The Basics

Official Name: Azelaic Acid.
Popular Brand Names: Azelex, Finacea and Skinoren.
Type of Treatment: Rx Medication – Antibiotic (Topical) and Keratolytic – Other Medications.

How it Works: Azelaic Acid inhibits the growth of bacteria that contribute to acne vulgaris symptoms. Azelaic acid also is a keratolytic agent that can decrease the formation of hyperkeratinized follicles (clogged pores).

Azelaic Acid Background

Azelaic Acid (Skinoren) Molecule

Azelaic acid is a medication that has a long history in the treatment of acne and rosacea.  Azelaic acid is an organic compound that is naturally produced by several types of grasses.  It is both an antibiotic and a keratolytic agent.  Studies have also suggested that it has some anti-inflammatory and immuno-modulatory properties.  In addition to the treatment of acne, azelaic acid is also an ingredient in skin lightening and hair-loss treatments.  Some research has suggested that azelaic acid may prevent the conversion of testosterone to dihydrotestosterone (DHT), which is involved in some cases of male pattern baldness.  Because of this connection, many homeopathic remedies for hair loss include azelaic acid, although it’s clinical effectiveness has not been proven.

Additional Names for Azelaic Acid: Acide azelaique, Acido azelaico, Acidum acelaicum, Acne-Derm, Acnederm, Aknoren, Anchoic acid, Azaclear, Azeclear, Azedose, Azelac, Azelainsäure, Azélaïque, Azelan, Azelderm, Aziderm, AzClear, Cevigen, Chemilaic, Cutacelan, Finevin, Hascoderm, Heptanedicarboxylic acid, Lepargylic acid, Nonandisäure, Nonanedioic acid, Rino-Azetin, Skinoderm, Zelaika, Zelface, Zeliderm, Zeliris and Zumilin.

Azelaic Acid in the Treatment of Acne

Numerous studies have demonstrated that azelaic acid can be an important part of an effective treatment program for acne vulgaris.  Almost all the available research suggests that azelaic acid treatment improves acne symptoms.  Like most other topical treatments, azelaic acid is most effective in treating mild to moderate acne.  While azelaic acid usually improves acne symptoms, it is rare that this medication completely clears acne symptoms on its own.  Azelaic acid is often combined with other forms of treatment, such as oral antibiotics.  Most dermatologists are familiar with this medication and are comfortable prescribing it for use in a wide range of patients.

Patient Reviews of Azelaic Acid

Azelaic Acid Reviews @ Acne.org Azelaic Acid Reviews – Acne.org has reviews and forums where patients can discuss their experiences with different acne medications. However, it is important to be aware that some of the information and statements posted on these forums are innacurate, or even completely wrong.
WebMD Azelaic Acid Reviews @ WebMD – WebMD also offers forums where patients can discuss and review their experiences. Again, some of the information submitted by users is not accurate.
Drugs.com Azelaic Acid Reviews @ Drugs.com – Another good resource for gathering information about other people’s experiences with this medication.

Cost and Availability of Azelaic Acid

If possible, azelaic should be obtained through consultation of a physician.  Most dermatologists are familiar with this medication.  Generic azelaic acid is inexpensive and is widely available.  Pure azelaic acid creams are generally available as prescription only medications.  However, there are numerous topical products that include azelaic acid that are availabel over the counter.  Many of these products are marketed as naturopathic medications.

Azelaic Acid Side Effects

The most common side effect of topical azelaic acid treatment is mild skin irritation. In rare cases, patients may experience more serious skin irritations.  Generally speaking, azelaic acid is well tolerated by patients and receives positive patient reviews.  Topically applied azelaic acid is not readily absorbed into the blood stream and systemic reactions are rare.

For more in-depth information about potential side effects of azelaic acid treatment, refer to the physician’s insert for azelaic acid, or consult a medical professional. For more information about contraindications in general, refer to Avoiding Negative Drug Interactions.

Related Articles from The Science of Acne

Avoiding Negative Drug Interactions
A Guide to Buying Prescription Medications on the Internet
Prescription Medications Used in Acne Treatment
What causes acne?

References and Sources

Books

PDR Staff Writers. 2011. 2011 Physicians’ Desk Reference
Gallagher. 2011. Antibiotics Simplified, Second Edition
Habif. 2009. Clinical Dermatology
Goodheart. 2006. Acne For Dummies
Bartlett. 2012. Johns Hopkins Antibiotics Guide 2012 (Johns Hopkins Medicine)

Online Resources

PubMed Health – The National Institute of Health (US)
Azelaic Acid @ Wikipedia
Physician’s Insert for Azelaic acid

Scientific Research Articles

1. Katsambas, et al. 1989. Clinical studies of 20% azelaic acid cream in the treatment of acne vulgaris. Comparison with vehicle and topical tretinoin.
2. Bladon, et al. 2006. Topical azelaic acid and the treatment of acne: a clinical and laboratory comparison with oral tetracycline.
3. Cunliffe, et al. 1989. Clinical and laboratory studies on treatment with 20% azelaic acid cream for acne.
4. Nazzaro-Porro, et al. 2006. Beneficial effect of 15% azelaic acid cream on acne vulgaris.
5. Nguyen, et al. 1995. AZELAIC ACID: PHARMACOKINETIC AND PHARMACODYNAMIC PROPERTIES AND ITS THERAPEUTIC ROLE IN HYPERPIGMENTARY DISORDERS AND ACNE.
6. Webster. 2002. Combination azelaic acid therapy for acne vulgaris.
7. Gollnick, et al. 2001. Comparison of combined azelaic acid cream plus oral minocycline with oral isotretinoin in severe acne.
8. Graupe, et al. 1996. Efficacy and safety of topical azelaic acid (20 percent cream): an overview of results from European clinical trials and experimental reports.
9. Akamatsu, et al. 1991. Inhibitory effect of azelaic acid on neutrophil functions: a possible cause for its efficacy in treating pathogenetically unrelated diseases.
10. Leeming, et al. 1986. The in vitro antimicrobial effect of azelaic acid.
11. Gollnick, et al. 2006. Azelaic acid 15% gel in the treatment of acne vulgaris. Combined results of two double-blind clinical comparative studies.
12. Worret, et al. 2006. Acne therapy with topical benzoyl peroxide, antibiotics and azelaic acid.