Does Azelaic Acid Treat Acne?

Azelaic acid is a skincare super-ingredient that people ignore, and that’s why Cassandra interviewed Dr. Sam Bunting. who not only has some of the best azelaic acid products but knows this ingredient like the back of her hand.  

Dr. Sam:Azelaic acid has been around for a long time, and I have been prescribing it for over a decade. But, it definitely took a long time for it to penetrate the skincare market, and that’s because it’s tricky to formulate. If you look at the BNF, which is what’s used for medicine in the UK, azelaic is by far the most broadly used active ingredient that we have.

It can be used for so many things. It can used for post inflammatory hyperpigmentation, melasma, rosacea, and perioral dermatitis. Everyone who comes through my clinic doors has the potential to benefit from azelaic acid.  That’s how useful it is! You can even use it if you’re pregnant. Its usefulness is why I’ve been championing azelaic acid on social media for at least 8-9 years!  I want people to know about this amazing superhero skincare!


How does Azelaic acid work on the skin?

Azelaic works with the toll-like receptors on the skin’s surface. Toll-like receptors interact with the environment, and they cue redness and trigger inflammation due to different things like temperature, wind, and environmental changes. Toll-like receptors are a tool that defends your skin by letting you know something is wrong. 

By making them less reactive, azelaic helps with different conditions because most of them have an inflammatory basis. 


Can you use azelaic acid every day?

Yes, even twice a day. For example, if somebody comes to me with rosacea and acne, they’re the perfect candidate. Often, they’ve started off with acne, and then it progresses into redness. In this case, you’ll want to build up slowly because any active ingredient on sensitive skin can be troublesome. So, make sure you have your gentle cleanser, a supportive moisturizer, and a mineral sunscreen that’s very soothing and calming. Then, you can slowly titrate your azelaic acid use.

Azelaic acid improves the process of natural desquamation (skin's natural process of exfoliating), and you don’t need an exfoliant in addition to it. With azelaic acid, you’re not just removing dead skin cells from the surface, you’re getting inside of the skin cell. That’s why it’s so powerful.


How does azelaic acid work for acne?

Azelaic acid is antibacterial, and it’s also anti-inflammatory. It also inhibits tyrosinase so you get less pigment and fewer post-inflammatory marks. 


Is Azelaic acid safe for people who have a Fitzpatrick skin type 4-6?

Some people are very sensitive, and it can sting a little upon application. So, in general, you’ll want to start at a lower percentage and work your way up that way it doesn’t sensitize the skin. You can easily get azelaic acid at a low percentage, especially with the proliferation of OTC products.


Dr Sam’s Flawless Nightly Serum - $60

For example, this is a great azelaic product. There’s also bakuchiol, vitamin C, and niacinamide.

We reformulated this product 39 times over 3 years. 

How is azelaic acid different from retinoids?

Azelaic acid turns down the intensity of our skin’s defense system. Azelaic acid turns the dial down, and it makes skin behave less sensitively. So, in turn, you can use azelaic acid first and then a retinoid so there will be less sensitization. Azelaic has the same capacity to correct the comedone proneness because it encourages natural exfoliation. So, for clearing pores and preventing acne, they are the ultimate power couple.

Retinoids interact with retinoid receptors and increase cellular turnover. This leads to improvement in keratinization, and likewise, they stop clogs from forming in the pores. Azelaic acid does something similar although it’s now so clear how. 


Is there something you shouldn’t use benzoyl peroxide with?

Layering azelaic acid and benzoyl peroxide is not very effective. You should use benzoyl peroxide to clear up the breakouts and then azelaic acid in the “tidy up” phase. This phase is when you’re solving concerns like texture, blocked pores, and post-inflammatory pigmentation. Benzoyl peroxide has no impact on these things.

However, azelaic acid does increase the skin’s tolerance to the other actives. When paired with niacinamide, the two can truly improve sensitivity and change the way the skin behaves long term.


Flawless Brighty 10% Azelaic Acid Serum - $60