Everything you need to know about azelaic acid

Your skin is an ecosystem. It thrives when natural processes (like skin cell production) and native organisms (like bacteria) stay in balance. Like zinc pyrithione and clindamycin, azelaic acid helps maintain your skin’s microbiome, correcting imbalances that can contribute to acne.

It also helps balance the melanin in your skin—that means it’s useful in treating skin concerns like post-inflammatory hyperpigmentation, uneven skin tone, and melasma. Azelaic acid is truly a talented multitasking ingredient that’s great for all skin types. 

If your skin goals include a clear complexion and even skin tone, azelaic acid might be right for you—here’s everything you need to know, based on the research. 

What is azelaic acid? 

Azelaic acid is a skincare ingredient that also occurs naturally in several whole grains (though, in skincare, it’s usually synthetically produced in a lab). As a topical treatment, it effectively battles acne, clogged pores, hyperpigmentation, inflammation, and more.¹ Certain strengths of azelaic acid are FDA-approved as prescription topical creams or gels (as with the brands Finacea and Azelex).²,³  

Notably, azelaic acid’s brightening effects can impact your skin's melanin production.⁴ When pigment-producing skin cells called melanocytes become overactive, it can cause hyperpigmentation concerns ranging from post-inflammatory hyperpigmentation to melasma. Azelaic acid selectively controls hyperactive melanocytes, making it an effective treatment for melasma⁵ and other types hyperpigmentation.

Here are some of our favorite azelaic acid products: 

• Your Custom Formula 

• The Ordinary 10% Azelaic Acid Suspension Cream

• Paula’s Choice 10% Azelaic Acid Booster

What azelaic acid can treat

• Acne

• Melasma

• Rosacea

• Post-inflammatory hyperpigmentation

The ingredient properties of azelaic acid⁶

• Anti-inflammatory: soothes and heals skin 

• Anti-keratinizing: treats and helps prevent clogged pores

• Antibacterial: controls bacteria that contribute to acne

• Anti-melanogenic: regulates pigment production

How azelaic acid works

Okay, so we know the benefits of azelaic acid, but how is it possible it can do so much?! We had the same question, so we asked our dermatologists to explain it to us. Here’s what we learned: 

1. Azelaic acid treats acne and helps prevent clogged pores. Azelaic acid helps dead skin cells shed and helps regulate the way you make new skin cells. Without proper regulation, dead skin cells can pile up, blocking pores and leading to breakouts. Azelaic acid keeps things running smoothly,  helping treat different types of acne such as whiteheads and blackheads.

2. Azelaic acid fights bacteria that contribute to breakouts. Azelaic acid helps prevent the spread of C. acnes, which plays a role in acne.

3. Azelaic acid fights melasma, and other types of hyperpigmentation. Azelaic acid does even more—it helps promote a clear, even complexion by blocking abnormal melanocytes, pigment-producing cells that have gone haywire.

4. Azelaic acid soothes inflammation. Ever take anti-inflammatories for a swollen knee? Azelaic acid helps reduce swelling and redness in your skin, calming the inflammation that contributes to rosacea and breakouts. 

How to use azelaic acid in your skincare routine

How you use azelaic acid will depend on what type of skincare product you’re using, so follow your label’s directions. If you’re using a Curology Custom Formula with azelaic acid, here’s how to do it: 

• Step 1: Cleanse with a gentle cleanser and let your face completely dry. 

• Step 2: Apply your azelaic acid treatment in a thin layer over your face and neck.

• Step 3: Moisturize with a non-comedogenic facial lotion or night cream (if you need the extra hydration boost). 

Be sure to apply your Custom Formula at night and practice wearing sunscreen during the day. 

If you’re using a serum with azelaic acid, apply it before your Custom Formula, moisturizers, and sunscreen. Serums are typically lightweight, so they spread and absorb easily into your skin, giving your skincare routine a little extra umph.

Ingredients to pair with azelaic acid 

These ingredients tend to work well with azelaic acid—and you can find them in products at your local pharmacy: 

• Niacinamide: a multitasking B vitamin that helps repair signs of sun-damage, reduce fine lines and dark spots, and improve skin elasticity.

• Sulfur: can help with both acne and rosacea. It may also decrease redness from inflammation!

