Azelaic acid is a naturally occurring acid found in grains such as barley, wheat, and rye.

It has antimicrobial and anti-inflammatory properties, which make it effective in the treatment of skin conditions like acne and rosacea. The acid can prevent future outbreaks and clean bacteria from your pores that causes acne.

Azelaic acid is applied to your skin and is available in gel, foam, and cream form. Azelex and Finacea are two brand names for prescription topical preparations. They contain 15 percent or more of azelaic acid. Some over-the-counter products contain smaller amounts.

Because it takes some time to take effect, azelaic acid by itself isn’t typically a dermatologist’s first choice for treating acne. The acid also has some side effects, such as skin burning, dryness, and peeling. Keep reading to find out everything you need to know about using azelaic acid for acne.

Azelaic acid works by:

  • clearing your pores of bacteria that may be causing irritation or breakouts
  • reducing inflammation so acne becomes less visible, less red, and less irritated
  • gently encouraging cell turnover so your skin heals more quickly and scarring is minimized

Azelaic acid can be used in gel, foam, or cream form. All forms have the same basic instructions for use:

  1. Wash the affected area thoroughly with warm water and pat dry. Use a cleanser or mild soap to make sure the area is clean.
  2. Wash your hands before applying the medication.
  3. Apply a small amount of medication to the affected area, rub it in, and let it dry completely.
  4. Once the medication has dried, you can apply cosmetics. There’s no need to cover or bandage your skin.

Keep in mind that you should avoid using astringents or “deep-cleansing” cleansers while you use azelaic acid.

Some people will need to apply the medication twice per day, but this will vary according to a doctor’s instructions.

Some people use azelaic to treat acne scarring in addition to active outbreaks. Azelaic acid encourages cell turnover, which is a way to reduce how severe scarring appears.

It also prevents what’s known as melanin synthesis, the ability of your skin to produce pigments that can vary your skin’s tone.

If you’ve tried other topical medications to help with scarring or blemishes that’re slow to heal, azelaic acid might help. More research is needed to understand who this treatment works best for and how effective it can be.

Azelaic acid is also used for other skin conditions, such as hyperpigmentation, rosacea, and skin lightening.

Azelaic acid for hyperpigmentation

After a breakout, inflammation can result in hyperpigmentation on some areas of your skin. Azelaic acid stops discolored skin cells from populating.

A pilot study from 2011 showed azelaic acid can treat acne while evening out hyperpigmentation triggered by acne. Further research on skin of color has also shown that azelaic acid is safe and beneficial for this use.

Azelaic acid for skin lightening

The same property that makes azelaic acid effective for the treatment of inflammatory hyperpigmentation also enables it to lighten skin that’s discolored by melanin.

Using azelaic acid for skin lightening in patchy or blotchy areas of your skin due to melanin has been found effective, according to an older study.

Azelaic acid for rosacea

Azelaic acid can reduce inflammation, making it an effective treatment for symptoms of rosacea. Clinical studies demonstrate that azelaic acid gel can continually improve the appearance of swelling and visible blood vessels caused by rosacea.

Azelaic acid can cause side effects, including:

  • burning or tingling on your skin
  • peeling skin at the site of application
  • skin dryness or redness

Less-common side effects include:

  • blistering or flaking skin
  • irritation and swelling
  • tightness or pain in your joints
  • hives and itching
  • fever
  • difficulty breathing

If you experience any of these side effects, stop using azelaic acid and see a doctor.

It’s always important to wear sunscreen when you go outside, but be especially mindful to wear SPF products when you’re using azelaic acid. Since it can thin your skin, your skin is more sensitive and prone to sun damage.

Azelaic acid isn’t for everyone. The effectiveness of the treatment may depend on your:

  • symptoms
  • skin type
  • expectations

Since it works slowly, azelaic acid is often prescribed along with other forms of acne treatment.

According to older research, azelaic acid cream may be as effective as benzoyl peroxide and tretinoin (Retin-A) for the treatment of acne. While azelaic acid results are similar to those of benzoyl peroxide, it’s also more expensive.

Azelaic acid also works more gently than alpha hydroxy acid, glycolic acid, and salicylic acid.

While these other acids are strong enough to be used on their own in chemical peels, azelaic acid isn’t. This means that while azelaic acid is less likely to irritate your skin, it also has to be used consistently and given time to take effect.

Azelaic acid is a naturally occurring acid that’s milder than some more popular acids used to treat acne.

While the results of treatment with azelaic acid might not be obvious right away, there is research that points to this ingredient as effective.

Acne, uneven skin tone, rosacea, and inflammatory skin conditions have all been shown to be effectively treated with azelaic acid. As with any medication, follow the dosing and application directions from your doctor closely.