Azelaic acid: how to reduce blackheads and other skin blemishes

Why is azelaic acid effective for acne and rosacea? Are those the only cases where it does a good job? Learn what it can do for you regardless of your skin type! The power of azelaic acid goes beyond diminishing the underlying inflammation of acne and rosacea-prone skin. And it’s easy to introduce in any skincare routine. But a good formulation matters a ton.

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Last updated: May 23, 2023

Hi! As you might remember, I’m one of those people with oily and rosacea-prone skin.

By the end of last summer, I noticed enhanced greasiness in my oily T-zone and also rosier cheeks with a hint of melasma. So I found the perfect moment to try azelaic acid, which I’d never used before.

The results have impressed me and I wanted to share them with you – that was part of the inspiration for this post. Also, azelaic acid is suitable for any skin type. So keep reading!

What is azelaic acid (AZ)?

Azelaic acid is a dicarboxylic acid. That means that it has two carboxyl groups (aka, -COOH), one at each side of the molecule (see the image below). Malassezia fungi – which are part of our cutaneous microbiome (the microorganisms that populate the skin) – produce azelaic acid.

Thus, azelaic acid is naturally present in our skin. However, there are other natural sources of azelaic acid: for instance, cereals such as wheat, rye, and barley.

Azelaic acid in dealing with an upset skin barrier

Even the more balanced skin will sometimes experience a disturbed skin barrier.

The skin barrier are the physical, chemical, and microbial layers and components of the epidermis and protect us from environmental aggressors, infections, and excessive water loss.

Regardless of your skin type, the skin barrier can get upset by certain environmental conditions or other factors. For example, the dry weather in the winter (if you want to learn more about that read my article Power molecules that fortify your winter skin).

The acidic pH (4-6) of our stratum corneum (the most external, dead layer of the skin) is essential to keep the enzymes and processes of the epidermis working properly.

When the skin barrier gets disturbed, the pH increases (becomes less acidic). That occurs in inflammatory skin diseases and also when there is some other kind of dis-ease in the epidermis.

A too elevated pH happens not only in typical inflammatory conditions – such as atopic dermatitis, irritant contact dermatitis (that arises when you get in touch with irritant substances), rosacea, or acne – but also in aged or dehydrated skin.

The acidification of the skin restores, at least to some degree, that unbalanced pH and skin barrier impairment.

Azelaic acid acidifies and hence strengthens the epidermal barrier. And regulates epidermal processes, improving different skin issues.

Therefore, having the right amount of Malassezia in your skin is a great thing! And azelaic acid is a good skincare ingredient.

How does azelaic acid work in the skin?

Azelaic acid affects the behavior of the cells of the epidermis: 

– keratinocytes (the cellular bricks that comprise the epidermis wall and produce keratin);

– melanocytes [located in the innermost layer of the epidermis, they produce the pigment melanin and thus give color to the skin];

– and bacteria and other microorganisms that make our skin struggle (when in the wrong quantity or conditions) or thrive (when in the right quantity and environment).

The keratins are the main proteins of the epidermis and endow the stratum corneum (the outermost layer of the skin) with its hard, protective consistency.

Azelaic acid has keratolytic properties: it helps to get rid of excess keratin. In other words, it has a mild exfoliating effect that evens out the skin surface – and works particularly well within the hair follicles (the pores, where hairs arise).

In the hair follicles, azelaic acid reduces keratinocyte over-proliferation, and thus, keratin over-production. That also diminishes any inflammation within the follicle (for example, in an acne lesion or pimple). 

Deep down the hair follicles are the sebaceous glands (that secrete oil to the skin surface through the hair canal).

By getting rid of excess keratin, azelaic acid prevents the formation of plugs of sebum and keratin – that stick together and clog the pore forming those annoying blackheads and whiteheads that you and me know – .

Therefore, azelaic acid also has a comedolytic effect: it helps unclog pores and minimize inflammation within them. And the azelaic power doesn’t end there!

In addition, azelaic acid has anti-microbial properties. In particular, among other bacteria (like Staphylococcus epidermidis), it kills Cutibacterium acnes, which grows within the hair follicles and causes acne. Besides, azelaic acid appears to knock off Demodex mites, which cause rosacea.

