A Complete Guide to Azelaic Acid, as Told by Dermatologists

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For those with problematic skin, salicylic acid, benzoyl peroxide and glycolic acid are probably already on speed-dial when skin starts acting up. But there's a lesser-known ingredient that's been picking up steam on the skin-clearing horizon: azelaic acid. But is it all that it's cracked up to be?

Here, what to know about the naturally occurring acid, what derms think about it, and how to tell if it's right for you.

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What is azelaic acid? 
Surprisingly, the naturally occurring acid comes from barley, rye grains and wheat and belongs to a family called carboxylic acids. Azelaic acid is known to have antibacterial, anti-inflammatory and antioxidant properties, making it effective in the treatment of skin conditions such as acne and rosacea.

However, some dermatologists feel that the ingredient is simply a gentle, pregnancy-safe alternative to much more effective ingredients. "Although I know it has been used for discoloration, acne, rosacea and even seborrhea, I don’t feel that it is very effective as a single agent—I typically use it in combination with other products to combat the above-mentioned issues," says Fort Lauderdale, FL dermatologist Dr. Igor Chaplik.

Does azelaic acid help fight acne?
In one word: yes. Boston dermatologist Dennis A. Porto, MD says the acid's antimicrobial properties absolutely help with acne, but the ingredient also goes one step further: "It treats the acne, as well as the hyperpigmentation that results from it," explains Conroe, TX dermatologist Lana Hawayek, MD, who loves the ingredient for darker skin types who deal with blemishes and the hyperpigmentation and scarring that may result from them.

However, when combined with additional skin-clearing ingredients—Ontario, Canada dermatologist Dusan Sajic, MD likes to combine it with retinol and a mild salicylic acid "as they have different mechanisms and work synergistically"—it delivers much stronger zit-zapping results.

Does azelaic acid lighten hyperpigmentation? 
New York dermatologist Marisa Garshick, MD contends the acid does indeed help even out skin tone and that it can even help lighten up melasma. Dr. Porto explains that azelaic acid also "decreases abnormal melanin, which helps it remove dark spots from the skin."

To treat hyperpigmentation, Dr. Sajic likes to combine azelaic acid with tranexamic acid, vitamin C, kojic acid and arbutin. "Several recent studies have shown a very similar effect for pigmentation compared to hydroquinone, which is falling out of favor," he adds.

Does azelaic acid reduce redness?
Wilmington, NC dermatologist Kendall Egan says she likes using azelaic acid for rosacea, and many dermatologists agree that perhaps the best benefit of azelaic acid is its ability to treat acne, rosacea and post-inflammatory acne at once. "I love azelaic acid for treating rosacea, but also for treating pigmentation, especially in patients with rosacea that will not tolerate some of the other bleaching agents," says Miami Beach, FL dermatologist Melissa Lazarus, MD.

Can you use azelaic acid everyday? 
Known to be easier than most acids to tolerate—Dr. Garshick says it's a great option for those with sensitive skin—it can be used daily. But if used in the morning, be sure to layer on SPF after, as the acid can make your skin more sensitive to UV. (It should be used after cleansing and before applying your other skin-care layers.)

The secret sauce to seeing results: consistency. "If patients follow the recommended regimen of using [azelaic acid] twice daily, along with a moisturizer and a sunblock, it is extremely effective," says Harrison, NY dermatologist Jennifer Silverman Kitchin. 

Can you use azelaic acid while pregnant? 
Laguna Hills, CA dermatologist Jennifer Channual, MD says azelaic acid is her "go-to for pregnant or breastfeeding patients." Dr. Lazarus adds: "I use it often in acne patients and melasma patients that are pregnant, as it is Category B and safe during pregnancy."

However, some doctors will only recommend the ingredient when their patient is pregnant. "I recommend it mostly in the setting of pregnancy, since we know azelaic acid is quite safe in that setting, but it is not as potent as other options such as retinoids," says Orange County, CA dermatologist Daniel Chang, MD. 

What to try
While prescription products such as Finacea Gel (15% azelaic acid) and Skinoren Cream (20% azelaic acid) are available from your dermatologist, over-the-counter products (commonly concentrations of 10%) can be found everywhere from Ulta to Sephora. Some favorites include The Ordinary Azelaic Acid Suspension 10% ($8)—Washinton, D.C. dermatologist Sarika Snell, MD says she recommends it to patients "all the time"—and Paula's Choice 10& Azelaic Acid Booster ($36).

However, Dr. Channual notes that these OTC options might not be enough for certain skin types. "A mild treatment and may not be strong enough for patients who have numerous lesions, in which case, an additional topical or oral antibiotic could be added," says Dr. Channual.