Azelaic acid: what it does, how to use it, what to expect
What azelaic acid does for breakouts, redness and dark marks, which strengths exist, how to start, what to pair it with, and when to see a dermatologist.
Written by the Glowpedia team · not yet reviewed by our dermatologist
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Azelaic acid is one of the gentler acids in skincare, and it is used for several things at once: breakouts, redness and the dark marks that breakouts leave behind. That mix of uses is a big reason it has become one of the most searched skincare ingredients.
Quick answer: Azelaic acid is a mild acid used on the face to help with pimples, redness and dark marks after breakouts. Lower strengths are sold in cosmetics; stronger gels and creams are prescription medicines in many countries. Start once a day, expect some tingling at first, and be patient: about a month for spots, up to 12 weeks for rosacea.
What is azelaic acid?
Azelaic acid is a naturally occurring acid that is also made by a yeast (Malassezia) that lives on human skin. The azelaic acid in products is usually made in a laboratory.
Dermatology references describe it as having anti-inflammatory and antioxidant properties. In plain words, it can calm red, swollen skin and help protect skin cells from damage caused by unstable molecules called free radicals.
It is sold in two broad ways. Cosmetic products, such as serums, creams and suspensions, usually contain lower strengths. Medicines, such as prescription gels and creams, contain higher strengths and are prescribed by a doctor. The rules differ from country to country, so what you can buy without a prescription depends on where you live.
What does azelaic acid do for skin?
The American Academy of Dermatology (AAD) explains that azelaic acid helps open clogged pores and keep them open, acts on the bacteria that are involved in acne, and reduces inflammation. That is why it is used for several kinds of breakouts, including blackheads, whiteheads and red bumps. See breakouts and acne-prone skin for more about the types.
It also has a second job. Azelaic acid is used to reduce pigment in overactive skin cells, so it is often chosen for the brown marks left behind after a pimple heals (see marks left after breakouts) and for melasma, a common pattern of brown patches on the face. Dermatology sources describe it as especially useful in darker skin with these marks.
Finally, a prescription 15% gel is approved in the US for the red bumps and pimples of rosacea. In two large studies of about 660 people with this type of rosacea, the gel used twice a day reduced inflamed spots more than a gel without the active ingredient, and no serious treatment-related side effects were reported. If your main concern is a flushed, easily irritated face, see redness and rosacea-prone skin.
Who is azelaic acid for?
| Concern | What to know |
|---|---|
| Mild to moderate acne | Used for blackheads, whiteheads and red bumps; often combined with other acne products |
| Marks after breakouts | Helps fade brown marks over time; sun protection is essential |
| Rosacea with red bumps and pimples | A prescription 15% gel is approved for this in the US |
| Melasma and uneven tone | Used by dermatologists, often alongside sun protection and other steps |
| Sensitive skin | Usually better tolerated than many exfoliating acids or retinoids, though it can still sting |
Azelaic acid is not a quick fix for every skin problem. It will not remove deep scars, and it does not replace a dermatologist's advice for severe acne or rosacea.
Which strength should you choose?
| Type | Typical form | Notes |
|---|---|---|
| Cosmetic products | Serums, creams, suspensions | Lower strengths; good for starting out or for mild concerns |
| 15% gel | Prescription in many countries | Approved in the US for rosacea; also used in some countries for acne |
| 20% cream or lotion | Prescription in some countries | Used for acne and, in some places, for pigmentation |
Strengths, names and rules vary around the world, so check the label and ask a pharmacist or doctor if you are unsure. A higher number is not always better. A lower strength you can use every day will usually do more than a stronger one that makes your skin sting and peel, so you stop using it.
How to use azelaic acid
- Cleanse first. Wash with a gentle cleanser and dry your skin.
- Start once a day. Apply a thin layer to the affected area. Dermatology guidance suggests starting with one application a day and moving to twice a day if your skin copes well.
- Keep it away from eyes, lips and the inside of the nose.
- Moisturize afterwards. A simple moisturizer helps with dryness.
- Use sunscreen every morning. This matters most if you are fading dark marks, because sun exposure darkens them again. See everyday sun protection.
Some creamy formulas can feel gritty or roll into small pills when you layer other products on top. Give each product a minute to sink in, and use thinner layers.
If you have very sensitive skin, test a small area first, for example along the jaw, for a few days before using it on your whole face.
What to expect: side effects and timing
Tingling, mild burning, itching and slight dryness are the most common reactions, especially in the first weeks. These usually settle as skin gets used to the product. Using it every other day for a while, or on top of a moisturizer, can make it easier to tolerate.
Results take time:
- Acne: some improvement after around a month, with the best results after several months of regular use.
- Rosacea: it can take up to 12 weeks before skin starts to improve.
