Azelaic Acid (Topical)

Azelaic acid is used in the treatment of various skin conditions, such as mild to moderate acne and rosacea, as well as a number of skin pigmentation complaints.

Overview

Azelaic acid is a dicarboxylic acid, usually administered as a topical cream, foam, or gel, and used in the treatment of a number of mild skin conditions, notably acne and rosacea, though it is also known to have some impact on pigmentation disorders, particularly amongst patients with a darker skin tone.

Azelaic acid is a saturated dicarboxylic acid found in rye, wheat, and barley and is produced when nonanoic acid is subject to bacterial degradation. It works by inhibiting hyperactive protease activity, which converts the anti-microbial peptide cathelicidin into LL-37.

Its effects on different conditions are caused in different ways through the same application. For patients suffering from moderate and mild acne, azelaic acid kills the bacteria that has infected the pores on their face and also decreases the skin's production of keratin, which promotes acne growth.

The use of azelaic acid in the treatment of rosacea lies in its anti-inflammatory properties, whereby it helps to clear the swelling and bumps caused by the condition.

In the treatment of pigmentation conditions, such as post-inflammatory hyperpigmentation and melasma, azelaic acid acts as a tyrosinase inhibitor, reducing the synthesis of melanin in the skin, and is often recommended as a substitute for hydroquinone.

Azelaic acid is only available with a prescription from your doctor and is applied topically to the affected area.

Conditions Treated

  • Rosacea
  • Acne
  • Melasma
  • Post-inflammatory hyperpigmentation

Type of Medicine

  • Dicarboxylic acid

Side Effects

As with many medical treatments, along with its desired effects, azelaic acid may also cause some unwanted conditions. Whilst not all the effects listed here might occur during a course of treatment, if they do, they require medical attention.

Should you develop any of the following conditions during your course of treatment with azelaic acid, you should speak to your prescribing doctor immediately.

  • Burning, tingling, or stinging of the skin
  • Itching, dryness, redness, or peeling of the skin
  • Burning, blistering, crusting, flaking, or dryness of the skin
  • Swelling, severe redness, scaling, or soreness of the skin
  • Fast heartbeat
  • Hives, skin rash, or fever
  • Hoarseness
  • Irritation
  • Stiffness, pain, or swelling of the joints
  • Large swellings (such as hives) appearing on the sex organs, face, feet, eyelids, legs, lips, hands, tongue, or throat
  • Tightness of the chest
  • Swelling around the eyes
  • Tightness of the chest
  • Trouble with swallowing or breathing

Some side effects might appear which normally do not require any form of medical attention. Such side effects should disappear during the course of treatment with azelaic acid, as your body becomes used to the effect of the medication. Alternatively, your prescribing doctor, or another healthcare professional, might be able to offer you a way to reduce or prevent these effects.

Should any of the side effects listed here continue throughout your treatment, or should they become bothersome, be sure to speak to a healthcare professional about minimizing the impact these unwanted effects have.

  • Changes to the color of skin in treated areas
  • Tearing
  • Blurred vision
  • Eye redness
  • Eye pain

There may be other side effects not listed here, which might occur among some patients. Should you notice any effects during your course of treatment with azelaic acid, inform your prescribing doctor.

Dosage

Different doses of azelaic acid are prescribed to different patients, depending on the nature and severity of their condition. For any given course of treatment, you should always follow the direct instructions of your prescribing doctor or the directions given on the medicine's label. The information included here only includes the average doses reported for the application of azelaic acid. If you are prescribed a different dosage from what is explained here, you are advised not to alter the amount of frequency of the dose without first speaking to your prescribing doctor or healthcare professional

The amount of medication prescribed will depend upon the strength of the azelaic acid itself. Likewise, the length of your particular course of treatment, the number of applications you are expected to make each day, and the amount of time you are expected to leave between administrations will all have been determined by the nature and the severity of whatever medical condition you are treating with azelaic acid.

For topical cream dosage for the treatment of acne:

Adults and children over the age of twelve should apply a thin layer of azelaic acid to the affected area twice a day, once in the morning, and once in the evening.

Children under the age of twelve should use a dosage of azelaic acid as prescribed by their healthcare professional.

For topical gel/jelly and foam dosage for the treatment of rosacea:

Adults should apply a thin layer of azelaic acid to the affected area twice a day, once in the morning, and once in the evening.

Children should use a dose of azelaic acid only as prescribed by their doctor.

If you miss your regular dose of azelaic acid, you should apply it as soon as you can, unless it is already close to your next application, in which case you should skip the missed dosage and return to your normal treatment schedule.

