Rosacea that won’t budge?

Breakouts that feel impossible to control?

Hyperpigmentation you just can’t seem to fade?

What if one ingredient could target all three — and more?

For decades, azelaic acid has been a household name in dermatology clinics, used to calm inflammation, reduce acne, and visibly improve uneven skin tone. Now, it’s risen to fame in the beauty industry and earned a spot on mainstream skincare shelves. But the question must be asked: is azelaic acid genuinely deserving of the hype — or is it just another “do-it-all” ingredient making big promises?

In this blog, we’ll break down exactly what azelaic acid in skincare is, the science-backed benefits behind it, who it’s best suited for, what to pair it with (and what to avoid), and ultimately whether it deserves a permanent place in your routine. Here’s the Doctor’s guide to azelaic acid in skincare.

A dicarboxylic acid (meaning it has two carboxyl groups), azelaic acid is a type of acid that can be found in grains like rye, wheat, and barley. It’s naturally produced by a yeast found on healthy skin known as Malassezia Furfur. However, azelaic acid in skincare products is generally formulated as a lab-engineered synthetic form, as it’s far more stable.

A quick note on product stability: When we talk of lab-engineered actives being ‘stable,’ essentially, we’re referring to the fact that there is less variability and more consistency with synthetic actives. They’re more controlled, meaning there’s less room for reactive impurities, and they can behave more predictably in formulas — the colour and texture won’t change, the ingredients won’t separate, the pH will remain the same. While people often read ‘synthetic’ and instantly think it means fake and impure, it’s important to understand that this is often a positive.

Okay, back to azelaic acid in skincare. So, what exactly does this mean to the non-science folk in the room? This powerful (and wildly versatile) antibacterial and anti-inflammatory ingredient is essentially a gentle exfoliating hero. It can do it all, from clearing pores and reducing skin redness to helping fade pigmentation and promoting skin cell turnover, and more. You can purchase it over-the-counter or prescription strength.

I mean, if you’re not already sold on the above points, let’s delve a little deeper into why this ingredient flies off the shelves and exactly what the science has to say.

However, it’s important to acknowledge that most research looks at prescription-grade azelaic acid. Thus, what you’ll find in over-the-counter skincare products is usually much lower in concentration (often 10% or less), so the benefits may take longer to see. 

One of azelaic acid’s most compelling and popular benefits is its role in treating acne. It does this in a few ways:

• It destroys acne-causing bacteria: By inhibiting the growth of Cutibacterium acnes (also known as P. acnes), which contributes to acne formation, azelaic acid's antimicrobial properties play a significant role in reducing unwanted breakouts.

• It reduces clogged pores: Azelaic acid in skincare is a mild chemical exfoliant, meaning it helps to break down keratin and reduce the buildup of dead skin cells and bacteria inside pores, minimising lesions (both inflammatory and non-inflammatory).

• It reduces redness and irritation: Acne flare-ups are often accompanied by redness and swelling, which can worsen visibility and discomfort. Due to azelaic acid’s natural anti-inflammatory properties, it can help reduce said irritation and redness, helping to minimise the appearance of flare-ups.
  
  

The science:

• A study of 55 patients with acne vulgaris found that 15% azelaic acid applied twice daily for 9 months was more effective in treating inflammatory lesions than 15% azelaic acid applied twice daily for 3 months.

• A study found that 20% azelaic acid cream was as effective as 0.05% tretinoin cream in treating comedonal acne.

You know those brown, patchy skin spots you’ve been struggling to get rid of? Well, azelaic acid might be exactly what you’ve been looking for.

Azelaic Acid is known to inhibit tyrosinase, which is an enzyme responsible for melanin production… the very thing that gives your skin its colour. Azelaic acid blocks this enzyme, which, in turn, slows melanin production and gradually fades dark spots over time due to inactivity. However, it’s important to note that this is dose-dependent, meaning the results you see are dependent on the strength of the azelaic acid formula you’re using — higher concentrations block more tyrosinase activity, while lower doses are gentler and take longer to work.

It also impairs hyperactive melanocytes (melanin-forming cells) by interfering with their DNA synthesis and mitochondrial enzymes. This results in reduced hyperpigmentation.

The science:

• A 24-week randomised trial found that azelaic acid cream (20%) significantly reduced facial hyperpigmentation in darker-skinned patients compared to the vehicle.

• A 12-week study of 72 patients with mild to moderate acne was part of a randomised, double-blind, placebo-controlled trial. Those who used 15% azelaic acid saw improved post-inflammatory hyperpigmentation (PIH) with minimal adverse reactions.

• A 24-week study of 155 patients of Indo-Malay-Hispanic origin participated in a study comparing azelaic acid (20%) and hydroquinone (2%) creams. 73% of the azelaic acid participants, compared with 19% of the hydroquinone participants, achieved good to excellent overall results, with reduced melasma pigmentary intensity.

Among azelaic acid’s growing list of accolades is its proven ability to reduce redness, swelling, and inflammation — often making it a skincare staple for acne-, eczema-, and rosacea-prone skin.

