Azelaic acid is the ingredient I end up recommending most often to customers who have two problems at once: redness they cannot settle, and pigmentation they cannot fade. Almost nothing else works on both.
What is azelaic acid?
A dicarboxylic acid that occurs naturally in barley, wheat and rye. Despite the name it does not behave like an exfoliating acid. It is not an AHA or a BHA, it does not resurface, and it will not cause the sting-and-peel cycle that glycolic acid does.
What it does instead is more interesting. It has four separate actions: it is anti-inflammatory, it is antimicrobial against the bacteria involved in acne, it inhibits tyrosinase so it slows melanin production, and it normalises keratinisation so pores clog less.
Four mechanisms in one molecule is unusual, and it is why azelaic acid turns up in dermatology guidelines for rosacea and for acne and gets used off-label for melasma.
Why is it used for rosacea?
Because it targets the inflammation rather than the surface. Prescription-strength azelaic acid at 15 per cent is a first-line treatment for papulopustular rosacea in most clinical guidelines, and it has a long safety record.
The over-the-counter versions, usually 10 per cent, are weaker but work on the same mechanism. For mild persistent redness they are a reasonable place to start before seeing a doctor. For rosacea with visible bumps and pustules, see a doctor. Prescription strength plus proper diagnosis will get you further than anything on our shelf, and I would rather say so.
One caution: azelaic acid does not treat the flushing type of rosacea, and it does nothing for visible broken capillaries, which need laser. If your rosacea is mostly redness that comes and goes with heat and wine, azelaic acid will disappoint you.
What about pigmentation?
This is where it earns its place for our customers specifically.
Azelaic acid inhibits tyrosinase selectively: it acts on overactive melanocytes and mostly leaves normal ones alone. In practice that means it fades dark spots without the risk of lightening the surrounding skin, which is a genuine concern with some other pigment ingredients on deeper skin tones.
It is also the only well-evidenced pigmentation ingredient considered safe in pregnancy and breastfeeding, which matters because pregnancy is one of the main triggers for melasma and almost everything else in the category is off the table.
For a fuller picture of which pigmentation you are actually dealing with, read dark spots on your face.
How does it compare to the alternatives?
- vs niacinamide: niacinamide is gentler and better tolerated, azelaic acid is stronger on both redness and pigment. Niacinamide first if your skin is fragile.
- vs vitamin C: vitamin C is better for general dullness and antioxidant protection, azelaic acid is better for redness. They work well as a morning and evening pair.
- vs a retinoid: a retinoid does more for texture and fine lines. Azelaic acid does more for redness. Many people over forty benefit from both, introduced separately.
- vs glycolic or salicylic acid: different category entirely. Those exfoliate. Azelaic acid does not.
How do you use it?
After cleansing and your hydrating layer, before moisturiser. Once daily to start, at night, on a barrier that is not already compromised.
If your skin is sensitive, apply it every other night for the first two weeks, or buffer it by applying moisturiser first.
We stock Anua Azelaic Acid 10% Hyaluron Redness Soothing Serum. The hyaluronic acid content matters more than it sounds: pure azelaic acid formulations can feel gritty and drying, and this one does not.
Expect a mild tingle for the first few applications. That is normal and it fades within a week or two. Persistent stinging, burning or worsening redness is not normal, and means you should stop.
How long until it works?
Redness: four to eight weeks. Pigmentation: eight to sixteen weeks. Acne: six to twelve weeks.
All three need daily sunscreen alongside, or you are fading pigment with one hand and making it with the other. See Daily Protection.
Common questions
Is azelaic acid safe during pregnancy?
It is generally considered one of the few pigmentation-active ingredients that is, which is why it is so often recommended for pregnancy melasma. Confirm with your own doctor or midwife rather than taking a shop's word for it.
Can I use azelaic acid with niacinamide?
Yes, and the combination is a good one. Introduce them a fortnight apart rather than starting both together.
Can I use it with retinol?
Yes, but not on the same night when you are starting out. Alternate nights until both are well tolerated.
Does azelaic acid cause purging?
It can, mildly, in the first three to four weeks if you are acne-prone, because it speeds pore turnover. It should settle.
Is 10% strong enough?
For mild redness and for pigmentation, usually yes. For diagnosed papulopustular rosacea, prescription 15% or 20% is more appropriate and worth asking a doctor about.