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What is azelaic acid?
Azelaic acid (AzA) is a dicarboxylic acid produced naturally by certain types of yeast on your skin. We are also exposed to AzA through dietary intake of grains and cereals. Data shows this compound is not acutely or chronically toxic and so the skin benefits of AzA are safely taken advantage of today in dermatology.[1]
Azelaic acid benefits
The use of AzA in skincare has several benefits:
– Helps treat acne
– Helps treat rosacea
– Targets hyperpigmentation
– It is a gentle exfoliator
– Can be used whilst pregnant and/or breastfeeding
(Read below how azelaic acid helps with each of these)
Azelaic acid for acne
Acne – a chronic inflammatory skin disorder – is known to be caused by a combination of factors, including abnormal desquamation of the follicular epithelium, excessive sebum production, inflammation and the presence of the bacterium Propionibacterium acnes (P. acnes). P. acnes uses sebum as a nutrient, fuelling P. acnes growth, inducing an inflammatory response (triggering the release of inflammatory cytokines) resulting in inflammation in the sebaceous follicle.[2]
Azelaic acid works to treat acne by decreasing the population of P. acnes on the skin surface and sebaceous follicle.[3,4] AzA acts as an antibacterial to P. acnes by inhibiting the thioredoxin reductase enzyme, affecting the inhibition of bacterial DNA synthesis. Azelaic acid 20% cream or 15% gel is typically recommended as first-line treatment for both non-inflammatory and inflammatory acne patients.[5]
Azelaic acid for rosacea
Rosacea is a common skin condition that often involves persistent redness of the skin and visible blood vessels of the face. Rosacea sufferers typically have excessive serine protease kallikrein-5 (KLK5) and abnormal antimicrobial peptide cathelicidin (CAMP). These have been shown to influence inflammation, angiogenesis and vascular ectasia. AzA has been shown to significantly decrease KLK5 as well as total protease activity. Mice treated daily with topical 15% azelaic acid gel for nine days had significantly less KLK5 and CAMP. AzA is presumably effective in the treatment of rosacea due to modification of KLK5 and CAMP.[5]
Papulopustular rosacea (PPR) shares features of both rosacea and acne; often referred to as inflammatory rosacea since pus-filled blemishes are also usually present. AzA targets PPR, likely as a result of anti-inflammatory and antioxidant properties of AzA.[1] Studies show 15% AzA gel’s anti-inflammatory effects on PPR via the downregulation of cathelicidin (LL-37) activation via inhibition of serine protease KLK5.[6]
Azelaic acid for hyperpigmentation
Hyperpigmentation – a darkening of the skin that occurs due to an excess of melanin, for example, in the case of age spots, freckles, melasma, and post-inflammatory hyperpigmentation. The most common way to treat hyperpigmentation is tyrosinase inhibition, the most critical and rate-limiting enzyme in the production of melanin.
Common ways to treat hyperpigmentation such as hydroquinone has various safety concerns. Treatment of hyperpigmentation with AzA represents a more mild way of treating this skin condition. AzA works to treat hyperpigmentation through its potential tyrosinase inhibition activity.[7]
A study containing 155 melasma patients were treated with either 20% azelaic acid or 2% hydroquinone cream twice daily for 24 weeks; 73% of the azelaic acid patients compared with 19% of the hydroquinone patients had good to excellent results.[8]
Top tips
– Make sure to use sunscreen whilst using azelaic acid (since it is an acid, it makes us more sensitive to the sun).
– Azelaic acid works pretty well with most ingredients (but try to stick to one active at a time at first) but care must be taken if using other acids in your skincare routine, so to avoid irritation.
Top picks
The Ordinary Azelaic Acid Suspension 10%
A wallet-friendly option: The Ordinary’s Azelaic acid suspension (10%). This suspension work to target uneven and blemish-prone skin.
eva naturals azelaic acid 10% serum
This 10% azelaic acid serum also contains vitamins A and C, hyaluronic acid, and niacinamide to help tone, tighten, and rejuvenate skin while reducing discolouration.
Paula’s Choice 10% Azelaic Acid Booster
Paula’s choice combines azelaic acid with salicylic acid to unclog pores, and liquorice to boost its skin-brightening powers.
References
[1] Del Rosso J. Q. (2017). Azelaic Acid Topical Formulations: Differentiation of 15% Gel and 15% Foam. The Journal of clinical and aesthetic dermatology, 10(3), 37–40.
[2] Apriani, E. F., Rosana, Y., & Iskandarsyah, I. (2019). Formulation, characterization, and in vitro testing of azelaic acid ethosome-based cream against Propionibacterium acnes for the treatment of acne. Journal of advanced pharmaceutical technology & research, 10(2), 75–80.
[3] Nguyen, Q. H., & Bui, T. P. (1995). Azelaic acid: pharmacokinetic and pharmacodynamic properties and its therapeutic role in hyperpigmentary disorders and acne. International journal of dermatology, 34(2), 75-84.
[4] Bojar, R. A., Cunliffe, W. J., & Holland, K. T. (1994). Disruption of the transmembrane pH gradient—A possible mechanism for the antibacterial action of azelaic acid in Propionibucterium acnes and Staphylococcus epidermidis. Journal of Antimicrobial Chemotherapy, 34(3), 321-330.
[5] Searle, T., Ali, F. R., & Al-Niaimi, F. (2022). The versatility of azelaic acid in dermatology. Journal of Dermatological Treatment, 33(2), 722-732.
[6] Yamasaki K, Gallo RL. Azelaic acid (AzA) gel 15% decreases kallikrein 5 in epidermal keratinocytes: critical elements in production of cathelicidin and the pathogenesis of rosacea. Poster presented at 68th Annual Meeting of the American Academy of Dermatology; March 5–9, 2010; Miami Beach, FL.
[7] Nautiyal, A., & Wairkar, S. (2023). A reduced dose of Azelaic acid-loaded solid lipid nanoparticles for treatment of hyperpigmentation: In vitro characterization and cell line studies. Journal of Drug Delivery Science and Technology, 104158.
[8] Verallo-Rowell, V. M., Verallo, V., Graupe, K., Lopez-Villafuerte, L., & Garcia-Lopez, M. (1989). Double-blind comparison of azelaic acid and hydroquinone in the treatment of melasma. Acta Dermato-Venereologica, 69, 58-61.
