Everything you need to know about Azelaic Acid
Azelaic acid may not be included in the list of most popular beauty products and skin medications; however, it has more to offer than meets the eye. AzA comes as a ‘package’ and if you have used it, you will agree with me that it is the perfect reflection of the saying ‘still waters run deep’.
If you have not used it, worry not; we have prepared enough to let you in on what you have been missing out on. To get a slice of the wonderful news, here is everything you need to know about Azelaic Acid.
What is Azelaic Acid?
Azelaic acid is a naturally occurring dicarboxylic acid found in grains like barley, wheat and rye. The acid’s anti-inflammatory, anti-bacterial, anti-keratinizing and melanin inhibiting properties make it very effective for use in treatment of skin problems like acne, rosacea and melasma .
It is also known for its powerful antioxidant benefits which improve your skin’s appearance and reduce signs of aging. A lab-engineered form of Azelaic acid is normally used for skin care because it is stable and more potent.
What Are the Benefits of Azelaic Acid?
Numerous studies have been done concerning the benefits of Azelaic acid. Surprisingly, not much of that has managed to hit the front page. In fact, we had to dig really deep to fetch the many abandoned researches.
Is Azelaic Acid an Effective Acne Treatment?
Benzoyl Peroxide, Tretinoin and Accutane are known for their effectiveness in acne treatments. You may as well add Azelaic Acid to the list; its efficacy in the job is something that cannot be ignored.
What is even better is the fact that it is perfect for all skin types and it comes with fewer side effects compared to the other treatments. To give you an even clearer picture, we have given you factual comparisons between Azelaic acid and these other treatments.
Azelaic Acid vs. Benzoyl Peroxide
Benzoyl peroxide is one of the best acne treatments. It has been used to treat acne since 1934. Azelaic acid on the other hand has been used for about 2 decades’, albeit with not much popularity. In a certain research, 15% Azelaic Acid and 5% Benzoyl Peroxide (BPO) was used by 351 people for 4 months. Another group of 229 patients used 1% Clindamycin at the same time.
The results of Azelaic acid matched those of Sodium Peroxide and Clindamycin. There were fewer side effects compared to BPO and slightly more compared to Clindamycin. Verdict; Azelaic acid rocks as an acne treatment!
Azelaic Acid vs. Tretinoin (Retin-A)
Azelaic Acid is equally effective in the treatment of acne compared to Tretinoin. This was proven in a clinical test involving 289 patients who were suffering from comedonal acne. 20% Azelaic Acid and 0.05% Tretinoin were used for a period of 6 months.
The results showed that the two acne treatments produced comparable response. Just like in the case with BPO, Azelaic acid was more tolerated and with lesser side effects.
Azelaic Acid vs. Accutane
Accutane (Isotretinoin) is considered very powerful in acne treatment and this is actually true. In a clinical research that involved 50 patients, oral accutane got rid of 100% acne lesions, reduced facial comedones by 83% and decreased papules and pustules by 97%.
When a combination of AZA and minocycline was used under the same conditions, it cleared 100% of lesions, 70% of comedones and 88% of and papules and pustules.
This is definitely close and it’s not all; The AzA combination displayed side effects with an incidence of 36.5% compared to Accutane which showed 65.7% incidence.
Apart from concluding that AzA is an effective acne treatment, the researchers recommended it as a ‘valuable alternative’ treatment due to the reduced side effects, better tolerance, and safety for use in female patients with childbearing possibilities.
How does Azelaic Acid work to treat Acne?
Acne involves hair follicles clogged with excess sebum, dead skin cells and bacteria. When you use azelaic acid on your skin, its various properties kick in.
Due to antibacterial abilities, AzA gets rid of acne causing bacteria, including the antibiotic resistant strains. It also strips your skin off free fatty acids on the skin’s lipid layer, making it bacteria intolerant and preventing further infections. It does this without interfering with your skin’s sebum production. In fact, when investigated, it was proven to reduce the amount of these fatty acids from 15.9 to 10.5% within a period of 1 month.
The anti-keratinizing property helps to modulate the process of keratinization which in turn reduces build-up of dead skin cells that would otherwise clog hair follicles. The anti-inflammatory ability reduces redness, inflammation and sensitivity.
