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Azelaic Acid

Azelaic Acid Cream

Azelaic acid cream is a topical medication approved by the FDA to treat mild to moderate acne and rosacea. It belongs to a class of drugs known as dicarboxylic acids and works by reducing acne-causing bacteria. The cream typically comes in a 20% formulation for acne and a 15% formulation for rosacea. It should be applied twice daily to clean dry skin. Azelaic acid is also effective in treating skin discoloration and hyperpigmentation by blocking the production of melanin. It has antibacterial and antioxidant properties, making it suitable for sensitive skin. Side effects may include stinging, burning, itching, or tingling, but these usually decrease with continued use. It’s important to follow your doctor’s instructions and not to use this medication if you’re allergic to azelaic acid or propylene glycol. Regular check-ups with your doctor are recommended to monitor progress and adjust treatment as needed.

Product Overview

Azelaic acid cream is a dermatological medication primarily used for the treatment of mild to moderate acne and rosacea. This dicarboxylic acid works by reducing the growth of acne-causing bacteria on the skin and promoting the opening of clogged pores, which in turn decreases the number of acne pimples. For acne treatment, a 20% cream formulation is commonly prescribed, to be applied twice daily to the affected areas after cleansing and drying the skin. In cases of rosacea, a 15% gel or foam formulation is used similarly.

Besides its anti-acne properties, azelaic acid is renowned for its ability to improve skin tone and address discoloration issues such as hyperpigmentation, dark spots, and red scars. This is achieved through its inhibition of tyrosinase, an enzyme responsible for melanin production. Its antibacterial, antioxidant, and anti-inflammatory properties further contribute to its effectiveness in treating acne and rosacea, making it a gentler alternative to more potent treatments like salicylic acid and adapalene. The cream should not be applied to irritated skin, and treated areas should not be covered with a bandage unless advised by a doctor. Patients should expect to see improvements within four weeks for acne and 12 weeks for rosacea, although this may vary depending on individual response.

Side effects are generally mild and may include temporary stinging, burning, itching, or tingling sensations at the beginning of treatment. If these persist or worsen, it’s advisable to consult a healthcare professional. In rare cases, skin color lightening (hypopigmentation) may occur, which is more noticeable in individuals with darker skin tones. Patients are advised to keep the medication out of reach of children, avoid applying it to sensitive areas such as the eyes, nose, and mouth, and to not use other potentially irritating skin products concurrently. Regular follow-ups with a doctor are essential to ensure the treatment is working effectively and to adjust the dosage or regimen as necessary. Always consult with a healthcare provider before starting or changing any medication regimen.

Uses of Azelaic Acid Cream

  • Used to treat mild to moderate acne
  • Hidradenitis suppurativa
  • Keratosis pilaris
  • Alopecia
  • Psoriasis Vulgaris
  • Reduces inflammation
  • Use to even skin tone

How to Use Azelaic Acid Cream?


It comes in the form of cream and has a strength of 20%.

Recommended Dosage for Different Patients

Topical Treatment of Mild-to-moderate Inflammatory Acne Vulgaris

Usual Dose for Adults: Apply a thin layer of the cream with a formulation of 20% to the affected area(s) twice daily.

  • Wash the area(s) affected by acne gently and pat them dry before applying the medication.
  • In the morning and evening, apply the drug to the affected area(s) and massage it gently but thoroughly.
  • The length of treatment depends on the individual and the severity of the acne.
  • Patients with inflammatory lesions typically see improvement within four weeks.

Topical Treatment of the Inflammatory Papules and Pustules of Mild to Moderate Rosacea

Usual Dose for Adults: Apply a thin layer of the gel/foam with the formulations of 15% to the affected area(s) twice daily. 

  • Before applying the medication, gently wash and dry the affected area(s) using a very mild soap or a soapless cleansing lotion.
  • Gently but thoroughly massage the medication into the affected areas in the morning and evening.
  • You may apply cosmetics once the treatment has dried.
  • If there is no improvement after completing 12 weeks of treatment, you should be reassessed by your healthcare provider.
  • If you are using a foam formulation of the medication, use the smallest amount necessary to adequately cover the affected area(s) with a thin layer.

Topical Treatment of Mild-to-moderate Inflammatory Acne Vulgaris

Usual Pediatric Dose for People 12 Years & Older: Apply a thin layer of the cream with a formulation of 20% to the affected area(s) twice daily.

  • Before applying the medication, the area(s) should be cleaned gently and dried with a soft patting motion.
  • In the morning and evening, apply the drug with a gentle but thorough massage into the area(s) affected.
  • For patients with inflammatory lesions, improvement is typically seen within four weeks.

[Note: Remember these recommendations may vary depending on person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

How to Take It?

