Nov 09, 2022 · 5 min read
Meet azelaic acid, a naturally occurring acid found in barley, wheat, and rye—and a multitasking ingredient in the skincare world. It’s kind of a big deal. After all, it has a whole slew of benefits. It has a mild exfoliative effect and helps to unclog pores and treat the bacteria and fungus that can cause acne. It also reduces redness and fades dark spots like melasma and post-inflammatory hyperpigmentation.
Here we’ll explain everything you need to know about how azelaic acid works to treat acne-prone skin and hyperpigmentation (spoiler alert—it’s one of our favorites!). But before we dive into the specifics about azelaic acid for dark spots and the potential benefits of adding it to your skincare arsenal, let’s take a look at what causes hyperpigmentation in the first place.
Hyperpigmentation (dark spots) describes spots or patches on the skin that are darker than your natural skin tone. Post-inflammatory hyperpigmentation, sunspots (aka age spots or liver spots), and melasma are common conditions that cause skin pigmentation changes, but they’re all treatable.
Post-inflammatory hyperpigmentation (PIH) appears after an inflammatory event, like acne. Inflammation can trigger an increase in melanin production.¹ Melanin is a substance in your body that affects skin color. In post-inflammatory hyperpigmentation, dark spots appear where acne lesions (or other types of inflammation) once were.
Sunspots generally occur later in life and are the result of prolonged exposure to the sun.
Melasma typically appears as symmetrical hyperpigmentation on the face and has several possible triggers including sun exposure, hormone treatments (like some types of birth control), and pregnancy. Melasma is sometimes referred to as the “mask of pregnancy,” and while it can resolve a few months after giving birth, it may also persist.²
Azelaic acid for the skin is used topically, and it can be gentler than other exfoliating ingredients like alpha-hydroxy acids (AHAs) and beta-hydroxy acids (BHAs). Azelaic acid treats rosacea and dark spots like PIH and melasma, but it’s also effective in treating acne.³
Technically speaking, it’s a naturally occurring dicarboxylic acid, but it’s almost always synthetically formulated for use in skincare products. Azelaic acid cream is available over the counter or by prescription, depending on the strength.
One of the many benefits of azelaic acid is that it blocks an enzyme called tyrosinase, which is necessary for the production of melanin. Melanin gives skin its color, and too much melanin causes hyperpigmentation. Azelaic acid also has anti-inflammatory, antibacterial, and anti-keratinizing properties, which help treat and prevent clogged pores.
Here’s how azelaic acid works for acne and common skin pigmentation concerns:
Acne. Hyperkeratinization happens when dead skin cells don’t shed as they should, which can result in clogged pores. Azelaic acid’s anti-keratinizing action sheds dead skin cells that clog pores. Its antibacterial properties also fight bacteria that can contribute to pimples. Azelaic acid can be combined with other active ingredients like tretinoin, benzoyl peroxide, or clindamycin for stronger acne-fighting action.⁴
Melasma. Topical applications block the enzyme tyrosinase, which in turn inhibits the production of melanin. This may improve uneven skin tone. It brightens the complexion by targeting hyperpigmented areas of the skin.⁵
Post-inflammatory hyperpigmentation. Its exfoliating properties, combined with its ability to inhibit melanin production, helps reduce the appearance of dark spots due to post-inflammatory hyperpigmentation. Its anti-inflammatory and antibacterial properties also work to treat acne, which can help prevent PIH from occurring in the first place.
Rosacea. The anti-inflammatory properties of azelaic acid have been shown to help reduce inflammatory lesions (papules and pustules) in rosacea.⁶
Skincare is different for everyone—we all have unique skin and skincare goals. That means what works for one person may not work for another. Azelaic acid can be a great choice for people with all skin types, including sensitive skin. Even so, it still helps to go slowly when first starting out. Apply azelaic acid no more than once or twice daily to see how your skin responds. You can also do a patch test prior to using azelaic acid if you have any concerns about how your skin may react.
