Medically reviewed by Minimalist Health Specialist -  Written by Arpita Singh (Beauty Expert)  on 12th Dec 2020

No BS Guide to Using Azelaic Acid for Your Skin!

Guide to Using Azelaic Acid for Your Skin

Acne, without any prior notice, can come knocking at your door. Think about the surprise tests that the kids get at school. Not a word of warning, and then on a bright Monday, right at the beginning of a day, they have question papers stuck onto their desks.

Quite similarly, you may wake up one morning and find red bumps on your face, forehead, or other parts of the body. Also, if you have acne-prone skin, the bumps will appear more in the manner of weekly home-works. So, be prepared for the hassles that come with it!

You can also follow some basic steps to prevent acne, and if pimples have already surprised you with an appearance, get down to some action, and introduce new and loyal friends to your skincare routine

How about a friend (a.k.a skincare ingredient) that doesn't irritate you? 

Well, it is rare to find one as such. But you can always trust azelaic acid. It is one of the most gentle acids that goes easy on your skin and builds up a good defense against acne-causing bacteria.

It is a dicarboxylic acid, which occurs naturally, and forms a part of the normal skin's habitat for humans and other animals. The commensal yeast Malassezia furfur, one which neither reaps any benefit for the skin nor causes any harm, produces azelaic acid in the skin. Wheat, rye, and barley can also lead to the systemic availability of azelaic acid in your body. Dietary intake of these generates acid as an end product. Even if you consume the grains daily, your body will get exposed only to minimal amounts of the acid.

Now, azelaic acid (AzA) is also one of the safest skincare ingredients to use. So far, there have been no "system safety signals" issued against it in any part of the world (i.e., to say, it doesn't cause damage to the body if little amounts of it pass into the body circulation). FDA has placed AzA under the pregnancy category 'B,' which indicates that sufficient evidence exists (with tests conducted on the animal models) to prove that it is non-teratogenic. In simple words, AzA neither induces any malformation in a growing human embryo nor causes complications for a lactating mother. It is non-mutagenic and doesn't alter the genetic material or cell DNA in any manner. 

Azelaic acid is a multiskilled ingredient. It can help your skin in different ways.

1) Counters moderate to severe post-inflammatory hyperpigmentation (PIH) 

Azelaic acid has a bias towards the abnormal (hyperactive) melanocytes, which produce an excess of melanin and cause dark patches, spots, or marks on the skin.

Research studies show that azelaic acid can have cytotoxic (this term refers to cell damage) effects on the malfunctioning melanocytes, thereby implicating their various cellular mechanisms. It even hinders the formation of the tyrosinase enzyme, which is responsible for converting tyrosine to melanin. In this way, azelaic acid pins down the excess production of melanin.

You must have heard about hydroquinone being an excellent skin-whitening ingredient. Hydroquinone goes out on all the melanocytes while azelaic acid sweeps out only the dysfunctional melanocytes.

Hence, it is considered a safe and credible agent for reducing the dark spots. It also evens the skin tone. 

2) Acne scars or marks. 

As mentioned earlier, azelaic acid puts a stop to the abnormal melanocytes, controlling their melanin activity.

It also affects the cell turnover rate and encourages the growth of new cells. In a couple of months, you find your acne scars fading and becoming faint. 

3) Bacteria can't dodge azelaic acid. 

Sam Bunting, dermatologist, Skin Care Clinic, London.Says

Dalacin, which contains topical clindamycin, belongs to the earlier generation of skincare products, employed for the treatment of acne. But once it is used for eight weeks, C.acne grows resistant to it, rendering its treatment ineffective. Same is the case with Zineryt, which has azithromycin,You face this problem with many of the topical antibiotics available in the market.

However, azelaic acid eliminates the bacteria without harming the antibiotics in the body. 

4) Deals with mild to moderate acne. 

Now, let's recapitulate a bit on how acne is formed.

The skin cells may multiply at a random rate, leading to the formation of extra keratin. The build-up of dead skin cells, and a mass of keratin in the pores, block the minute openings on the skin. Sebum and other oils get poured into the pores, making the situation worse. C.acne (bacteria usually associated with acne) visit these sites. Which ends up causing inflammation, which contributes to the lesions showing up on the surface. 

Azelaic acid fights acne using the following strategies. 

