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Recently I was prescribed by my PCP a combination of clindamycin (antibiotic) and tretinoin (comedolytic/keratolytic) treatment. After using them for several weeks, I developed an itchy rash on my forehead which was caused by the tretinoin. So i stopped using the tretinoin but continued with the clindamycin. Clindamycin works for the pimples but it does not treat blackheads and whiteheads. So i asked my doctor to replace the tretinoin with azelaic acid. Unfortunately, there is no generic for it and my insurance (Blue Cross) classified azelaic acid as non-formulary (non-preferred). With the tretinoin, I only spent $10 for it per month, but with azelaic acid it will cost me $40 and it's actually cheaper to buy it online ($33.60 at http://www.rxsellermeds.com/ with free shipping). It's too bad because azelaic acid is known to also treat post inflammatory hyperpigmentation caused by acne.

Azelaic acid

Azelaic acid is a natural material produced by a yeast that lives on normal skin, Malassezia furfur (also known as Pityrosporum ovale).

In New Zealand, azelaic acid is available at a concentration of 20% as Skinorenâ„¢ Cream and Acne-Dermâ„¢ Medicated Lotion.

Azelaic acid is used as a topical treatment for mild to moderate acne, and may be combined with oral antibiotics or hormonal therapy. It is useful for both comedonal acne and inflammatory acne.

Azelaic acid is:

Antibacterial - it reduces the growth of bacteria in the follicle (Proprionibacterium acnes and Staphylococcus epidermidis)

Keratolytic & comedolytic - it returns to normal the disordered growth of the skin cells lining the follicle

A scavenger of free radicals - i.e. it reduces inflammation.

Azelaic acid also helps reduce pigmentation, so it's particularly useful for darker skinned patients whose acne spots leave persistent brown marks or who have melasma.

The cream should be applied to the area affected by acne initially daily, then if tolerated building up to a generous twice-daily application after thoroughly cleansing the skin.

Acne responds slowly to treatment. Some improvement should be seen after one month of using azelaic acid cream. Further improvement should occur with maximum results after six months' continuous use. Treatment may be continued safely for months or years if the acne remains active.

Azelaic acid is nontoxic and is well tolerated by most subjects. However, those with very sensitive skin or who suffer from eczema, may find it irritating to apply, resulting in a mild irritant dermatitis.

Discontinue applying the cream and seek medical advice if you develop severe:

Redness

Scaling

Itching

Burning

Azelaic acid does not result in:

Bacterial resistance to antibiotics

Reduction in sebum production

Photosensitivity (easy sunburn)

Staining of skin or clothing

Bleaching of normal skin or clothing

Azelaic acid cream may also be useful in the treatment of:

Postinflammatory pigmentation

Melasma

Rosacea

Lentigo maligna, a type of early melanoma. Azelaic acid is not recommended for most cases of this pre-cancerous lesion; where possible, surgery should be performed.

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