• Zinc pyrithione: can help ordinary acne as well as fungal acne. It may also help to reduce oil (aka sebum).

Curology’s Custom Formula mixes azelaic acid with other active ingredients to target your skin concerns. That’s because your formula is prescribed to you by a licensed dermatology provider, so its ingredients are tweaked to meet your needs.

Ingredients NOT to pair with azelaic acid

Okay, we’re being dramatic—azelaic acid usually plays well with the rest of your skincare routine. That said, there are some ingredients that you’ll want to temporarily stop using while your skin is adjusting to its new azelaic acid treatment: 

• Benzoyl peroxide

• Alpha hydroxy acids or AHAs (like glycolic acid)

• Beta hydroxy acids or BHAs (like salicylic acid)

• Vitamin C

• Retinol

• Rotating brushes

• Face scrubs

• Physical exfoliators

These can sometimes increase your risk of dryness and irritation. Feel free to use your judgment when re-introducing these into your routine. When in doubt, keep it simple. 

When to expect results with azelaic acid

You’ll likely notice a difference with azelaic acid by month 2 of your treatment. Acne patients using azelaic acid may get results sooner, around 4-6 weeks. Rosacea patients may not notice results until 3 months after consistently using a treatment with azelaic acid.⁷ That said, this can vary from person to person!

If, after a few months, you decide you like using azelaic acid, then keep at it! It’s good to keep up a skincare routine after breakouts have cleared to help prevent new blemishes and for anti-aging benefits. As always, be sure to make sunscreen a staple of your day.

Azelaic acid side effects

Azelaic acid’s side effects are usually mild (when they happen at all). Some side effects of azelaic acid include:⁸

• A burning, stinging sensation

• Itchiness

• Dryness

• Scaling

• Temporary redness

Azelaic acid is generally non-toxic and safe to use. Most people experience no significant side effects beyond mild stinging or itching at first. If these sensations are irritating you, let your provider know.

Like literally anything in the world, it’s possible to have an allergic reaction to azelaic acid. Signs of an allergic reaction may include facial swelling and hives. Let your medical provider know if you experience these side effects—they’re here to help! 

By the way, if you’re pregnant or nursing, azelaic acid is generally safe to use.⁹ Just chat with your OB-GYN before starting new topical medications to make sure it’s all groovy. 

Where can I get azelaic acid?

Depending on the strength, you can get azelaic acid over the counter and by prescription. That means you can pick up skincare products with azelaic acid at your local drugstore and at cosmetic shops like Ulta and Sephora. 

Just be sure to use products that are free of potentially pore-clogging or irritating ingredients because those can make conditions like acne and rosacea worse. 

You can also get a Custom Formula by Curology sent to your door for free right now. We offer a range of strengths of azelaic acid (from 2% to 10%). Your Custom Formula features a mix of active ingredients like azelaic acid, tretinoin, and clindamycin, picked for you by one of our in-house dermatology providers.* 

Your first month of Curology is on the house and comes with any of our recommended skincare products. It’s subject to consultation (it is a prescription, after all), and you’ll pay $4.95 (plus tax) to cover shipping and handling. After that, you can cancel any time or tweak your box to meet your skin’s evolving needs. 

Get your personalized skincare routine with Curology

Ready to get started? Start your Curology free trial now. 

P.S. We did our homework so you don’t have to. 

1. A. L. Zaenglein, et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. (2016).

2. Marta Rendom, et al. Treatment of melasma. Journal of the American Academy of Dermatology. (May 2016). 

3. Willis Hughes Lyford, et al. Melasma Treatment and Management. Medscape. (April 27, 2020). 

4. Brian C. Schrute, et al. Azelaic Acid: Evidence-based Update on Mechanism of Action and Clinical Application. Journal of Drugs in Dermatology. (September 2015). 

5. Harald Gollnick and Alison Layton. Azelaic acid 15% gel in the treatment of rosacea. Journal of Expert Opinion on Pharmacotherapy. (October 2008). 

6. Medline Plus. Acid Topical. National Library of Medicine. (December 15, 2016). 

7. Brian C. Schrute, et al. Azelaic Acid: Evidence-based Update on Mechanism of Action and Clinical Application. Ibid.

*Ingredients subject to provider consultation. 

Written by

Curology Team

Medically reviewed by

Nicole Hangsterfer, PA-C