Azelaic acid
Best studied for: Acne and breakouts; Rosacea and facial redness; Dark spots and hyperpigmentation. Clears acne, calms rosacea redness.
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What is it? Azelaic acid is a naturally occurring dicarboxylic acid that is found in grains like barley, wheat, and rye. It is also produced by the yeast that normally lives on human skin. How does it work? Azelaic acid works by inhibiting the growth of Propionibacterium acnes, the bacteria that causes acne. It also has anti-inflammatory effects and can reduce the production of keratin, which can clog pores. What forms does it come in? Azelaic acid is available in a topical cream, gel, or foam form for use on the skin. When was it first used for medicinal purposes? Azelaic acid was first used for medicinal purposes in the early 1990s for the treatment of acne.
Helps
What does Azelaic acid help with? Acne and breakouts: Azelaic acid targets acne from multiple angles — it slows the growth of acne-causing bacteria, reduces the keratin buildup that blocks pores, and calms the inflammation that makes breakouts red and painful. It's particularly useful for inflammatory acne (papules and pustules) and is generally gentler on skin than benzoyl peroxide. Rosacea and facial redness: At prescription strength ( 15% gel or foam), azelaic acid is one of the few topicals with FDA approval specifically for rosacea. It reduces the inflammatory bumps (papules and pustules) of rosacea and helps calm persistent facial redness over time with regular use. Dark spots and hyperpigmentation: Azelaic acid blocks tyrosinase, the enzyme your skin uses to make melanin, which helps fade existing dark spots and prevents new ones from forming. It works on sun spots, age spots, and the discoloration left behind after acne heals, without causing the irritation that stronger agents like hydroquinone often do. Post-acne marks (PIH): Post-inflammatory hyperpigmentation — the dark marks left after a pimple heals — responds well to azelaic acid because it directly inhibits the overproduction of melanin triggered by skin inflammation. Studies show meaningful lightening of PIH, especially in medium and deeper skin tones where this is a major concern. Melasma: Azelaic acid ( 20% cream) has been studied as an alternative to hydroquinone for melasma, showing comparable efficacy in some comparisons with a better tolerability profile. It's considered a go-to option for people who can't use hydroquinone or want a gentler long-term approach. Perioral dermatitis: Though not its primary indication, azelaic acid's antibacterial and anti-inflammatory properties make it a useful option for perioral dermatitis — the red, bumpy rash that appears around the mouth and nose. It's often used when topical antibiotics are not preferred. Blackheads and clogged pores: By reducing abnormal keratin buildup inside the pore lining (a process called keratinization), azelaic acid helps keep pores clearer and less prone to developing blackheads and whiteheads. It's more gentle than physical or chemical exfoliants for this purpose. Pregnancy-safe skin treatment: Azelaic acid is classified as pregnancy category B, meaning it is considered one of the safer active skincare ingredients to use during pregnancy. It provides a viable option for pregnant individuals dealing with acne or melasma who need to avoid retinoids and certain other actives. Uneven skin tone: Beyond treating specific dark spots, regular use of azelaic acid gradually creates a more uniform complexion by suppressing overactive pigment-producing cells throughout the skin. Results build steadily over 2–3 months of consistent use. Sensitive or reactive skin (gentle active option): Compared to retinoids, AHAs, and benzoyl peroxide, azelaic acid causes less dryness and photosensitivity, making it one of the better-tolerated actives for people with sensitive, redness-prone, or easily irritated skin who still want meaningful results.
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