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Other actives

Azelaic acid

A prescription treatment for acne, rosacea and dark marks at 15-20%. Cosmetic serums use about 10% or less, where it is much less studied.

Moderate evidenceTypical strength: Up to 10% cosmetic; 15-20% Rx

What it is

Azelaic acid is a dicarboxylic acid made by yeasts that live on skin and found in grains. It kills acne bacteria, normalizes the way pore-lining cells shed, calms inflammation and slows overactive pigment cells. That mix makes it one of the few ingredients that address acne, rosacea bumps and post-acne marks at once.

The proven products are prescription: a 15% gel for rosacea and a 20% cream for acne and pigment. Over-the-counter serums typically contain 10% or less, or list azelaic acid low in the ingredients, so expect gentler and less certain results.

How strong is the evidence?

Moderate evidence

Prescription 15-20% azelaic acid is backed by multiple randomized trials; the 2024 US acne guideline gives it a conditional recommendation, and a Cochrane review found it probably works about as well as tretinoin but less well than benzoyl peroxide for acne. Evidence at the lower strengths used in cosmetics is sparse.

What it's used for, checked

Acne

Holds up

At prescription strength it matched tretinoin and other standard treatments in trials; weaker than benzoyl peroxide.

Rosacea bumps and redness

Holds up

The 15% gel is an approved rosacea treatment.

Dark marks and melasma

Holds up

20% cream was at least as effective as hydroquinone for melasma in older controlled trials.

Low-strength cosmetic versions work the same

Unproven

Serums around 10% or less have little trial data.

Works well with

  • Niacinamide
  • Sunscreen
  • Benzoyl peroxide or retinoids, as a clinician advises

Who should be careful

  • Stinging, burning and itch are common in the first weeks, especially on rosacea-prone skin, and usually fade.
  • Often suggested as one of the safer acne and pigment options in pregnancy and breastfeeding; confirm with your clinician.
  • Rarely it lightens skin around the treated area in darker skin tones; report unexpected light patches.

The studies

Every citation is checked against its PubMed record.

  1. Azelaic acid. A review of its pharmacological properties and therapeutic efficacy in acne and hyperpigmentary skin disorders.
    Fitton A, Goa KL · Drugs · 1991 · Review

    Reviews azelaic acid, usually as a 20% cream: in controlled studies it matched tretinoin, benzoyl peroxide, erythromycin and oral tetracycline for acne and was at least as effective as hydroquinone for melasma, with mostly mild, transient irritation.

  2. Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha-hydroxy acid) for acne.
    Liu H, Yu H, Xia J, Liu L, Liu GJ, Sang H, Peinemann F · Cochrane Database of Systematic Reviews · 2020 · Systematic review

    49 trials (3,880 people): azelaic acid is probably less effective than benzoyl peroxide and about as effective as tretinoin for acne; evidence for salicylic acid, nicotinamide and alpha-hydroxy acids was low or very low quality, from small head-to-head trials, and no conclusions were reported for zinc or sulphur.

  3. Guidelines of care for the management of acne vulgaris.
    Reynolds RV, Yeung H, Cheng CE, Cook-Bolden F, Desai SR, Druby KM, et al. · Journal of the American Academy of Dermatology · 2024 · Guideline

    The American Academy of Dermatology's acne guideline makes strong recommendations for benzoyl peroxide, topical retinoids, topical antibiotics and oral doxycycline, and conditional (lower-certainty) recommendations for topical salicylic acid, azelaic acid and clascoterone.