- Dark marks: usually several months, and older marks take longer. Daily sunscreen helps protect your progress.
Azelaic acid can be used for a long time, as long as your skin stays comfortable and your doctor or pharmacist agrees. Many people keep using it to maintain results.
Less common but important
- Severe irritation. Stop and get advice if you have strong redness, scaling, itching or burning that does not settle. People with eczema or very sensitive skin are more likely to get irritation.
- Skin lightening. Rarely, azelaic acid can lighten skin in the treated area. This is easier to notice on darker skin. If you see pale patches, stop and ask a dermatologist.
- Asthma. Worsening asthma has been reported with its use. If your asthma flares while you are using it, talk to a doctor.
- Allergy. Stop using any product that causes swelling, hives or a rash that spreads.
What to pair it with
Azelaic acid fits into most routines, because it is less harsh than many exfoliating acids.
- Niacinamide. A popular partner for redness, oil and marks. See azelaic acid + niacinamide.
- Retinoids. Azelaic acid and retinoids can often be used in the same routine for acne and dark marks, but together they may dry out or irritate skin. Many people use one in the morning and the other at night, and add the second slowly. See azelaic acid + retinoids. If you are pregnant or breastfeeding, ask your doctor before using a retinoid.
- Benzoyl peroxide. A common acne pairing, since the two work in different ways. Expect more dryness, and see benzoyl peroxide for how to use it.
- Hyaluronic acid and ceramides. Good for offsetting dryness. These are moisturizing ingredients that help skin hold water and keep its barrier comfortable.
- Vitamin C. Many people use both. If your skin stings, use them at different times of day.
What not to mix
- Many strong exfoliants at once. Glycolic acid, salicylic acid, scrubs and peels, used together with azelaic acid, can overwhelm the skin. Add one new active at a time and wait a couple of weeks before adding the next.
- Broken, sunburned or freshly treated skin. Wait until it has healed, including after a peel, a laser or microneedling, unless the person who did the procedure tells you otherwise.
- Harsh scrubbing. Rubbing skin harder does not help acne or dark marks and can make both worse.
Azelaic acid on sensitive and darker skin
Azelaic acid is popular for sensitive and darker skin tones because it can help with both breakouts and the marks they leave, without the strong peeling that some acids cause. Even so, "gentle" does not mean "no effect on the skin". A slow start, a good moisturizer and daily sunscreen make it far more comfortable.
On darker skin, watch for pale patches after weeks of use, and remember that picking spots usually causes darker, longer-lasting marks than the spot itself.
Pregnancy and breastfeeding
Only a small amount of azelaic acid passes through the skin into the body, and it is often discussed as an option when retinoids are avoided. Even so, data from pregnancy are limited. If you are pregnant or breastfeeding, ask your doctor before using it. If you breastfeed, do not apply it to the breast or nipple area.
When to see a doctor
- Your acne is painful, deep or leaves scars.
- You have no clear improvement after about 8 to 12 weeks of regular use.
- Your face is persistently red, burns or stings, or you have visible small blood vessels, which may be rosacea.
- Rosacea affects your eyes, causing dryness, grittiness, redness or swelling of the eyelids.
- A dark patch is growing, changing shape or color, bleeding or looks different from your other marks.
- You notice pale patches, swelling, hives or a spreading rash after using it.
A dermatologist can confirm what is causing your skin concern and, if needed, prescribe stronger options.
FAQ
Is azelaic acid an exfoliant like glycolic acid?
Not in the same way. It helps keep pores from clogging, but it is usually much gentler than alpha hydroxy acids such as glycolic acid, which loosen the top layer of dead skin cells.
Can I use azelaic acid every day?
Yes, many people do. Start with one application a day and build up if your skin is comfortable. If it stings or peels, use it less often for a while.
Does azelaic acid make skin sensitive to the sun?
It is not usually described as making skin sun-sensitive in the way AHAs do. Sunscreen is still essential, especially if you are fading dark marks.
Can I use it with makeup?
Yes. Apply azelaic acid first, let it absorb for a minute or two, then moisturizer, sunscreen and makeup.
Will azelaic acid lighten my natural skin color?
It is used to reduce excess pigment, not to lighten healthy skin. Rarely, it can cause pale patches, especially in darker skin, so stop and ask a dermatologist if you see them.
Sources
- Azelaic acid (DermNet)
- Acne: Diagnosis and treatment (American Academy of Dermatology)
- Efficacy and safety of azelaic acid (15%) gel as a new treatment for papulopustular rosacea: results from two vehicle-controlled, randomized phase III studies (PubMed, NIH)
- Azelaic Acid, Drugs and Lactation Database (LactMed) (NIH)