Azelaic acid

Azelaic Acid at Prescription Skin

Azelaic acid is a dermatology staple that has been used for years to treat acne, rosacea and hyperpigmentation.[1][2][3][5] It is a true multitasker that can help clear inflamed spots, calm redness and sensitivity and soften the flat brown marks that linger after breakouts. Although it is called an acid, it is not a harsh peel. In skincare, acid refers to chemistry and pH, not automatically to strength.

At the right dose, azelaic acid sits in a useful middle ground. It is active enough to treat real problems, yet gentle enough that it can often be used on acne-prone, rosacea-prone and pigment-prone skin with careful planning.[1][2][7] At Prescription Skin, we usually prescribe azelaic acid as part of a personalised formula rather than as a stand alone product, so that it fits with your other actives, your climate and your day-to-day routine.

Key takeaways

• Azelaic acid has antimicrobial, anti-inflammatory, mild keratolytic and pigment-regulating effects, so it can help with acne, rosacea and post-inflammatory hyperpigmentation.[1][2][3][5]
• Guidelines list azelaic acid as an option for mild to moderate acne and as a first-line topical for papulopustular rosacea in many patients.[2][6]
• It does not reduce oil production on its own, so we often combine it with other prescription actives like retinoids or benzoyl peroxide for breakouts, or with brightening agents such as hydroquinone or ascorbic acid for pigment support when appropriate.[1][2][5]
• Mild tingling, dryness or light flaking in the first one to two weeks are common. Escalating redness, burning or rash are not, and mean the routine needs to be adjusted or paused.[7]
• For most concerns, changes are gradual over weeks. Acne and congestion often look calmer after four to eight weeks, rosacea-type redness and bumps can take six to eight plus weeks, and pigment such as melasma may need three to four months with strict sunscreen.[1][3][4][5]

How azelaic acid works

Antimicrobial support

In acne prone skin, pores can become blocked and overpopulated with certain bacteria. Azelaic acid helps reduce the overgrowth of acne related bacteria in these blocked follicles.[1][2] With fewer bacteria and a calmer environment inside the pore, breakouts are less likely to become large, inflamed spots.

Anti inflammatory action

Azelaic acid calms several inflammatory pathways in the skin. Over time this can make acne lesions look less red and swollen and can reduce the background inflammation seen in papulopustular rosacea.[1][3][4] Many people describe their skin as feeling less hot, less prickly and less reactive after a few weeks of consistent use.

Keratolytic and pore normalising effect

Azelaic acid has a mild keratolytic effect, which means it helps the dead cells inside the follicle shed in a more organised way.[1][2] Pores are less sticky and less prone to clogging, so comedones and small bumps can gradually soften. This keratolytic action is gentler than many alpha hydroxy acids (AHAs) or beta hydroxy acids (BHAs), which is one reason azelaic acid is often chosen for sensitive or rosacea prone skin.

Pigment regulation

Azelaic acid inhibits tyrosinase, one of the key enzymes that melanocytes use to produce melanin pigment.[1][5] By slowing new pigment production in treated areas, it can help improve post inflammatory hyperpigmentation and can support the management of melasma as part of a broader routine that always includes high quality sunscreen. It is often combined with other pigment targeting ingredients and routines discussed in our guides to hyperpigmentation and melasma.

What azelaic acid does not do

Azelaic acid does not directly reduce oil production. In prescription routines for acne or oily skin, we usually combine it with ingredients that help normalise oil or speed up cell turnover, such as retinoids, or with agents like benzoyl peroxide, to get faster and more stable results.[2][6]

What can azelaic acid help with?

In clinical studies and guidelines, azelaic acid has been used for a range of concerns that often overlap in real life.[1][2][3][5]

• Comedones, inflamed breakouts and the flat post acne marks that linger after spots clear.
• Background redness, sensitivity and small inflammatory bumps in rosacea type skin.[3][4][6]
• Uneven tone and post inflammatory hyperpigmentation, including in darker skin tones.[1][5]
• Support for melasma treatment as part of a routine that also includes high SPF, sun avoidance and, in some cases, other pigment targeted prescriptions.[5]
• Texture that feels rough or bumpy because of recurrent clogging.
• Providing a gentler corrective option for people who have not tolerated stronger peels or high strength retinoids.

