I know this post is from years ago, but I figured I'd answer it for those who might still stumble upon this topic. I experienced an initial breakout with Azelex about 2 weeks into using it and it took about 2 weeks to clear up. But this is expected. Azelex causes an intial "purge" effect or "intitial breakout" because it brings your present unseen acne (acne developing inder your skin that hadn't surfaced yet) to the surface once you start it. But this will clear up within a few weeks if you continue to use it as directed and not miss doses. On the other hand, if you continue to get worse on it or don't see the intial breakout clearing up within 4 weeks, then you should go back to a derm because you might be allergic to it or it just might not be the right fit for your skin. In my personal experience of being on my 18th month using azelex along with adapalene, I have had tremendous results in clearing my acne (I had mild acne here and there to begin with, nothing too bad). I was mainly prescribed azelez because it fades hyperpigmentation and redness/red spots, especially in people of colored complexions (I have medium-light skin tone and of mexican and white ethnicity). It's a better choice than fade creams and bleach creams that can cause more damage and bleached looking spots on people of color. I highly recommend azelex, if you can tough it out during the intial breakout you're likely to see great results. It even improves skin texture due to it's moisturizing ingredients.