Skincare with Friends Episode 58. Azelaic Acid

Nia and Natalie discuss our experiences with Azelaic Acid, why we love it so much and how to use it so that it really works for your skin. Azelaic acid is a saturated dicarboxylic acid found naturally in barley and rye, it is produced by a yeast that lives on the skin called Malassezia Furfur. It has no relation to phenol or benzene, unlike hydroquinone, so no theoretical threat of cancer.

Azelaic acid has loads of benefits, it can

• Kill bacteria, particularly p. Acnes found in sebum follicles
• Decrease production of keratin (the protein produced by skin which blocks the pores in acne)
• Reduce inflammation
• Inhibit tyrosinase (the enzyme involved in melanin production)
• It also has a protective effect towards skin cells, protecting from oxyradical toxicity from sun and pollution

As a side note, studies have shown that while Azelaic helps unblock pores by reducing keratin production and reducing bacteria levels, it doesn’t affect oil production, so it doesn’t mega dry the skin out while treating acne.

(Disclaimer- This post isn’t sponsored, I received a sample of the Dermatica 20% Azelaic Cream to try but have subsequently purchased it, the links may be affiliate, meaning that if you click and spend, Skincare with Friends will get a small amount of cash to spend on the podcast).

The Side Effects of Azelaic Acid

It does increase cell turnover so there is a possibility of purging/worsening acne in some. Purging seems to be a rare side effect, we don’t get many reports of worsening acne with Azelaic in the Deciem Chatroom or The Ordinary Subreddit where I moderate, but it does happen.

You can expect some soreness, redness, itchiness, burning. But these should be temporary. I’ve used it myself and I have experienced some soreness, mainly around the nose area and a bit of itchiness. Nothing visible or overly troublesome. I’m using Dermatica 20% Azelaic Cream (which is a fantastic product- read my review here).

There is some evidence that a lower percentage of Azelaic will be as effective and with less irritation, if you do find that the 20% is too much for your skin. Generally it is well tolerated and people cope with that bit of temporary irritation.

You can Treat Melasma with Azelaic Acid

Azelaic inhibits tyrosinase enzyme, which converts dopamine into melanin. It also reduces free radicals via it’s antioxidant effect, which will have a hand in reducing sun damage and pigmentation. 

In studies, Azelaic has no effect on the normal pigmentation of the skin, or freckles but has selective effects on abnormal melanocytes. Effects are seen after 3 months. 

There has been double blind randomised control studies (the best sort) that showed 20% Azelaic has an equivalent effect to 4% Hydroquinone and with far fewer side effects, and another study showed that it is superior to 2% Hydroquinone. It can be combined with tretinoin or glycolic acid to increase it’s anti-melasma effect.

Check out our Hydroquinone post for more melasma tips and product suggestions.

Treating Rosacea with Azelaic Acid

Azelaic has a three prong attack against rosacea-

• via reducing inflammation,
• UV generated free radical which attack the skin’s immune system,
• and by reducing bacteria.

Studies have shown Azelaic to be superior to the other main treatment for rosacea- metronidazole. It’s effect is seen after 12 weeks but keep increasing beyond 15 weeks according to the study. It seems to be something that will keep improving the skin long term but there is evidence that it can reduce inflammation overnight.

Acne and Azelaic Acid

Azelaic is a fantastic option for acne sufferers, one of my top picks, for sure. It’s not as irritating as a lot of other treatments so easier to get on with, it is a safe option for pregnant and breast feeding women. In terms of in controlled studies, topical azelaic acid demonstrated comparable anti-acne efficacy to topical tretinoin, benzoyl peroxide, erythromycin and oral tetracycline and is more gentle than salicylic acid.

It needs to be used consistently and often, for months at a time and twice a day is ideal. You might want to treat your acne with something faster acting alongside the AZA if it’s taking it’s time, like an antibiotic topical from the docs.

Fitting Azelaic Acid into your Routine

Azelaic is stable and doesn’t degrade easily there is no vitamin C like issues with air and water, it isn’t sensitive to light like Tretinoin and doesn’t cause sun sensitivity like glycolic acids. So you can use it in the day. It is a lot safer for the moisture barrier than the other acids as is doesn’t exfoliate in the same way- it doesn’t breakdown the top layer of skin as aggressively so it’s less risky in terms of sun sensitivity and moisture barrier.

You might still get some irritation with it of course so you should still hydrate and definitely use spf.

I use mine after hydrating layers have absorbed and under spf in the morning. In the evening I do hydrating layers, B vitamins, Azelaic, then leave a couple of hours (you don’t have to leave that long) then tretinoin and hydroquinone.

If your skin isn’t as tretted up as mine you could just use it in the morning and tret in the evening. 

Deciem doesn’t recommend using at the same time as other acids which sounds right. Or with the peptides or EUK-134 because they are affected by low pH. It’s pH isn’t that low- 4.55 or thereabouts, so until Deciem release their evidence about that, I guess we’ll just have to abide by their rules.

Interesting New Research

This recent study, ( Hung et al, 2021 “Preparation and Evaluation of Azelaic Acid Topical Microemulsion Formulation: In Vitro and In Vivo Study” Pharmaceutics Journal) investigates the the ability of Azelaic Acid to diffuse through rat skin. It doesn’t absorb easily. The study concludes that a well formulated cream preparation is best, specifically oil in water microemulsions.

Other findings in this study include that-

• Azelaic Acid takes a long time to reach high concentrations in the skin- up to 25 hours, so I would take fro that, as I mentioned above, it should be used as often as possible. Also shouldn’t be washed off, as opposed to something like vitamin C which absorbs quickly so can be used as a mask treatment.
• Lower concentrations have equal anti inflammatory effects, meaning that if you have issues with 20% causing irritation, you may well be fine using a lower percentage and still getting results.
• AZA is stable at room temperature in cream formula, no need to refrigerate.

Azelaic Products to Check Out

• Dermatica 20% Azelaic Cream £19.99
• Skinoren 20% cream, Finacea 15% Gel- on prescription
• The Ordinary 10% Azelaic Suspension £5.50
• Facetheory 15% Azclear Serum £24.99
• Typology 10% Mattifying Azelaic Serum £12.90
• Paulas choice 10% £37