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.

Uses of 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 for acne scars

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 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 side effects and precautions

Azelaic acid can cause side effects, including:

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

What are the benefits of azelaic acid?

“Azelaic acid is effective against a number of skin conditions, such as mild to moderate acne, melasma and rosacea,” Dr. Thiede said. “More recent research shows it may even help with hidradenitis suppurativa, alopecia, keratosis pilaris and psoriasis vulgaris.”

It is very safe and gentle, with minimal side effects. Azelaic acid is one of the few treatment options that can be used in children and people who are pregnant or breastfeeding. 

“This is great for pregnant people as many options we typically use for acne treatment aren’t safe in pregnancy,” Dr. Thiede said.

Here’s how azelaic acid helps your skin:

• Reduces inflammation. Azelaic acid can counter or neutralize free radicals that cause inflammation. It has significant skin-calming effects and helps to improve redness.
• Evens skin tone. It decreases pigmentation, inhibiting an enzyme called tyrosinase that leads to hyperpigmentation, or dark patches of skin. This is why azelaic acid is great for acne breakouts, post-acne scarring and melasma.
• Fights acne. Azelaic acid kills bacteria on your skin that cause acne. “It decreases the activity of bacteria called Propionibacterium, the bacteria found in acne, due to its bacteriostatic (limits the production of bacteria) and bactericidal properties (kills bacteria),” Thiede said