A topical acne and rosacea treatment
Azelaic acid
A topical treatment that unblocks pores and reduces bacteria and redness, used for acne and rosacea.
What is Azelaic acid?
Azelaic acid is a cream or gel applied to the skin for acne and for rosacea. It works by unblocking pores, reducing the bacteria involved in acne and calming redness and inflammation. It can cause mild stinging, burning or itching when you start, and occasionally lightens darker skin.
Education and reference only. This is a plain-language guide to Azelaic acid — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Azelaic acid is a cream or gel that you apply to the skin to treat acne or rosacea. In the UK it is usually prescribed rather than bought over the counter. It is a useful option for people who cannot tolerate other acne treatments, or for those with rosacea where it helps reduce spots and redness. It is often used twice a day on the affected areas.
How it works
It helps to unblock pores by reducing the build-up of dead skin cells, and it lowers the numbers of bacteria that contribute to acne. It also has anti-inflammatory effects, which is why it can calm the redness and bumps seen in rosacea. Because it can interfere with excess pigment production, it may also help even out some of the dark marks left after spots.
Company & origin
Originated / developed by: A topical skin treatment.
A topical treatment used in the UK on prescription for acne and for rosacea.
What it treats
Conditions Azelaic acid is used for
Practical use
How to take Azelaic acid
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Wash and gently dry the affected skin, then smooth a thin layer over the whole area, usually morning and night.
- Rub it in gently and wash your hands afterwards, keeping it away from your eyes, lips, mouth and the inside of your nose.
- Expect some mild stinging or tingling at first; if irritation is troublesome, your prescriber may suggest using it once a day for a while.
- Use sun protection on treated skin and keep up your normal gentle skincare routine.
- If you forget an application, apply it at the next usual time rather than using extra to catch up.
Weighing it up
Advantages & disadvantages of Azelaic acid
Advantages
- Useful for both acne and rosacea, reducing spots, bumps and redness.
- Does not cause bacterial resistance and does not bleach clothing or towels.
- May help fade some of the dark marks left behind after spots heal.
Disadvantages
- Commonly causes stinging, burning or itching, especially in the first weeks.
- Can occasionally lighten areas of darker skin.
- Takes several weeks of consistent use before benefits are clear.
Practical use
Good to know
Azelaic acid often causes mild stinging, burning, tingling or itching when you first start, and this usually eases with continued use. It does not normally bleach fabrics like some other acne treatments, which some people find more convenient. It can occasionally lighten patches of darker skin, so mention any concerns to your prescriber. As with most acne and rosacea treatments, it takes several weeks of regular use before you notice a clear improvement. Avoid getting it in your eyes, mouth or on broken skin.
Who should not take it / use with caution
- Anyone who has had an allergic reaction to azelaic acid should not use it.
- It should not be applied to broken, raw or sunburnt skin.
- People with very sensitive skin should start carefully and seek advice if irritation is severe.
Monitoring
- No blood tests are needed; progress is judged by how your skin looks over several weeks.
- Reduce how often you apply it if the skin becomes too irritated.
- Return to your prescriber if acne or rosacea is not improving or is getting worse.
Side effects
- Burning, stinging, tingling or itching of the treated skin, particularly when starting.
- Dryness, redness or mild peeling at the application site.
- Occasionally lightening of darker skin, or rarely a more pronounced allergic reaction.
Key interactions
- Using it with other strong or peeling skin products can increase irritation.
- There are very few important interactions with tablets or other medicines.
- Tell a pharmacist about other creams or gels you apply to the same area.
Available as: Creams and gels applied to the skin.
Answers
Azelaic acid: frequently asked questions
Can it be used for rosacea as well as acne?
Yes, azelaic acid is used for both; in rosacea it helps reduce the spots and redness, and in acne it unblocks pores and lowers bacteria.
Why does it sting when I put it on?
Mild stinging, burning or tingling is common at first and usually settles with continued use; using it once a day for a while can help.
Will it lighten my skin?
It can occasionally lighten patches of darker skin, so tell your prescriber if you notice this or have any concerns.
Does it bleach clothes like benzoyl peroxide?
No, azelaic acid does not usually bleach towels, bedding or clothing, which some people find more convenient.
How long until I see results?
It usually takes several weeks of regular use before there is a clear improvement, so keep applying it as directed.
The wider class
About Topical acne/rosacea treatments
Azelaic acid belongs to the topical acne/rosacea treatments class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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