Another outstanding thing about azelaic acid is that it blocks melanogenesis by inhibiting the enzyme tyrosinase, which is indispensable for melanin production. That’s why azelaic acid can fade cutaneous hyper-pigmentation (dark spots).

But wait! You’ll see now how many headaches you can ditch with AZ.

When is azelaic acid worth a try?

Chances are you’ll like AZ if you are in any of the following situations.

1 · Post-Inflammatory Hyperpigmentation (PIH)

Cutaneous inflammation, such as in acne lesions, can over-activate surrounding melanocytes. As a result, those melanocytes generate too much melanin. And that excess pigment deposition resulting from inflammation is called Post-Inflammatory Hyperpigmentation (or PIH).

PIH is more pronounced in people with medium and dark skin tones. The good news is that azelaic acid, thanks to its anti-melanogenesis and anti-inflammatory properties, can deal gently and effectively with that.

But you’ll have to be patient! Azelaic acid is softer than other skin-depigmenting ingredients, such as hydroquinone. Therefore you’ll have to apply it consistently for months to fade any dark spots.

Azelaic acid can effectively counteract PIH resulting from acne lesions, cosmetic procedures (such as lasers), dark spots from sun exposure, or even scars (surgical or traumatic).

2 · Melasma

Melasma is another skin hyperpigmentation (you can see it in the image below).

It most often happens in women. Sexual hormones (such as estrogens) and pro-inflammatory molecules induce too much melanin production in localized areas of the skin (usually the cheeks, nose, and upper lip regions).

Melasma happens in people whose skin tans in the sun (you might never experience it if your skin is quite fair) and can be very persistent. Pro-inflammatory molecules released in the skin upon exposure to ultraviolet, infrared, and blue light from the sun accentuate melasma.

Azelaic acid might be a good option if you have sensitive skin with melasma and depigmenting skincare ingredients such as hydroquinone or kojic acid don’t work for you.

Indeed, azelaic acid has proven to be as effective as hydroquinone for melasma in peer-reviewed scientific studies (find them at the bottom of the article).

Due to its gentleness, you’ll likely enjoy azelaic acid in your skincare routine. Just because of that, it’ll be easy to comply with its daily use.

And importantly, it’s safe in pregnancy, when melasma often appears.

3 · Acne-prone skin

As I told you before, azelaic acid reduces the bacterial and cellular over-growth within hair follicles that causes acne. It also diminishes the inflammatory component of acne. And the excess oil that results from the over-activation of the sebaceous glands. 

But it doesn’t target the hormonal component of acne. However, it’s usually effective for mild to moderate acne.

Most likely, it’ll prevent and treat occasional breakouts if you have acne-prone skin. AZ will help keep your skin under control!

In fact, in well-done scientific studies topical azelaic acid (a 20% cream) was as effective as 0.05% tretinoin (retinoic acid) , 5% benzoyl peroxide, or 2% erythromycin, which are all common effective treatments for acne.

4 · Blackheads

Azelaic acid is a blackhead eraser, I love it!! Its comedolytic and anti-inflammatory properties make azelaic acid efficacious for eliminating blackheads regardless of your skin type.

So, if you have dry skin but still get those nasty black dots on your nose, go ahead and apply azelaic acid over that area!

5 · Rosacea

Topical azelaic acid is excellent if you have rosacea, especially inflammatory rosacea (also called acne rosacea).

Due to its keratolytic, antimicrobial, and anti-inflammatory properties, it clears the tiny whiteheads of acne rosacea and helps with the skin swelling and redness of any type of rosacea.

However, it won’t get rid of your dilated blood vessels or facial telangiectasias – you’ll need a laser or IPL (Intense Pulsed Light) procedure for that.

By the way, you can learn more about the different subtypes of rosacea here.

We also know that 15% azelaic acid reduces the excessive amount of the cathelicidin peptide, present in the skin with rosacea. And diminishes the activity of an enzyme (kallikrein 5) that cuts cathelicidin.