Follow all the instructions on your prescription label and any medication guides or instruction sheets. Use the cream exactly as prescribed. Here are steps on how to apply the cream:

  • Do not ingest the cream. It is meant for use on the skin only.
  • Wash your hands before and after using the cream.
  • Before each use, shake the foam well.
  • Clean the affected area with mild soap or a soap-free cleanser and gently pat dry with a soft towel. Then, apply the medication as instructed.
  • Avoid applying the cream to sunburned, windburned, dry, chapped, irritated, or broken skin.
  • Do not cover the treated area with a bandage unless advised by your doctor.
  • It may take up to 4 weeks for your symptoms to improve. If your symptoms do not get better after 12 weeks of treatment, contact your doctor.
  • Inform your doctor if you experience excessive burning, dryness, or skin irritation.
  • Store the cream at room temperature, away from moisture and heat. Dispose of the foam eight weeks after opening.
  • The azelaic acid topical foam is flammable. Avoid using it near high heat or open flames, and do not smoke until the gel has completely dried on your skin.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Azelaic Acid Cream Work?

Azelaic acid is a skincare ingredient with multiple benefits. It mainly helps to even out skin tone and reduce discoloration, such as dark spots in darker skin and red scars in lighter skin. It does this by blocking an enzyme called tyrosinase, which produces melanin, the pigment that gives color to our skin. By inhibiting this enzyme, azelaic acid can help lighten areas of hyperpigmentation caused by conditions like melasma or acne.

Additionally, azelaic acid has antibacterial and antioxidant properties, making it effective in clearing clogged pores, reducing inflammation, and treating acne. It’s gentler than other acne treatments like salicylic acid and adapalene, so it’s a good option for people with sensitive skin, acne, or rosacea. With its dual ability to address discoloration and acne-related issues, azelaic acid is a versatile and valuable skincare ingredient.

Important Safety Information

Side Effects

Common side effects of Azelaic acid cream include temporary sections of:

  • Stinging 
  • Burning
  • Itching
  • Tingling 

These sensations usually decrease as your body gets used to the medication. If minor irritation persists, your doctor may suggest using the product once a day.

Most people using this medication do not experience severe side effects. Serious side effects:

  • A rash
  • Itching
  • Swelling (especially in the face, tongue, or throat)
  • Severe dizziness
  • Difficulty breathing
  • Hypopigmentation 

In rare cases, some individuals might notice their skin color becoming lighter after using this medication. This is more noticeable in people with darker skin. Talk to your doctor if you observe any changes in your skin color. Although very rare, some people might have a serious allergic reaction to this drug.

[Note: Seek immediate medical attention if you experience these symptoms. Remember, this list does not cover all possible side effects. If you notice any other effects not mentioned here, contact your doctor or pharmacist.]


  • Do not share your medicine with others, and keep all medications out of children’s reach.
  • Inform your doctor if you are pregnant, breastfeeding, or have asthma.
  • For topical use: Only apply this medicine to skin conditions that your doctor has examined.
  • Contact your doctor if your symptoms don’t get better or if they worsen.


  • Regularly visit your doctor while using this medication to ensure it’s effective and not causing any adverse effects.
  • If you’re using this medicine for acne, expect to see improvement within four weeks. If your acne gets worse or doesn’t improve, inform your doctor.
  • For rosacea, improvement should be noticeable within 12 weeks. If there’s no improvement or your rosacea worsens, contact your doctor.
  • Be alert for allergic reactions such as itching, difficulty breathing, or large swellings on different parts of your body (face, throat, hands, feet, etc.). These can be serious and require immediate medical attention.
  • The medicine may cause skin reactions like rashes, burning, dryness, redness, peeling, stinging, swelling, or irritation. If you experience any of these symptoms, inform your doctor immediately.
  • If azelaic acid cream or gel gets in your eyes, nose, mouth, rectum, or vagina, rinse with water. Call your doctor if you have ongoing irritation after getting this medicine in your eyes.
  • Avoid using other medications on the areas treated with azelaic acid topical unless advised by your doctor.
  • Don’t use products on your skin that can cause irritation, such as skin products with alcohol, spices, harsh soaps, astringents, or lime, skin cleansers.
  • Your doctor may advise avoiding drinks or hot foods, spicy foods, alcoholic beverages, and other beverages or foods that may cause redness or flushing of the skin during treatment with azelaic acid topical.
  • Inform your doctor if you are pregnant or breastfeeding.
  • If you breastfeed, avoid applying this medicine to your nipple area.

Azelaic Acid Cream Contraindications

  • Azelaic Acid Cream is not suitable for everyone. You should not use this medication if you are hypersensitive to propylene glycol, azelaic acid or any of its ingredients. 

Missed Dose

  • If you forget to take your medicine, use it as soon as you remember. 
  • If it’s nearly time for your next dose, skip the one you missed. Continue with your usual schedule.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]


If you suspect an overdose, immediately contact your local poison control center or seek medical attention. Be prepared to provide details about what was consumed, the quantity, and the time of the incident. 

