You might think you know azelaic acid (AZA) but think again. AZA is a dicarboxylic acid that exists naturally in grains like rye, wheat and barley and can be found in human urine. Hopefully that fun fact does not start a new social media trend! I know, gross, right? While AZA is a natural ingredient, the synthetic form is typically used for skincare products due to its stability and effectiveness. Azelaic acid has several attractive properties that make it a powerhouse for the skin. It can gently exfoliate, even tone and fade dark spots left behind from acne lesions. It also has antibacterial properties and yes, antioxidant power to help calm inflammation.
Another source of AZA is one of our skin’s normal inhabitants, Malassezia. Ever had Pityrosporum versicolor aka tinea versicolor? Well, the why behind the white spots is due to AZA. Malassezia produces and secretes AZA and because AZA inhibits melanocytes (the pigment producing cells in the skin), white spots may occur. And a new fact unknown to me until researching this article—azelaic acid was also used to treat melanoma back in the 1980s. While its use for melanoma is no longer recommended, it’s amazing to see the history of azelaic acid and where it is today.
Azelaic acid’s hallmark is its ability to target melanocytes without affecting normal cells. AZA competitively inhibits tyrosinase activity—translation—it can stop melanocytes from producing pigment. As a result, AZA is a great option to help lighten dark spots on the skin or treat skin conditions like melasma. As a dicarboxylic acid, azelaic acid can also improve your skin’s texture through removing dead skin cells.
If you have acne, you likely have experienced one of those pesky dark marks left behind after a juicy pimple finally went away. Not only can azelaic acid work to lighten that spot, but it can also be used to prevent future acne and treat current pimples. AZA has also been shown to reduce oil production and can ward off Cutibacterium acnes, the main bacteria responsible for acne. Because it is considered safe in pregnancy, it is often a first line off-label option for mamas to be suffering with acne. And double bonus—if you have melasma or dark areas in pregnancy, azelaic acid can safely be used to treat that as well.
For all you rosacea sufferers, azelaic acid might offer some relief. It can reduce redness and pimple bumps and tends to be well tolerated. If you’re considering AZA, there are over-the-counter options (OTC) as well as prescription versions. The prescription is a higher concentration than what you can find OCT and FDA approved for rosacea. Other uses for AZA in dermatology include male-pattern baldness and follicular keratosis. While not recommended as standard of care for skin cancer, some promising studies have suggested revisiting AZA as a skin cancer therapy.
Overall, azelaic acid is a great add into your skincare routine and can typically be used even with sensitive skin. It’s a friendly ingredient, meaning it doesn’t inactivate other skin care players and can work well in combination with other products. Often it’s considered an add-on or a booster to maximize results for lightening or treating acne. One of the best things about azelaic acid is how quickly you can appreciate its soothing effects. Most people report improvement in a few days while fading dark spots and correcting uneven tone can take several months and requires strict sun protection.
Trotter’s Take: Azelaic acid is an underappreciated tool for skincare but can offer many skin benefits and personally, it’s my rosacea go to.
Want to hear about azelaic acid and get the latest update on rosacea? Then join me with Dr. Linda Stein-Gold as she gives a clear picture of what rosacea is and how to treat it.