Two common scenarios are acne plus pigment and rosacea plus sensitivity. If you are mainly concerned about breakouts and oil, you can read more in our acne guide. If redness is your main problem, our rosacea overview explains how prescription and non prescription strategies fit together.

How azelaic acid is used in Prescription Skin

At Prescription Skin, azelaic acid is prescribed as part of a personalised formula rather than as an off the shelf cream. We choose the concentration, base and partner actives based on your skin type, severity and goals, as well as whether you are treating acne, rosacea, pigment or a combination.[2][6][7]

Many patients do well in the 10 to 20 percent range for leave on creams or gels. For acne and congestion, azelaic acid is often paired with prescription retinoids or benzoyl peroxide on alternate nights so that inflammation, blocked pores and bacteria are all addressed.[2] For redness and rosacea type sensitivity, we usually place azelaic acid into soothing, non occlusive bases together with niacinamide, humectants and barrier support.[3][6]

For pigment support, azelaic acid is combined with strict daily sunscreen and, when suitable, other doctor selected brightening agents. These might include ascorbic acid for antioxidant support or hydroquinone in time limited courses for stubborn melasma, as discussed in our article on hydroquinone 2 vs 4 in Australia.[1][5]

If you are pregnant or planning pregnancy, topical azelaic acid is often considered as one of the options your doctor may choose, because long term experience suggests a favourable safety profile when used as directed.[7] For a broader discussion of routines in this setting, see our guide to prescription skincare during pregnancy.

How to apply azelaic acid

Application technique affects both results and comfort. The aim is to give azelaic acid a consistent chance to work while keeping the barrier happy.[7]

1. 1. Apply to clean, completely dry skinApplying on damp skin can increase penetration and irritation.
   2. Start slowStart every second night for one to two weeks, then increase to nightly if your skin is comfortable and your prescriber has recommended this.
   3. Use the right amountUse a pea sized amount for the full face or follow the specific quantity your doctor has set. Over applying rarely speeds things up but often increases irritation.
   4. Follow with a moisturiserIf you are reactive, the moisturiser sandwich method (moisturiser, then azelaic acid, then another thin layer of moisturiser) can soften the impact.
   5. Avoid layering immediatelyAvoid applying straight after shaving, waxing, peels or in clinic procedures unless your clinician has said it is safe.

You will get the best results if azelaic acid is one part of a simple, repeatable routine, rather than layered on top of multiple scrubs, strong acids and high strength retinoids on the same night. Our article on the first eight weeks on prescription skincare includes more tips for easing in new actives.

What to use with azelaic acid

Azelaic acid usually plays well with other actives if you space and sequence products carefully.[2][6][7]

• With retinoids: Many routines use azelaic acid on some nights and a retinoid on others to balance efficacy and tolerance. You can read more about choosing between cosmetic retinol and prescription tretinoin in our retinol vs prescription retinoid guide.
• With vitamin C: Vitamin C in the morning and azelaic acid at night can work well for tone support. Our ascorbic acid overview explains how these antioxidants fit in.
• With AHAs or BHAs: Strong acids can be helpful in some acne and pigment routines, but they increase the risk of stinging. Space applications and avoid stacking multiple exfoliants on the same night unless your doctor has advised it.
• With benzoyl peroxide: Azelaic acid and benzoyl peroxide can sit in the same overall plan, often on different nights to balance dryness while still targeting bacteria and clogged pores.[2]
• With sunscreen: Daily broad spectrum SPF is essential whenever you treat pigment or use active ingredients. Sunscreen helps prevent new discoloration and supports results from azelaic acid and other brightening agents.[5][7]

If you are also shaving regularly, as many of our men’s skincare patients do, it is often best to apply azelaic acid at night on non shaving evenings, at least while you are getting used to it.

Side effects and what is normal

Most people tolerate azelaic acid better than stronger peels or high strength retinoids, especially when they ease into it. Expected effects in the first one to two weeks can include mild tingling or warmth right after application, slight dryness and light flaking around areas such as the nose, mouth and chin.[1][4][7]

Less commonly, patchy redness, escalating stinging or irritant dermatitis can occur. This is more likely if your barrier is already compromised, if you apply on damp skin, or if you stack scrubs, AHAs or BHAs and a retinoid on the same night. You can reduce this risk by applying to dry skin, starting every second night and following with moisturiser.[7]

If irritation does not settle after reducing frequency, or if you develop persistent burning, itching or rash, pause the product and speak with your prescriber. A different base, different strength or a slower schedule can often make a big difference, but sometimes a different active is a better choice.