As these processes go on, the melanin inhibition abilities help to restore the tone of your skin where acne scarring has caused hyperpigmentation.
Azelaic Acid Treats Rosacea
What is Rosacea?
Rosacea is a skin condition characterized by redness of on cheeks, nose, forehead and chin. The rosy colour can also appear on the chest, ears and neck. Severe rosacea can result to visible thickened and swollen blood vessels
It’s mostly observed in fair skinned women. Men are however more likely to get more severe type of the disease. It usually manifests in families with a history of the disease. The disease is classified as type 1 and 2 based on severity.
FDA Approval and Studies
Topical Azelaic Acid was approved by FDA in July 2015 as a treatment for skin lesions and whiteheads of mild to moderate rosacea. This followed a 12-week clinical trial involving 1362 subjects with papulopustular rosacea.
The agent used was Finacea foam (15% Azelaic Acid). Among other findings, AzA was found to be an effective anti inflammatory agent.
When 15% AzA is used in combination therapy with antibiotics its effectiveness has been found to improve. The study involved 172 subjects who took oral doxycycline and applied Azelaic Acid twice daily over a 12-week period.
Azelaic Acid Treats Hyperpigmentation and Melasma
Hyperpigmentation is a broad term that stands for skin conditions that result in discoloration or darkening of the skin.
Melasma is a type of hyperpigmentation caused by overproduction of melanin. It is triggered or aggravated by exposure to sunlight, inflammation and changes in hormone levels. It mostly affects women with darker skin tones.
It is hard to talk of hyperpigmentation without mentioning hydroquinone. It is popularly known for its strong melanin inhibition properties. So, how does AzA perform compared to it?
Azelaic Acid vs. Hydroquinone?
Hydroquinone (HQ) is a common ingredient in most skin lightening products. It’s also used in treating hyperpigmentation and melasma. Hydroquinone use is usually riddled in controversy with many countries banning its use.
2% hydroquinone is available over the counter. Higher strengths are dispensed by compounding pharmacies and require a prescription to buy.When it comes to treating the skin, 20% Azelaic acid is usually compared to 2% hydroquinone.
In testing the efficacy of the two, 155 Indo-Malay-Hispanic melasma patients were treated over a period of 24 weeks in a study. Sunscreen was used simultaneously with the treatments. “Good to excellent” results were recorded in reduction of pigmentation in 74% of AzA patients compared to 19% of hydroquinone patients.
A different study using 20% AzA and 4% HQ concluded that the acid may be more effective than Hydroquinone in treating mild melasma. Unlike HQ, AzA does not cause photosensitivity and exogenous ochronosis (bluish black discoloration) after prolonged use.
When faced with a choice between AzA gel and cream, go for the gel. Even though 20% cream has a higher concentration of AzA, a study showed that it has a lower bio-availability compared to a 15% gel.
Does Azelaic Acid Reduce Hair Loss?
There are creams and suspensions with AzA that are claimed to treat hair loss. Home remedies for treating the scalp more often than not contain the acid as a major ingredient. So is there any truth to this assertions?
Yes there is. Azelaic acid has been found to inhibit or suppress the amount of dihydrotestosterone (DHT) in the scalp. DHT is the hormone which is mainly responsible for hair loss, in that it damages hair follicles. DHT makes the follicles to produce less or thinner hair and eventually no hair at all.
Inflammation is another factor that causes baldness. The anti-inflammatory properties of the acid come into play by alleviating the inflamed skin for improved hair growth.
But Azelaic Acid Can also Cause Hair loss, Right?
Not really. The notion stems from mainly misunderstanding how DHT works. The hormone is responsible for both pattern baldness and hair growth; it’s the reason you will see a bald man with a hairy face. The acid will help you keep baldness at bay but
Use of AzA has been known to reduce hair loss on the scalp. It can also reduce or thin facial hair. A research found that 5 participants in a group of 30 men reported reduction in coarse facial hair.
Summary of Azelaic Acid Benefits
In a nutshell, Azelaic Acid has antioxidant, anti-inflammatory and antibacterial properties. It’s also an anti-keratinizing agent. You won’t have to worry about blocked pores or build-up of dead skin and lastly, it may be handy in reducing hair loss.