Major Drug Interactions

There are certain medications that should not be used together owing to the negative side effects their interaction may cause. In other circumstances, two different types of medicine might be used concurrently, even if an interaction is known to occur. In such cases your prescribing doctor may wish to alter the dose of azelaic acid, or perhaps take such other precautions as they feel necessary. You should tell your doctor if you are taking any other medication, be it prescription or an over-the-counter treatment.

Warnings

Whenever you decide to take a course of medication, you must weigh the benefits it will provide against the potential risks of its administration. This is a decision that will be made by you and your prescribing doctor before embarking on a course of azelaic acid.

You must always tell your doctor should you have ever had an unusual or allergic reaction to azelaic acid in the past, or to any other kind of medication. Also inform your doctor whether you suffer from any other form of allergies, including an allergic reaction to animals, dyes, foods, or preservatives.

Studies performed to date do not demonstrate any specific pediatric concerns that would limit the effectiveness of azelaic acid as a treatment for children over the age of twelve. The efficacy and safety of this drug in children under the age of twelve have yet to be established.

Studies performed to date do not demonstrate any specific geriatric concerns that would limit the effectiveness of azelaic acid as a treatment for the elderly.

Animal studies have shown no evidence azelaic acid causing harm to the fetus during pregnancy. However, there have not been adequate studies performed in pregnant women.

No adequate studies have been undertaken in women to determine the risk to infants when using azelaic acid whilst breastfeeding. You should discuss the potential risks and potential benefits with your healthcare professional before beginning a course of treatment while breastfeeding.

The presence of pre-existing medical conditions might affect the use of azelaic acid. Be sure to inform your doctor if you suffer from any other medical condition, especially asthma, as the use of azelaic acid has been reported to exacerbate this condition in some users.

It is vital that you only use azelaic acid as directed. You should not use more of it, nor should you apply it more often, nor should you administer it for a longer time than that prescribed by your doctor. Should you do any of these things, your skin may become irritated as a result.

Azelaic acid is only to be used on the skin. Do not get any of it in your vagina, nose, eyes, or mouth. Should you get any of it in those areas, immediately rinse it off with water and contact your doctor straight away.

In order to completely clear up your acne or rosacea, it is essential that you finish your course of treatment as prescribed by your healthcare professional, and that you do not miss any doses.

The use of alcoholic astringents, tinctures, and cleansers, as well as peeling agents and abrasives, alongside the azelaic acid gel or foam, should be avoided in order to prevent irritation of the skin.

Whilst using the azelaic acid gel, you should avoid eating thermally hot food and drink (hot coffee and tea, for instance), alcoholic beverages, and spicy food.

Azelaic acid foam is flammable, so patients should avoid smoking and being around open flames and fire when applying the foam, and immediately afterward.

It is essential that your prescribing doctor checks your progress regularly for any unwanted effects that your use of azelaic acid might be causing.

If taking azelaic acid for acne and it does not improve your condition within four weeks, or if your acne becomes worse, you should consult your doctor.

If taking azelaic acid for rosacea and it does not improve your condition within twelve weeks, or if your rosacea becomes worse, you should consult your doctor.

Hypopigmentation has been reported to occur when using azelaic acid. If your skin turns a lighter color in the areas you are treating, you should consult your doctor immediately, particularly if you have dark skin.

You should see your prescribing doctor straight away if your skin starts itching, if you have difficulty breathing, or if you develop large swellings (like hives) on your sex organs, hands, legs, throat, tongue, feet, eyelids, lips, or face, whilst you are on a course of treatment using azelaic acid.

You should see your prescribing doctor straight away if you develop a skin rash, swelling, stinging, redness, irritation, dryness, or burning of the skin.

Storage

Always keep azelaic acid beyond the reach of children.

Do not keep hold of outdated medication, or any medicine that is no longer required.

If you are not sure, be certain to ask your prescribing doctor or other healthcare professional how to dispose of any azelaic acid you do not use.

Remember to store your azelaic acid medication at room temperature, in a closed container. You should always keep it away from direct light, heat, and moisture, and also ensure that you keep it from freezing.

The azelaic acid gel pump should be thrown away eight weeks after opening.

The azelaic acid foam can should never be stored at temperatures that exceed 120 degrees F (or 49 degrees C). You must never throw the foam can into a fire, nor should you poke holes into the foam can, even if the can itself is empty. Any unused azelaic acid foam medication should be thrown away eight weeks after you use the can for the first time.

Summary

Azelaic acid is a topically applied dicarboxylic acid, commonly employed for the treatment of acne. It has few recorded side effects and even fewer reported negative interactions with other drugs, making it a relatively safe method of treatment for this and other skin conditions.

Resources
Last Reviewed:
December 25, 2017
Last Updated:
April 04, 2018