If you’re new to routine skincare, it may be best to start with a once a day application and under the guidance of a medical professional—like your Curology dermatology provider! Azelaic acid doesn’t replace good skincare habits. You should still use a cleanser and moisturizer—and don’t forget the sunscreen if you’re going outside.
Most dermatology providers say that with a prescription-strength azelaic acid cream, you’ll notice a difference in your skin between six months and a year—although this can vary! While researchers found an improvement in hyperpigmentation in as few as two months,⁷ many variables—like skin type and commitment to a skincare routine—can impact how quickly you see results.
Some people who use azelaic acid to treat acne notice results around four to six weeks, and others start seeing results by the second month of treatment. For more challenging skin conditions, it can take longer. The good news is most people can tolerate products with azelaic acid and it can also be combined with other products to increase its effectiveness. That said, your dermatology provider may recommend that you temporarily stop using certain products as your skin adjusts, like benzoyl peroxide, AHAs and BHAs, vitamin C, retinol, and physical exfoliators.
Yes! Today, Curology treats skincare concerns related to acne, anti-aging, rosacea, and hyperpigmentation. We offer a range of strengths of azelaic acid from 2% to 10% that we combine with other ingredients, like tretinoin and clindamycin, as part of your personalized prescription formula. We’re committed to taking the guesswork out of your skincare routine—licensed dermatology providers work with you to examine your skin, assess your skincare goals, and provide custom treatment options.
Curology is free for 30 days—you’ll get a personalized prescription formula, plus any of our recommended skincare products, for just $4.95 (plus tax) to cover shipping and handling.* That’s a full skincare routine prescribed by your dermatology provider and sent straight to your door.
Hyperpigmentation describes spots or patches on the skin that are darker than your natural skin tone. Post-inflammatory hyperpigmentation, sunspots (aka age spots or liver spots), and melasma are common conditions that cause skin pigmentation changes, but they’re all treatable.
Azelaic acid is a naturally occurring dicarboxylic acid, but it’s almost always synthetically formulated for use in skincare products. It treats rosacea and dark spots like PIH and melasma, but it’s also effective in treating acne.
Azelaic has anti-inflammatory, antibacterial, and anti-keratinizing properties, which help treat and prevent clogged pores, it also blocks an enzyme called tyrosinase, which is necessary for the production of melanin (too much melanin causes hyperpigmentation).
Azelaic acid can be a great choice for people with all skin types, including sensitive skin. Apply azelaic acid no more than once or twice daily to see how your skin responds. If you’re new to routine skincare, it may be best to start with a once-a-day application and under the guidance of a medical professional—like your Curology dermatology provider!
Silpa-archa, Narumol, et al. Postinflammatory hyperpigmentation: A comprehensive overview.Journal of the American Academy of Dermatology. (October 2017).
Gupta, A.D., et al. The treatment of melasma: A review of clinical trials.Journal of the American Academy of Dermatology. (2006, October 4).
Zaenglein, Andrea L., et al. Guidelines of care for the management of acne vulgaris.Journal of the American Academy of Dermatology. (2016, February 17).
Webster, G. Combination azelaic acid therapy for acne vulgaris.The Journal of the American Academy of Dermatology. (2000, August 1).
Sheth, Vaneeta M., Pandya, Amit G. Melasma: A comprehensive update. Part II.Journal of the American Academy of Dermatology. (2011, October 1).
Thiboutot, D., et al. Standard management options for rosacea: The 2019 update by the National Rosacea Society Expert Committee. Journal of the American Academy of Dermatology. (2020).
Hollinger, J.C., et al. Are natural ingredients effective in the management of hyperpigmentation? A systematic review.The Journal of Clinical and Aesthetic Dermatology. (February 2018).
* Subject to consultation. Subscription is required. Trial is 30 days. Results may vary.
Nicole Hangsterfer is a licensed physician assistant at Curology. She obtained her masters in physician assistant studies at the Feinberg School of Medicine at Northwestern in Chicago, IL.
Nicole Hangsterfer, PA-C