|INDICATION||SIZE OF EFFECT||DESCRIPTION|
|ACNE TREATMENT||STRONG||Reduces comedones, papules and pustules, and is suitable for long term maintenance therapy|
|ROSACEA TREATMENT||STRONG||Effective treatment for rosacea|
|MELASMA TREATMENT||STRONG||20% azelaic acid cream lightens melasma as effectively as 4% hydroquinone.|
|SKIN LIGHTENING||MODERATE||Depigments the skin by killing abnormal melanocytes and inhibiting tyrosinase. Not effective against age spots, however.|
It is a naturally occurring compound with antibacterial, antioxidant and anti-inflammatory effects. It belongs to a group of medicines known as dicarboxylic acids and can be found in grains .
Azelaic acid reduces inflammatory lesions and works to stop the growth of propionibacterium acnes (the bacteria associated with the formation of acne) .
All medications have some side effects so it is important to be aware, however do not be alarmed. One advantage of azelaic acid is that it is safe on sensitive skin and is not associated with systemic adverse events. It has also shown to be tolerable in clinical trials. One trial looked specifically at comedonal acne and Azelaic acid was found to have a better safety profile compared with tretinoin . Reported side effects include mild itching, stinging, rash and pruritus .
Hyperpigmented lesions can be evident in middle-aged and elderly patients following long term accumulated sun exposure .
Azelaic acid should be used as second line treatment for mild acne once first line treatment prove to be ineffective.
One study showed that azelaic acid had comparable anti-acne efficacy to topical tretinoin, benzoyl
peroxide, erythromycin and oral tetracycline. Overall, azelaic acid was found to be well tolerated,
with side effects limited to mild, short-term irritation .
Treatment comparisons have shown that 20% azelaic acid cream is an effective treatment in mild to moderate acne and is comparable to that of tretinoin (0.05 %), benzoyl peroxide (5 %), and topical erythromycin (2 %) .
A clinical trial tested 20% azelaic acid cream in a 3 month double blind study of 92 patients with moderate inflammatory acne. In a second study of 289 patients with comedonal acne, topical azelaic acid was compared with 0.05% tretinoin cream over 6 months. Collective results from both studies showed that 20% azelaic acid significantly reduced the number of acne lesions. In the study of comedonal acne, 20% azelaic acid cream was found to be equally effective as 0.05% tretinoin cream. Overall azelaic acid showed fewer side effects.
A randomised trial compared the efficacy and safety of 15% azelaic acid versus adapalene 0.1% gel in the treatment of 55 females with acne. The study concluded that 15% azelaic acid and 0.1% tretinoin gel were equally safe and effective in the treatment and maintenance of female acne .
Despite the evidence, more high quality research is needed to support the use of azelaic acid compared to other topical treatments, and the clinical effect of azelaic acid has been reported to be disappointing by some experts [7; 8].
Azelaic acid is clinically proven to treat rosacea.
Rosacea is a common chronic skin disorder that is characterized by central facial erythema, papules, pustules, flushing, and swelling .
An open label study included 20 patients with mild to moderate rosacea. They were treated with 15% azelaic acid (Finacea Gel®) to the face twice daily for 12 weeks. Results were positive and showed a significant reduction in all lesions types. Overall, 15% azelaic acid gel was found to be safe and well-tolerated. Side effects included mild itching and stinging .