It’s suggested that azelaic acid’s anti-inflammatory and antimicrobial properties may be responsible for its benefits in reducing swelling and redness. Although more research is required to fully understand the relationship between the two, several clinical trials have confirmed its benefits.

The science:

• A review analysing three randomised controlled trials involving 1624 patients found that azelaic acid 15% was more effective than vehicle in reducing redness severity in patients with rosacea.
• A systematic review of randomised controlled trials found that azelaic acid 20% cream and 15% gel are effective in treating papulopustular rosacea, especially in reducing inflammatory lesion count and the severity of erythema.
• During a 15-week study, azelaic acid 15% gel was found to be an effective and safe first-line treatment for patients with mild-to-moderate papulopustular rosacea.

A large part of azelaic acid’s appeal is that it’s considered a relatively gentle and well-tolerated ingredient, making it suitable for many skin types and conditions, even those with sensitive or easily irritated skin.

If you’ve been following along this long, you’ve likely guessed who will benefit most from using this powerhouse ingredient:

• Acne-prone skin

• Rosacea-prone skin

• Those with hyperpigmentation and melasma

Yet, that’s not all — there are a few other notable benefits:

• It’s safe for sensitive skin

• It’s pregnancy-safe

• It doesn’t increase your sensitivity to the sun like many other exfoliating acids

There are many misconceptions about azelaic acid in skincare. Because it’s an acid, it’s easy to assume this ingredient should be used sparingly to avoid irritation. However, this couldn’t be further from the truth. Let’s jump straight into when to use azelaic acid and where it fits in your skincare lineup.

Azelaic acid in skincare can be used in the morning, at night, or both. However, to get started, we recommend using it once a day (AM or PM) and building up to twice per day (as tolerated) if you’re not seeing the results you want after 4 weeks. Keep in mind that this depends on the concentration — if you’re using a lower dosage (10%) over-the-counter option, you may find it takes up to 8 weeks to see results. If you’re using a prescription azelaic acid product, please follow only the instructions your doctor provided.

There is no clear-cut answer to this question, as it depends more on the formula you’re using. As azelaic acid can come in a cream, gel, or serum, the order will be dictated by what type of product you’re using. Let’s take a closer look.

• Azelaic acid serum: This will be applied early in the routine. Once you’ve cleansed your face and applied toner (optional), apply your azelaic acid serum. It may also be layered over other compatible serums. To follow, you’ll apply your moisturiser and SPF (AM). Azelaic acid can increase your skin’s sun sensitivity, so SPF is a must during the day.

• Azelaic acid cream or gel: Once you’ve cleansed your face and toner (optional), and applied your serums, you will use your azelaic acid cream or gel, followed by your moisturiser and SPF (AM). Azelaic acid can increase your skin’s sun sensitivity, so SPF is a must during the day.
  
  

If you’re looking for more information on how to structure your skincare routine and how to effectively layer serums in the correct order, the following guides will help:

• How to Layer Serums: The Ultimate Guide

• How to Build A Skincare Ritual: An AM to PM Guide to Glowing Skin

Good news: this powerful ingredient mixes well with most ingredients, meaning it won’t cause damage to your skin or negate the benefits of other products.

Here are a few ingredients you may have success pairing with your azelaic acid. As always, we recommend consulting your skin specialist before trying anything new:

While there are no obvious ingredients to avoid pairing with azelaic acid, there are a couple of factors to be aware of if you’re considering adding this to your skincare lineup:

1. If you’re using a prescription azelaic acid, it’s important that you consult your doctor before pairing it with anything — potency can impact how it plays with other skin products.

2. Azelaic acid is known to enhance the effects of the ingredients it’s paired with. While this might sound great on paper, it can also worsen their side effects. As such, it’s important to start slow and pay attention to potential side effects.

The science is there, and it’s hard to deny. So, is azelaic acid worth the hype? If you have acne-prone skin, rosacea, or hyperpigmentation, azelaic acid may be a great addition to your skincare routine, along with other products and treatments.

Azelaic acid is gentle, which means it plays well with most products, is suitable for most skin types, and is even fine to use while pregnant or breastfeeding. Its compatibility alone makes it  deserving of its popularity. However, gentleness does come with one main drawcard: it may take longer than you’d like to see the results you’re after.

While well worth the hype, there is a caveat: it all depends on the product's potency and delivery system, Dr Tanya explains.

“The concentration of azelaic acid is important. [Products] on the market range from 10% to 20%,” says Dr Tanya.

“But the fact is that if you are using a gel medium of delivery, it is definitely going to absorb better, at least 8% better absorption from a 15% gel to a 20% cream. So, the delivery medium of this ingredient is also important. It’s not limited to the percentage of the azelaic acid in your product; what’s more important is the delivery system.”

According to Dr Tanya, the benefits of the product depend on the product quality — including what it’s paired with, its concentration, and its delivery system. Here’s exactly what Dr Tanya would prescribe to her patients for optimal results:

• Azelaic acid between 10%-20% (depending on the skin concern)

• Gel format

• Add other ingredients such as salicylic acid (great for acne prevention and management) and niacinamide (great for pigmentation, blemishes, and skin brightening).