she says. “Blending alpha arbutin (a plant-based alternative to the brightening chemical hydroquinone), lactic acid (an exfoliant), and azelaic acid — it is gentle yet effective and suitable for all skin types.” 

The bottom line: While azelaic acid may be effective for treating acne and rosacea symptoms, it's best to introduce a new skincare ingredient into your routine with caution to prevent irritation and redness.

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