The thing is that the peptide resulting from the cleavage of cathelicidin (called LL-37) makes rosacea become worse: LL-37 gives rise to new, prone-to-dilate superficial blood vessels.

And people that have higher levels of kallikrein activity (and thus more LL-37) tend to have more rosacea symptoms. So azelaic acid is such a game-changer for rosacea!

In addition, 15% azelaic acid can be as effective as topical metronidazole (an antibiotic and a gold-standard treatment for rosacea).

In Europe, you can purchase 15% azelaic acid over-the-counter (and up to 10% in the USA). If you have rosacea, don’t wait, buy it!! Azelaic acid will improve your life.

6 · Uneven skin tone or texture

If you have trouble dealing with topical hydroxy acids (such as glycolic or salicylic acids) or can’t put up with common skin depigmenting ingredients, try azelaic acid.

To benefit from a regular mild peel & polish, apply azelaic acid once a day. For deeper depigmenting purposes, you’ll require more potency: try 10-15% azelaic acid twice a day. You can apply it only on localized areas (such as dark spots).

Azelaic acid smooths out the skin surface gently, but remember that sunscreen is mandatory. Otherwise, all your skincare efforts will be worthless!

My experience using a 15% azelaic acid serum

You can combine azelaic acid with many skincare ingredients, including retinol or hydroxy acids (such as glycolic acid). It’s easy to introduce into your skincare routine, especially if you just apply it on localized regions (such as the nose or chin).

Unless you happen to be allergic to it – something that may occur with any skincare ingredient – you’ll probably like it and your skin will benefit from it.

I apply azelaic acid in the morning, after I wash my face. I do it on my T-zone (the forehead, nose, and chin – which is oily and rosacea-prone). And on the cheeks, where I have vascular rosacea and melasma.

Here’s the azelaic acid product I use: Lumizela A15 Serum (with 15% azelaic acid) from Facetheory.

When I saw the product texture, I thought it might be too thick for me (it’s not an entirely liquid serum). But it isn’t! After a gentle massage, it gets quickly absorbed into the skin.

During the first weeks, I occasionally experienced mild itchiness or redness that went away shortly after application. On the first days, the itchiness was more intense. 

Azelaic acid leaves a matte finish on the skin. I love it!! The serum from Facetheory leaves also a velvety finish and doesn’t feel tight or dry. When you apply moisturizer on top of it (you might need less of that), the skin tone and texture look more even.

The best is that I noticed results almost immediately: my skin discoloration – redness mainly – faded, although not completely. And now my skin is less oily and inflamed.

Besides, this serum swiftly eliminates the blackheads on my nose. At the same time, the areas of my skin that aren’t oily don’t feel tight or dry.

This azelaic acid serum includes significant amounts of glycerin – a top skin humectant –, colloidal oat – a medical-grade skin-soothing ingredient – and green tea extract (all of them included in my list of top science-proven ingredients for sensitive skin).

Those ingredients contribute to the gentleness and non-drying features of this high-strength azelaic acid serum.

If you try azelaic acid and notice any enhanced skin dryness, don’t use it every day. Apply it for example every other day instead.

That could happen to you in the beginning, until your skin gets used to it. Introduce azelaic acid slowly in your skincare routine until you find the right pace for your skin and skincare goals (hyperpigmentation requires more patience).

And that’s it! Azelaic acid will have its place in my skincare routine for a long time. Now I can’t live without this blackhead eraser, as I call it 😉

Have you tried azelaic acid? How was your experience? Please leave your comments below!

Take care and see you soon!

María

REFERENCES –AZELAIC ACID SKIN BENEFITS

Cathelicidin, kallikrein 5, and serine protease activity is inhibited during treatment of rosacea with azelaic acid 15% gel. Alvin B Coda et al., J Am Acad Dermatol, 2013; 69 (4): 570-7.

Comparative study of therapeutic effects of 20% azelaic acid and hydroquinone 4% cream in the treatment of melasma. Farshi S, J Cosmet Dermatol, 2011; 10 (4): 282-7.

The efficacy and safety of azelaic acid 15% foam in the treatment of facial acne vulgaris. Peter W Hashim, J Drugs Dermatol, 2018; 17 (6): 641-645.

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