  • It's anti-keratinizing action removes the excess mass of skin cells from the pores, clearing the blockage. In the process, it helps you diminish the non-inflammatory lesions, i.e., the blackheads and whiteheads. 
  • It kills the aerobic (for example, C.acne bacteria) and anaerobic bacteria; protect your pores from the infection they may cause. 
  • It inhibits the proper functioning of protein structures in the microbes and eliminates them; it doesn't allow them to gather in your skin. 
  • It douses the inflammation and brings relief to acne's inflammatory forms, namely pimples, papules, pustules, nodes, and cysts.

5) Rosacea, to some extent, calms down. 

According to Dr. Andrea Suarez, MD, Colorado

Bacteria that naturally forms a part of the skin biome, produces cytokines which act as chemical messengers. Whenever these cytokines try to alert the skin's immune system, they incite inflammation.

Now, azelaic acid mainly deals with the papulopustular form of rosacea. It kills the bacteria, dousing all the pathways that lead to inflammation.

"It lessens the severity and number of red bumps appearing on the skin but doesn't treat the baseline redness. Overall, it makes the rosacea look a little manageable from its previous situation. Still, it doesn't guarantee a complete reversal of the redness that dominates throughout the condition."

Azelaic acid also takes care of the blood vessels that become apparent on the skin's surface. 

Minimalist tip:

Dust, pollen, sunlight, or any other allergen can trigger a response from your skin's defense system. As far as the sunlight is concerned, try and protect yourself from it. Avoid going out during the peak hours of the day, and if you must, rub in a sunscreen having a minimum of SPF 30.

Or, it may so happen that your skin is hypersensitive and gets you rosacea more often. If so, avoid alcoholic beverages, hot food items, spicy dishes, and drinks such as coffee, tea, etc. 

6) Treats melasma. 

Melasma(also known as the mask of pregnancy) can appear as a ring of brown patches around your nose and covering your cheeks as well. You know, azelaic acid chases down abnormal melanocytes. As a result, the patches lighten and fade away. 

7) Fixes perioral dermatitis. 

Do you know, the unwarranted use of steroids or highly fluorinated toothpaste can give you small, red, pus-filled pimples around your mouth? Well, catch yourself now. They can also spread to the nose, cheeks, and eyes.

Azelaic acid works on flare-ups and brings relief to you. 

8) Doesn't mess with your clothes

You can use azelaic acid without worrying about it staining your clothes or bleaching any article around. 

9) Lesser or no irritation observed. 

Azelaic acid is "locally well-tolerated" and causes no significant disturbance to your skin. It is milder than the AHAs and BHAs.

"For some, benzoyl peroxide may dry their skin to the soul," exclaims Dr. Suarez. "But when you use azelaic acid, you don't need to bother about dryness or irritation."

Another bonus with azelaic acid, it maintains a cordial relation with the other active skincare ingredients. No severe cases of drug interaction have been recorded for it yet.

However, it remains compulsory for the patients to inform their doctors about the entire list of medicines they take or have taken in recent history. 

10) A possible solution for alopecia. 

Loss of hair, accompanied with bald patches - is what the symptoms of alopecia look like. There is no certified evidence that proves the efficiency of azelaic acid in treating alopecia. But we have some convincing studies and anecdotal accounts, all of which point to azelaic acid being useful in treating the hair condition. 

All you should know about the topical use of Azelaic Acid 

Various formulations can contain Azelaic Acid. It's available in gels, creams, and foams. You need a written prescription to avail the higher concentrations, such as a 20% azelaic acid cream or a 15% gel. They are necessarily employed in monotherapies. One can find extensive data supporting these products.

Moreover, products having 10% azelaic acid or less do not have much evidence verifying their performance. You can effortlessly get them over the counter in many drug stores around you. They can act as a helping ingredient, which would supplement the functions performed by the more potent ones in the therapy or administered in an authorized hormonal treatment. The concentration matters, but it shouldn't concern you about the systemic absorption of azelaic acid. As under no circumstances would it exceed 4%.

Reports claim a 20% azelaic acid cream is as working and capable as a 5% benzoyl peroxide, a 0.05% tretinoin, and a 2% clindamycin. 

Note:

Despite being derived from wheat, azelaic acid doesn't initiate a gluten sensitivity or reaction. Field experts hold that it is primarily due to its insignificant absorption through the skin.

The three most popular brands whom you can trust are - Finacea, Azelex, and Finevin. Or, you may get their empirical names, two being - Heptanedicarboxylic acid and Lepargylic acid. 

How do you apply Azelaic Acid?

