Azelaic Acid

Topical Antibacterial

Azelaic acid is available as a prescription and non-prescription topical treatment. It is available in cream, foam, and gel forms, but physicians normally prescribe the cream to people with acne. 

  • Available forms:

    • Topical treatment: 

      • Cream:
        • Brand names (US):
          • Azelex® (other brand names may exist)
            No generic available (US)
      • Foam: 
        • Brand name (US):
          • Finacea® (other brand names may exist)
            No generic available (US)
      • Gel: 
        • Brand name (US):
          • Finacea® (other brand names may exist)
            No generic available (US)
  • Available in these doses:

    • Cream: 20%
    • Foam: 15%
    • Gel: 15%
  • Who is it for? 

    • Gender:
      • Males and females
    • Severity of acne:
      • Mild-to-moderate acne
    • Age:
      • Children of 12 years and older, adolescents, and adults 
    • Other:
      • It is particularly recommended to treat red / dark marks left behind after acne lesions heal (post-inflammatory hyperpigmentation)

How to use it:

Azelaic acid is a topical treatment and is available as a cream, foam, and gel. 

Your physician will specify how much of the medication you need to apply and how often.

Azelaic acid is usually applied twice a day, once in the morning and once in the evening. Use it at the same time every day to avoid missing doses.

Improvement of acne is usually seen after 4 weeks of treatment. If your symptoms do not improve or get worse, contact your physician. 

The dosing for children of 12 years and older and adolescents is the same as the dosing for adults.

Azelaic acid should only be applied to intact skin. If azelaic acid gets into a cut or scrape, rinse it off with water. Do not get azelaic acid in your eyes, nose, or mouth. If it does get into your eyes, wash your eyes with a generous amount of water and seek medical attention if there is any irritation. 

Azelaic acid foam is flammable. Stay well away from fire and flames, and avoid smoking while applying azelaic acid foam, or for a short time afterward. 

Follow the instructions on your prescription carefully and use azelaic acid exactly as prescribed by your physician. Do not change the dose or the frequency of your medication. If you have any questions about the medication or the prescription, ask your physician or pharmacist. 

Cream, foam, or gel application: 

Before applying azelaic acid, wash the acne-affected skin with water and a mild cleanser. Pat the skin dry with a soft towel. You can ask your physician to recommend a gentle cleanser. Avoid alcohol-containing cleansers, tinctures, abrasives, astringents, and peeling agents (especially when you have rosacea). 

  • Cream and gel:
    • Apply a thin layer on acne-affected areas and allow it to absorb it into the skin. 
  • Foam:
    • Shake the foam well before use.
    • Apply a thin layer on acne-affected areas and allow it to absorb into the skin. Do not use bandages, dressings, or wrappings to cover the affected area.

After applying adapalene, wait until your face is dry before applying makeup. Once you have finished applying the medication, wash your hands with soap and water. 

Be aware of: 

  • Before using azelaic acid, let your physician or pharmacist know if you are allergic to azelaic acid or to any of the other ingredients in the cream, foam, or gel (such as propylene glycol). 
  • Before using azelaic acid, inform you physician about the prescription and non-prescription medications, vitamins, nutritional supplements, and herbal products you are using/taking. 
  • Before using azelaic acid, inform your physician if you ever have ever suffered from asthma, or recurrent cold sores. Aggravation of existing asthma has been reported in patients using azelaic acid.
  • If you are using azelaic acid and are pregnant or are planning to become pregnant, talk to your physician about using azelaic acid during pregnancy.
  • If you are using azelaic acid and are breastfeeding, talk to your physician about using azelaic acid during this period.
  • Azelaic acid may cause the skin to lighten (hypopigmentation) in the areas where it is applied, especially if you have a darker skin tone. Inform your physician if you see any changes in your skin color. 
  •  If azelaic acid was prescribed for acne, you can continue your regular diet unless your physician advises otherwise.
  • Do not use azelaic acid for a skin condition that it was not prescribed for, without consulting your physician first. 
  • Do not share your medication with anyone else. 
  • Keep your regular appointments with your physician to track your response to azelaic acid.

Drug interactions: 

Do not use alcohol-containing or abrasive skin care products, or peel off products (including facial masks) while using azelaic acid. Inform your physician or pharmacist about all the prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take before starting azelaic acid. Also inform your physician or pharmacist of the skin products you use including soaps, cleansers, moisturizers, and cosmetics. 

Do not swallow

If azelaic acid is swallowed, contact an emergency facility or call the American Association of Poison Control Centers at 1 (800) 222-1222 (available 24/7).

If immediate assistance is necessary because the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, call 911.

Information can also be found online at https://www.poisonhelp.org/help

What if I miss a dose?

As soon as you recall that you have missed a dose, apply the missed dose. However, skip the missed dose if it is almost time for your next dose and continue with your prescribed dosing schedule. Do not increase the quantity or frequency of application to make up for the missed dose. 

Storage:

Store your medication in the container that the pharmacist provided and keep it out of reach and out of sight of children. Many containers can be opened by children. Keep the container tightly closed. Always lock safety caps and immediately place the medication in a safe location that is up and away from the sight of young children, to prevent poisoning (www.upandaway.org).

Store the medication at room temperature. Keep the medication away from excessive heat and moisture – do not store in the bathroom. Do not freeze azelaic acid.

Foam: The can of azelaic foam should not be stored at temperatures above 49 degrees Celcius (120 degrees Fahrenheit). Do not poke holes in the can. Azelaic acid foam is flammable so keep it well away from flames and extreme heat. Do not throw the can into a fire, even when the can is empty. Throw away the unused medication 8 weeks after opening the can for first use (see below for safe disposal).

Gel: Throw away the unused medication 8 weeks after opening the tube for first use (see below for safe disposal).

Disposal:

Do not keep outdated medication and medication that you no longer use. Unneeded medications should be disposed of in a way that pets, children, and other people cannot consume them. Do not flush the medication down the toilet. Contact your pharmacist to learn about the availability of a medicine take-back program in your neighborhood, or get in touch with your local garbage/recycling department to ensure safe disposal. If you do not have access to a take-back program, you can find more information on safe disposal of medication on the FDA website: (https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm)

References
  1. Medlineplus.gov. (2018). Azelaic Acid: MedlinePlus Drug Information. [online] Available at: https://medlineplus.gov/druginfo/meds/a603020.html [Accessed 4 Apr. 2018].
  2. Ncbi.nlm.nih.gov. (2018). Azelaic Acid. [online] Available at: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0009168/?report=details. [Accessed 4 Apr. 2018].
  3. Toxnet.nlm.nih.gov. (2018). Azelaic Acid. [online] Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~Upp86y:4. [Accessed 4 Apr. 2018].
  4. Uptodate.com. (2018). Azelaic Acid. [online] Available at: https://www-uptodate-com.eresources.mssm.edu/contents/azelaic-acid-drug-information?search=azelaic%20acid&source=search_result&selectedTitle=1~14&usage_type=default&display_rank=1. [Accessed 4 Apr. 2018].
  5. Epocrates.com. (2018). Azelaic Acid. [online] Available at: https://online.epocrates.com/drugs/42910/Azelex/Monograph. [Accessed 4 Apr. 2018].