When it comes to skincare acids, azelaic acid is one of the lesser-known staples. But, after years in the shadows as an elusive ‘If you know, you know’ skincare ingredient, word is spreading about the many ways to use it – especially for skin that is sensitive and acne-prone, or if pigmentation and mild to moderate rosacea are concerns.
Driven largely by TikTok, search around azelaic acid is seeing upwards of 52 million views – even Hailey Bieber has posted a video praising its benefits for soothing perioral dermatitis. Echoes of this hype can also be seen on the high street after Boots launched its own multi-tasking azelaic acid cream.
The best azelaic acid skincare
I thought the rash around my nose and mouth was an allergic reaction or hayfever-related.
That said, it's not a straightforward skincare hero. The fact that azelaic acid is a mild exfoliator that also moonlights as an anti-inflammatory can be confusing when it comes to slotting it into your regimen.
Below, our experts explain what makes azelaic acid such a hard-working ingredient, how to incorporate it alongside your other skincare actives and what skin types will benefit most from using it.
What is azelaic acid?
Azelaic acid is an acid derived from grains such as rye, wheat and barley. It is also produced naturally by yeast that lives on healthy skin.
When it comes to skincare products, though, it is typically chemically engineered in a lab to ensure it is as stable and effective as possible.
What does azelaic acid do to the skin?
Azelaic acid has antibacterial properties that help break up the blockages in your pores that lead to breakouts. It is also an anti-inflammatory, meaning it takes the heat out of angry spots, reduces the swelling and flattens the size.
One study published in the Journal of Medical Sciences found that all 40 participants who used a 10% azelaic acid gel saw their mild-to-moderate acne improve after just 8 weeks. So, unsurprisingly, products such as Dr. Dennis Gross Alpha Beta On The Spot Gel and Q&A's Azelaic Acid Facial Serum protect against spot-forming bacteria and balances oil levels.
Studies also show that azelaic acid regulates skin cell turnover. This is important for two reasons. It keeps pores clear of debris and tackles what consultant dermatologist Dr Anjali Mahto calls “hyperkeratinisation” – a key issue for acne sufferers that basically refers to the abnormal shedding of skin cells.
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Azelaic acid is known to block the enzyme tyrosinase. This causes excess melanin production in the skin and shows up as dark brown or red discolouration. "As a tyrosinase inhibitor, azelaic acid can also be used to fade lingering acne marks and treat hyperpigmentation," says Dr Ifeoma Ejikeme, founder of the Adonia Medical Clinic.
Azelaic acid is also a powerful antioxidant with skin-brightening properties, making it "a good option for reducing pigmentation often associated with pregnancy,” says Dr Mahto.
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Azelaic acid gels are often prescribed by dermatologists for the treatment of rosacea. Because it's an anti-inflammatory, red and irritated patches of skin are soothed.
One study found that the topical application of a 15% azelaic acid gel on rosacea-prone skin reduces the trigger for inflammation. It also treated the redness, raised bumps and pustules.
Better still, "It is one of the few topicals that is safe to use during pregnancy and breastfeeding, allowing women to continue treating their rosacea or acne, which can flare up during this period," explains Dr Ejikeme.
Created with rosacea in mind, The Inkey List Super Solutions 10% Azelaic Acid Serum delivers a double whammy of anti-inflammatory azelaic acid to dial down redness and a green-tinted formula to help mask flushed skin.
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Azelaic acid isn't an ‘acid’ in the traditional sense of the word because it doesn't break down the bonds between skin cells, causing them to peel away. It's also a large molecule that is harder for the skin to absorb, making it less irritating.
According to Dr Ejikeme, azelaic acid is a milder exfoliator than resurfacing alpha-hydroxy acids (AHAs), including glycolic, lactic and mandelic acids, which makes it a good choice for dry or sensitive skin in need of brightening.
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Hailey Bieber captioned a TikTok famous video with: “Azelaic Acid is found to be effective in treating the inflammation caused by POD”. And she's absolutely right – azelaic acid helps to reduce the redness and bumps associated with perioral dermatitis (POD).
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It's famously tricky to diagnose, but we need to talk more about rosacea in women of color.
Can you use azelaic acid every day?
That depends on the concentration and the skin concern you're trying to treat. “Azelaic acid can be obtained over the counter in strengths of 10%, or on prescription in the form of Finacea (15%) and Skinoren (20%),” says Dr Mahto.
Generally speaking, a 10% over-the-counter formula can be applied once a day. When it comes to treating perioral dermatitis, cosmetic dermatologist Dr Sam Bunting says that, while a low dose of azelaic acid can dial down redness and spots, it's best to initially use it on alternate days until your skin gets used to it.
For prescription products, follow your doctor's instructions and the manufacturer's guidelines.
How to use azelaic acid for the best results:
- Apply azelaic acid to clean skin before moisturiser.
- Use it all over if you have acne rather than as a targeted treatment on spots, recommends Dr Bunting.
What should you not mix with azelaic acid?
DON'T… mix azelaic acid with more acids: "It is exfoliating, so take care if you are using other acids," warns Dr Ejikeme. “To avoid over-exfoliating the skin, stick to one resurfacing ingredient and increase slowly unless advised differently by your doctor.”
DON'T… use azelaic acid with ‘deep-cleansing’ face washes. You should avoid using astringents at the same time as azelaic acid to avoid dry, red and sore skin.
DO… combine azelaic acid with niacinamide: "It's good to combine azelaic acid with other soothing and brightening ingredients like niacinamide or antioxidants," adds Dr Ejikeme – advice that is especially beneficial for those experiencing patches of uneven skin tone.
Is azelaic acid a retinoid?
The short answer to this is ‘no’, azelaic acid is not a retinoid, but the confusion is understandable given that both ingredients can treat acne, pigmentation and improve skin texture.
Azelaic acid works very differently to retinol. It's great for reducing inflammation and works well on sensitive skin. But it is also gentle, so, unlike retinol, it may not be the best choice for those with severe acne if you use it as a standalone treatment.
There is a compromise, though. Dr Ejikeme believes that azelaic acid partners well with retinoids when used at different times of day: azelaic acid as a serum in the morning and a retinoid cream at night.
Everyone's skin is different, so always consult your dermatologist, who may recommend a stronger skincare acid or more potent topical treatment.
Azelaic acid vs salicylic acid
According to Dr Bunting, azelaic acid and salicylic acid are both excellent for treating acne-prone skin. So much so, she encourages her patients to use them in tandem, starting with salicylic acid at 2% for those with very oily skin and angry breakouts, she says in a video. Once a patient is out of the acute acne phase and their skin is looking better, she suggests they switch to azelaic acid for “future preventative action”.
Some products such as Paula's Choice 10% Azelaic Acid Booster, Medik8 Blemish SOS and Glow Recipe Strawberry Smooth BHA+AHA Salicylic Serum are powered by both acids to unclog pores and boost their skin-brightening prowess.
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Azelaic acid side effects
"Of all the acids, azelaic acid is usually well tolerated with minimal side effects," Dr Ejikeme notes. However, like any exfoliating ingredient, there is the chance that skin could flare up and become red.
"When starting an acid, I usually recommend you go slow and only start one active at a time to prevent irritation to the skin," she adds.
And finally, while SPF should already be an integral part of our everyday skincare regime, Dr Ejikeme explains that it's even more important to diligently apply it when using azelaic acid. "All acids can make skin more sensitive to the sun," she says.
For more from Fiona Embleton, Glamour's Associate Beauty Director, follow her on @fiembleton.
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