[Note: If you consumed more than recommended dose, get medical help right away, or call the Poison Help line at 1-800-222-1222.]


  • Keep the medication out of children’s reach to ensure their safety.
  • Do not hold on to medicine that is outdated or no longer needed for your treatment.
  • Consult your healthcare professional for guidance on how to properly dispose of any unused medication.
  • Store the medication in a sealed container at room temperature, ensuring it is away from heat, moisture, and direct sunlight. Avoid freezing the medication.
  • For foam can medications, do not store them at temperatures above 49 degrees Celsius (120 degrees Fahrenheit). 
  • Do not puncture the can or throw it into a fire, even when empty. Dispose of any unused foam medication eight weeks after the first use.

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Azelaic Acid Cream Interactions

  • Transparency with Doctor: Before using Azelaic acid cream, it’s important to discuss it with your healthcare provider and pharmacist. Inform them about all the medications you’re currently taking, including prescription, over-the-counter drugs and any vitamins, herbs, or supplements. This will help prevent any unwanted interactions.
  • Use Carefully: If the cream accidentally gets into your eyes, nose, mouth, rectum, or vagina, rinse the area thoroughly with water. Contact your doctor if irritation persists in your eyes after rinsing.
  • Avoiding Medications: It’s best to avoid applying other medications to the areas you’re treating with azelaic acid unless your doctor advises otherwise. If you have concerns about how different drugs might interact with each other, don’t hesitate to ask your healthcare provider or pharmacist for advice.
  • Skin Irritating Products: Steer clear of skin products that could irritate your skin. This includes products with harsh chemicals, alcohol, spices, astringents, or lime.
  • Foods and Drinks: During your treatment with azelaic acid, your doctor might suggest avoiding certain foods and drinks that can trigger flushing or redness of the skin, such as spicy foods, hot foods or drinks, and alcoholic beverages.
  • Products to Avoid: Avoid the below-mentioned products when using Azelaic Acid Cream:
    • Cleansers containing alcohol
    • Tinctures
    • Astringents
    • Abrasives
    • Peeling agents

[Note: This isn’t a complete list, and there could be other drugs that interact with Azelaic Acid Cream. Make sure to tell your doctor any prescription, over-the-counter medicines, and herbal products you’re taking.]

Azelaic Acid Cream Alternatives

  • Solodyn (minocycline)
  • MetroLotion (metronidazole)
  • SSS 10-5 (sulfacetamide sodium/ sulfur)
  • Finacea (azelaic acid)
  • Monodox (doxycycline)
  • Oracea (doxycycline)
  • MetroGel (metronidazole)
  • Rosadan (metronidazole)
  • Bencort (benzoyl peroxide/hydrocortisone)
  • Soolantra (ivermectin)
  • Mirvaso (brimonidine)
  • Rhofade (oxymetazoline)
  • Doryx (doxycycline)
  • Clearasil (benzoyl peroxide)
  • Avar-E (sulfacetamide sodium/ sulfur)
  • MetroCream (metronidazole)
  • Azelex (azelaic acid)
  • Vibramycin (doxycycline)

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

How long does azelaic acid cream take to work?

Azelaic acid cream typically takes time to show results. You may notice some improvement within a month of regular use, but it can take longer to experience the full benefits. It’s important to continue using the cream as prescribed by your doctor. If there’s no improvement after a month, or if your condition worsens, make sure to consult your doctor. 

Is it okay to use azelaic acid everyday?

Yes, it’s generally okay to use azelaic acid every day. Applying it twice a day can be safe and effective. For consistent results, regular daily use is recommended. However, if you have sensitive skin or conditions like rosacea or perioral dermatitis, it’s advisable to start with every other day application to see how your skin reacts. 

What should you not mix with Azelaic acid cream?

When using azelaic acid cream in your skincare routine, it’s important to avoid certain ingredients that might not work well with it or could irritate your skin. These include:

  • Benzoyl peroxide
  • Beta hydroxy acids (BHAs) like salicylic acid
  • Alpha hydroxy acids (AHAs) like glycolic acid
  • Retinol
  • Physical exfoliators
  • Rotating brushes
  • Vitamin C
  • Face scrubs

Combining azelaic acid with these ingredients may reduce its effectiveness or increase the risk of skin irritation. It’s always best to consult with a dermatologist or skincare professional to ensure your skincare routine is suitable for your skin type and concerns.

Who should stay away from azelaic acid?

Azelaic acid is a skincare product used for various skin conditions, but it’s not suitable for everyone. Individuals with darker skin tones should use it cautiously, as it can cause changes in skin color. If you notice any lightening of your skin, it’s important to inform your doctor immediately. Additionally, people with asthma need to be cautious, as azelaic acid could potentially worsen their condition. If you have asthma and experience any adverse effects after using azelaic acid, it’s crucial to discuss this with your healthcare provider.

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