AzA matches the efficacy of Benzoyl Peroxide, Accutane and Tretinoin (Retin-A) in treating acne. It’s also effective in treating acne, melasma, rosacea and hyperpigmentation among other forms of skin conditions.
Azelaic Acid is non-teratogenic which means it does not affect the growth of embryos. It’s well tolerated by the skin and as such does not induce photosensitivity. Neither does it make the skin resistant to bacteria.
Use of AzA also has the added advantage of leaving the skin-water barrier intact. This means that your body won’t lose water via the skin which a common side effect of Benzoyl Peroxide.
Side Effects of Azelaic Acid
Use of topical creams, gels or foams containing AzA is associated with some side effects. The common ones, especially for first time users are skin dryness, itching, burning and a tingling sensation. The effects clear as the skin gets used to the treatment; usually after few applications.
Other less common side effects include blistering, crusting and severe redness of the skin. If any of this manifest, you should discontinue use and contact a derma for advice.
A rare and isolated side effect of topical AzA is hypopigmentation. Same goes for eye and mucous membrane irritation.
Rare side effect of AzA – Hypopigmentation – Image Source: HealthLine.com
While no side effects have been seen in developing embryos or breastfeeding babies, it is advisable to notify or seek advice from your doctor if you are either pregnant or breastfeeding.
Best Way to Use Azelaic Acid
As with most lightening skin creams, carry out a patch test first. Use mild soaps or soapless lotions to cleanse your skin before application. Mild irritation is to be expected but can be reduced by moisturizing your skin first.
Apply a thin film on a small part and observe for 24 hours. If you experience extreme irritation, contact a dermatologist.
AzA should be applied and massaged once in either the AM or PM. Comparative studies on twice and once a day use of 15% AzA gel have shown no discernible difference in results.
Avoid using substances or foods that causes reddening or blushing of the skin when you are on treatment. These include drinks such as hot beverages, alcohol and overly spicy foods.
What if I forget a dose?
Apply as soon as you remember but if it is almost time for the next one, ignore the missed one and continue as usual. You should never make up for a missed dose by applying twice.
When will I see results?
When used as per the ‘how to use’ instructions or the derma’s prescription AzA works pretty fast. A study based on data obtained from private clinics showed noticeable results in 35 days from 81.9% of dermatologists. The number increased to 93.9% in 73 days. The 1-year study involved treatment of over 1200 acne patients with 15% AzA. The study also reported that 95.7% of patients “very well tolerated” AzA.
How do I store or dispose AzA?
Keep the medication in its container, tightly closed and away from excess heat and moisture. AzA foam is flammable; keep it away from flames. Do not freeze it or use it 8 weeks after opening the container. Dispose any remainder plus the container through a medicine-take-back programme offered by pharmacists or local garbage departments.
Where can You Buy Azelaic Acid?
With a prescription you can buy Azelaic Acid creams OTC at select local pharmacies. However, that’s not to say that you cannot buy the product without the direct involvement of a dermatologist. There are various cream, gels and foams sold online with different concentrations of AzA.
Amazon: Paula’s Choice is a mild cream with 10% Azelaic Acid at $36 (30ml). A more potent cream is GIGI Bioplasma with 15% Azelaic Acid at $34.87 (30ml). Ecological Formulas Melazepam has 20% AzA making it one of the most potent, creams and goes $13.18.
Ebay: Two products that stand out are from Bayer; Skinoren Cream 20% Azelaic Acid, $39 (30g) and Finazea 15% Gel, $100 (100g). You can also try a milder option; The Ordinary 10% Azelaic Acid Suspension, $15 (30ml).
Azelaic Acid is not popular but its efficacy is comparable to some of the best skin treatments in the world. These include Benzoyl Peroxide, Accutane, Retin-A and Hydroquinone. It also displays comparatively less side effects and is more tolerable.
The ‘stealth operator’ is enabled to work by its anti-oxidising, anti-inflammatory, and bacterial and anti-keratinizing qualities. If you were hesitant before, you are now better placed to make your own assessment!
Have you used Azelaic Acid products? What are you thoughts and experiences? Let us know in the comments below!
Sonia Knight is the founder of be:skinformed.
Apart from having her own experience with hyperpigmentation, Sonia has gained vast knowledge in the dermatology field. For more info on this, check out our about us page.