Azelaic acid is a compound that can be derived from grains like wheat, rye, and barley. Yet is most often created from chemicals derived from oils or fats. Though typically prescribed as an acne treatment there is evidence to support its effectiveness in the treatment of hyperpigmentation, especially in patients with darker skin tones.
It is becoming a popular treatment method prescribed by dermatologists for this purpose, in addition to its more common uses for rosacea and acne.
Azelaic Acid vs Hydroquinone
Azelaic acid (AzA) is a recommended alternative for those sensitive to using hydroquinone for the treatment of hyperpigmentation or melasma. It is most effective in concentrations of 15%-20% in topical creams or gels. A 20% azelaic acid is said to be comparable to a 2% hydroquinone cream as far as efficacy in reducing area hyperpigmentation. While it is effective in the treatment of melasma, it is not very effective in lightening freckles or age spots. It is also beneficial in treating post-inflammatory hyperpigmentation caused by acne lesions that have left red or brown marks.
Azelaic acid is safe for long-term use and for women who are pregnant, but women who are breastfeeding may be discouraged from using these products. Those with sensitive skin or pre-existing skin conditions like eczema may find it difficult to use this type of product due its irritating properties. However, irritation caused by azelaic acid can be treated with an anti-inflammatory agent.
Azelaic acid is most effective when used in combination with other active ingredients such as retinoids, alpha hydroxy acids, and vitamin C. It may take some experimenting to find the right combination that works best for each patient depending on how they react to the treatment.
Azelaic Acid Side Effects
Common, though temporary, side effects include redness, flaking, and peeling due to excessive skin dryness. Mild itching, tingling, or burning sensations may also develop. These symptoms usually subside over time with repeated use by adjusting the dosage or reducing the number of applications from twice to once daily.
It may be necessary to use another topical ointment (hydrocortisone cream) to counteract these unpleasant adverse reactions, which calms itching, redness, or burning sensations. Allergic reactions are possible especially in those prone to skin allergies.
Patients should always tell their doctors what other medications (over-the-counter and prescription) they are taking before beginning any treatment regimen containing azelaic acid in order to reduce the possibility of drug interactions or allergic reactions.
More severe, yet rare side effects may include the appearance of hypopigmentation (white spots) in darker complexions. There are only isolated reports of such side effects occurring, but patients with darker complexions should be monitored closely, because they are most susceptible to developing hypopigmentation. Any abnormal discoloration of the skin should be immediately reported to a physician along with discontinuation of the product.
Products Containing Azelaic Acid
Some popular name brand azelaic acid skin creams are Azelex and Finacea, which are both only available by prescription only. Azelex is a 20% concentration, whereas Finacea contains 15% concentration in a gel form. Cosmetic skincare products usually contain less than 1% azelaic acid and are available over-the-counter. Prices vary depending on the name brand.
Azelex is a 20% concentration cream available by prescription to be applied twice daily or as otherwise directed. Finacea is a gel that works similarly to Azelex by inhibiting overactive melanocytes, the cells that produce melanin in the skin giving it its color.
GIGI Bioplasma is an over-the-counter azelaic cream with a 15% concentration. The azelaic acid found in this cream is derived from wheat grain, not oils or fats. This cream has received very good reviews from users on Amazon with 6 out of 7 reviews giving a 5 star rating.
Azelaic Acid Reviews
There are mixed reviews on the efficacy of both Azelex and Finacea. Some people claim they work great, but the side effects (itching and stinging) can be difficult to tolerate. Others state that they became more prone to acne breakouts, but did see marked improvement in post-inflammatory hyperpigmentation afterward.
This may explain why azelaic acid is most effective when used in combination with other topical products such as retinoids, which provide proper exfoliation of the pore lining, thus reducing the occurrence of acne.