Azelaic Acid: What It Does and How to Use It

Azelaic acid is a topical medication that fights bacteria, calms inflammation, and lightens dark spots. People use it for acne, rosacea, and post-inflammatory hyperpigmentation. It works differently from benzoyl peroxide and retinoids, so it’s a useful option if other treatments irritate your skin.

How azelaic acid helps: quick facts

It kills acne-causing bacteria and reduces swelling in the skin. It also slows the pigment cells that cause brown spots, so it’s helpful for melasma and dark marks after pimples. Typical strengths are 10% (often OTC), 15% gel (common prescription form), and 20% cream (prescription in some countries).

Clinical use usually shows visible improvement after 8–12 weeks. For rosacea, a 15% gel can reduce redness and bumps when used consistently.

How to use azelaic acid safely

Start with clean, dry skin. Apply a pea-sized amount for the whole face (not just spots), once or twice daily depending on the product instructions. If your skin is sensitive, try every other day at first, then increase frequency. Avoid getting it in your eyes, mouth, or broken skin.

Combine with a gentle moisturizer to reduce dryness and irritation. Use sunscreen every morning — azelaic acid can make your skin more prone to sun sensitivity when you’re treating pigmentation.

Mixing tips: many people use azelaic acid with benzoyl peroxide or topical retinoids, but that can raise irritation. If you want to combine treatments, alternate them (morning vs evening) or introduce one product at a time and watch for redness or peeling.

Patch test: apply a small amount behind your ear or on the inner forearm for 48 hours. If you get severe redness, swelling, or blistering, stop and ask a clinician.

When to see a doctor: if your skin gets very painful, has spreading redness, or shows signs of infection, stop the product and seek medical advice. Also talk to your doctor before starting azelaic acid if you are pregnant or breastfeeding — data is limited and a clinician can advise you.

Common side effects are mild burning, stinging, itching, or dry skin. Rarely, azelaic acid can cause lightening of skin beyond the treated area. If you notice unexpected color changes, consult your provider.

Want to pick a product? OTC 10% creams are a good start for mild concerns. For stronger or persistent issues, a 15% gel or 20% cream prescribed by a clinician may work better. Follow instructions and give it time — results usually build over weeks, not days.

Looking for more answers? Check our linked guides and reviews on topical acne treatments, rosacea options, and pigmentation care to compare pros and cons and find what fits your skin routine.