When will I see results?

Azelaic acid works on processes that change over weeks rather than overnight. Improvements are usually gradual and depend on what you are treating and what else is in your routine.[1][3][4][5]

• Acne and congestion: Many people notice calmer, less inflamed breakouts and fewer clogged pores from around four to eight weeks, especially when azelaic acid is part of a broader acne plan.
• Rosacea type redness and bumps: Some patients see a more even tone within three to four weeks, though background redness and small inflammatory bumps often take six to eight or more weeks to settle.[3][4][6]
• PIH, melasma and uneven tone: Eight to twelve weeks is a realistic starting point and three to four months is common for stubborn melasma. Daily sunscreen is non negotiable, otherwise pigment tends to return.[1][5]

Azelaic acid is usually suitable for long term maintenance when it is tolerated well, so once you improve, you can often keep it in the routine and adjust stronger or more irritating actives around it.[1][2]

When to avoid or use caution

Like any active, azelaic acid is not right for every situation or every night.[7]

• Take extra care if your skin is acutely inflamed or broken, for example weeping eczema, sunburn or post procedure skin that has not healed.
• Avoid using azelaic acid if you have just had an in clinic treatment and were advised to avoid actives, or if you are already reacting to several new products at once.
• Very dry, over exfoliated or sunburnt skin will react more strongly to any active, including azelaic acid. In these phases, focus on barrier repair and sunscreen first.
• Apply to dry skin only and do not layer it on the same night as strong peels or scrubs unless specifically directed.
• Always use broad spectrum SPF if you are treating pigment with azelaic acid or any other brightening ingredient.

If you get persistent redness, burning or itching despite spacing applications and using moisturiser, stop and get advice. Your clinician may adjust the strength, base or frequency, or suggest a different approach for your skin.

How to get started with azelaic acid at Prescription Skin

To start, you sign up with Prescription Skin, complete a detailed online skin questionnaire and upload clear photos. During your telehealth consult, an Australian registered doctor reviews your skin history, triggers and goals, including whether you are also managing concerns such as acne, rosacea, hyperpigmentation or fine lines.

If azelaic acid is appropriate, your doctor will prescribe a personalised formula, which is compounded, packed and shipped directly to you. Many patients choose our ongoing custom prescription skincare subscription, which allows formula reviews at regular intervals. For practical questions about pricing, refills and follow ups, see our Frequently Asked Questions.

Azelaic acid FAQs

How long until I see results with azelaic acid?

For acne, look for calmer, less inflamed breakouts from around four to eight weeks. For redness, early tone changes can appear after three to four weeks, with background redness and bumps often needing six to eight plus weeks. For PIH and melasma support, allow eight to twelve weeks at least and keep using daily SPF for sustained results.[1][3][4][5]

Can I use azelaic acid with a retinoid?

Yes. Many routines use azelaic acid on some nights and a retinoid on others to balance efficacy and tolerance. Your doctor will set the schedule based on your skin type and goals.[2][6]

Will azelaic acid dry out my skin?

Mild dryness or light flaking can occur in the first one to two weeks, particularly around the nose, mouth and chin. Apply to dry skin, start every second night and follow with moisturiser. Most people tolerate azelaic acid well long term compared with stronger acids or high strength retinoids.[1][7]

Is azelaic acid suitable for rosacea type skin?

Yes. Topical azelaic acid is commonly used to calm redness and small inflammatory bumps in papulopustular rosacea, and is listed as a first line option in many treatment guidelines.[3][4][6] At Prescription Skin we pair it with soothing bases and barrier support for comfort.

Do I need sunscreen if I am using azelaic acid?

Yes. Sunscreen is essential when you are treating pigment and helps prevent new discoloration. Apply a broad spectrum SPF every morning and reapply if you are outdoors. This also supports overall skin health and protects the results you gain from azelaic acid and other actives.[5][7]