How Does Azelaic Acid Work on Skin?

When it comes to trying to choose products that treat acne, four main ingredients have been medically tested and proven: salicylic acid, benzoyl peroxide, sulfur, and retinoids. As for the red marks that acne leaves behind, the treatment approaches are completely different. 

These marks become red and inflamed, but on deeper skin tones, they can even look purple or brown. So, what can we do to help with that? Well, the inflammation is actually helpful because it causes something called angiogenesis to happen. 

Angiogenesis is the new formation of tiny blood vessels, and it’s great because blood vessels bring nutrients, oxygen, and other cells to that area to repair the skin or a wound in the body. And angiogenesis also brings red blood cells to the surface of the skin, but that redness can stick around and be rough to deal with. The good news is that some medically proven ingredients have been shown to stop redness in as little as 16 days.

However, you need to be consistent,  and some of the treatments are prescription only. But, let's talk about one of the most helpful ingredients for redness apart from retinol - azelaic acid.

Azelaic acid is a dicarboxylic acid. It comes from rye bread, and it’s made by our bodies naturally. There are a few special things about azelaic acid. Number one, it’s pregnancy safe. If you are pregnant, speak to a doctor, dermatologist, or your OBGYN. But, azelaic acid is generally regarded as safe for pregnancy, and it helps to get rid of active acne as well as redness, purpleness, or brown spots in the skin. 

What’s very special about azelaic acid is that it only works on cells inside of your skin, and it helps them rapidly produce more of themselves. You can apply azelaic acid to pimples that are beginning to pop up, and you can keep using it on those dark spots.

There is a prescription azelaic acid that Cassandra loves.

Agency Future Formula 

If you subscribe to Agency, they will customize the formula to your skin needs. And what you get may be very different than what Cassandra received. Agency matches you up with doctors and derms who look at your skin. Then, they provide formulas, and you can even ask them for prescription-only ingredients you want to try. They might not always give it to you, but when they assess your skin and determine that the ingredient will help, you may be able to get it, they are usually pretty good at working with you to make sure your formula is just right. 

But, if you don’t want a prescription route, you can get azelaic acid at a lower percentage over the counter. For example, there are options from Paula’s Choice. 

Paula’s Choice 10% Azelaic Acid Booster 


So, this would not be recommended if you’re pregnant or breastfeeding because of the salicylic acid. But, for anyone else, including those who have active breakouts and acne, this is a great one. 

Another option is finacea gel. Finacea gel is prescription azelaic acid. It usually comes at higher percentages, but you could ask your doctor or derm about that too. 

How to incorporate azelaic acid into your routine

Number one, azelaic acid can be used during the morning, evening, day, or night. Using it at night is probably the better option because you can lock it in with moisturizer. Azelaic acid is also a pretty good ingredient to layer with other things. For example, Cassandra’s azelaic acid formula from Agency is mixed in with resveratrol and hydroquinone. Azelaic acid plays well with other things, and there aren’t any major concerns when it comes to putting it into your routine. 

For azelaic acid, Cassandra would recommend leave-on products as opposed to those that rinse off. For example, an azelaic acid cleanser might be okay, but it might not be the best use of your money.

Cassandra would get it in a serum or moisturizer formula that you can leave on the skin. This gives the azelaic acid a chance to penetrate and work. In fact, it can work in as little as 60 days!

Our bodies are constantly renewing themselves and turning over cells. During this process, azelaic helps to get rid of both acne and redness/pigment in as little as 60 days, especially if you use it regularly.

As a bonus, azelaic acid has also been medically proven to help with rosacea. It’s one of the first-line treatments for rosacea. So, if your skin is naturally very red and you get flushed a lot, azelaic acid is a great way to go too!

Photo cred: Procoal