What Is It?
Azelaic acid is a naturally occurring acid found in grains like barley, wheat, and rye. It helps clear acne by slowing the growth of acne bacteria and reducing inflammation in the skin.
Strength of Evidence
Average 68% reduction in acne after 18 weeks
- Tomić, I., Miočić, S., Pepić, I., Šimić, D. & Filipović-Grčić, J. Efficacy and safety of azelaic acid nanocrystal-loaded in situ hydrogel in the treatment of acne vulgaris. Pharmaceutics 13, 567 (2021).
- Hashim, P. W., Chen, T., Harper, J. C. & Kircik, L. H. Efficacy and safety of azelaic acid 15% foam in the treatment of facial acne vulgaris. J Drugs Dermatol 17, 641–645 (2018).
- Schaller, M., Sebastian, M., Ress, C., Seidel, D. & Hennig, M. A multicentre, randomized, single-blind, parallel-group study comparing the efficacy and tolerability of benzoyl peroxide 3%/clindamycin 1% with azelaic acid 20% in the topical treatment of mild-to-moderate acne vulgaris. J Eur Acad Dermatol Venereol 30, 966–973 (2016).
- Thielitz, A. et al. A randomized investigator-blind parallel-group study to assess efficacy and safety of azelaic acid 15% gel vs. adapalene 0.1% gel in the treatment and maintenance treatment of female adult acne. J Eur Acad Dermatol Venereol 29, 789–796 (2015).
- Hayashi, N., Koyanagi, E., Nogita, T., Fujiyama, M. & Kawashima, M. A randomized placebo-controlled investigator-blinded face split study of 20% azelaic acid cream to evaluate the efficacy and safety in Japanese patients with acne vulgaris. The Journal of Dermatology 39, 53–280 (2012).
- Pazoki-Toroudi, H. et al. Combination of azelaic acid 5% and erythromycin 2% in the treatment of acne vulgaris. J Dermatolog Treat 21, 212–216 (2010).
- Gollnick, H. P. M., Graupe, K. & Zaumseil, R.-P. Azelaic acid 15% gel in the treatment of acne vulgaris. Combined results of two double-blind clinical comparative studies. J Dtsch Dermatol Ges 2, 841–847 (2004).
- Graupe, K. & Zaumseil, R. P. Skinoren-ein neues Lokaltherapeutikum zur Behandlung der Acne vulgaris. in Jahrbuch der Dermatologie (Wissenschaftliche VerIagsgesellschaftBiermann, 1991).
- Katsambas, A., Graupe, K. & Stratigos, J. Clinical studies of 20% azelaic acid cream in the treatment of acne vulgaris. Comparison with vehicle and topical tretinoin. Acta Derm Venereol Suppl (Stockh) 143, 35–39 (1989).
- Hjorth, N. & Graupe, K. Azelaic acid for the treatment of acne. A clinical comparison with oral tetracycline. Acta Derm Venereol Suppl (Stockh) 143, 45–48 (1989).
- Cunliffe, W. J. & Holland, K. T. Clinical and laboratory studies on treatment with 20% azelaic acid cream for acne. Acta Derm Venereol Suppl (Stockh) 143, 31–34 (1989).
- Cavicchini, S. & Caputo, R. Long-term treatment of acne with 20% azelaic acid cream. Acta Derm Venereol Suppl (Stockh) 143, 40–44 (1989).
- Bladon, P. T. et al. Topical azelaic acid and the treatment of acne: a clinical and laboratory comparison with oral tetracycline. Br J Dermatol 114, 493–499 (1986).
Low-medium side effects and adverse reactions
Acne.org's Real World Take
At prescription strengths (15 - 20%) studies show it should help reduce mild-to-moderate acne by a significant and noticeable amount after 3 months or so of treatment, so that’s not too shabby. However, it is unlikely to completely clear the skin on its own.