Dr. Alexis Stephens, the founder of Parkland Dermatology and cosmetic surgeon in Tropical Coral Springs, Florida, has come up with an easy-to-go-along morning routine for people suffering from persistent acne or rosacea. 

  • Start with a 0.5% salicylic acid face wash, and remove your makeup. It also helps to shoot the germs and dirt out of your face.
  • Layer in a vitamin C serum, and pat it dry.
  • Now, apply the azelaic acid cream, foam, or gel. The foam has entered the market not long before and is gentle. It can be applied to other parts of the body as well. 
  • A hydrating moisturizer (which should contain vitamin B3) will come next in the morning ritual. 
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  • Lastly, follow it with a broad-spectrum sunscreen with an SPF 30. Remember, "azelaic acid thins out the stratum corneum (the outermost layer of your skin), reducing its thickness. It makes your skin more tender/sensitive to the sun," warns Dr. Stephens. 

Azelaic acid works in tandem with vitamin C, vitamin B3, salicylic acid, and retinoids.

If you have sensitive skin or using it for the first time, you may want to take it slow. Begin with the acid, applying it only on alternate days. In a day, you should keep the number of applications to a maximum of two. And as your skin gets more accustomed to it, switch to using it daily.

"One can increase the amount of azelaic acid that penetrates through the skin by rubbing in the acid on a dampened surface," Dr. Suarez shares a trick.

It may take a month for the first signs of improvement to show on your skin. But one thing is for sure - if you dedicate yourself to the consistent use of azelaic acid, there are absolute chances for your red bumps or comedones to shed off. The overall treatment may stretch for six months or more to get the maximum results. 

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What does the research say about Azelaic Acid? 

FDA has recently pointed out the benefits of the 15% azelaic acid gel. Some being,

  • Greater stability. 
  • Higher fraction of azelaic acid in each dose, allowing for a better (and an increased) release of the drug. 
  • Achieve bioavailability at a lower concentration. 

Now, let's read about Lentigo Maligna. It is a condition that gives rise to cancerous and precancerous melanocytes and causes dark spots on the skin, which are pretty similar to the sunspots in their shape and size.

According to the preliminary findings of cancer research (conducted in 1986 and 1987), azelaic acid has an antiproliferative effect on the human malignant melanocytes and inhibits cell growth. It also induces damage upon the tumor cells, or at best, kills them, establishing its cytotoxic nature. However, the mechanism behind this selective cytotoxicity is unclear. It requires more studies to reach a definite conclusion.

Yet, some dermatologists don't seem to be too excited about this theory. "Azelaic acid can only lighten the dark patches and will not affect the internal factors. You mustn't content yourself with false optimism and delay a diagnosis. What you are dealing with should be understood and not assumed," cautions Dr. Surez. "Lentigo Maligna calls for specialized treatment. It can be harmful to your skin."

In the (2008) clinical studies carried by the American Society of Health-System Pharmacists, some adults applied the 15% azelaic acid gel twice daily for about 12 weeks. The results came quite in their favor. Those suffering from mild to moderate rosacea observed a reduction of 50%-58% in their papules and pustules.

According to a 1989 study, 20% azelaic acid cream could significantly improve the inflammatory lesions (red, pus-filled bumps). But it failed to produce any change in the symptoms of seborrhoeic dermatitis (eczema).

A few clinical studies (1989) was staged over a group of adults suffering from melasma. "It showed that 20% of azelaic acid was superior to 2% hydroquinone, and it was as effective as 4% hydroquinone, with the latter's undesirable side effects."

In another set of experiments, a combination of azelaic acid and tretinoin was used for three months. It came out that tretinoin enhanced azelaic acid activity, and the two worked together to produce more skin lightening. 

Azelaic Acid and its Side Effects 

Mild symptoms, including pruritus (irresistible urge to scratch a body part), burning, and stinging, can annoy you in the first few weeks of the therapy. However, they subside soon. In case the irritations grow severe and become recurrent, quit the applications. And visit your dermatologist first.

Severe symptoms may occur too. But they have been identified in extremely small numbers.  

However, they can be held accountable for the following conditions to worsen:

  • Asthma. 
  • Vitiligo (loss of skin color in blotches, as the pigment-producing cells have already died or have stopped functioning).
  • Hypertrichosis (excessive hair production/growth, all over the body, or isolated to small patches). 
  • Keratosis pilaris (rough patches and small, acne-like bumps on the skin). 
  • Herpes labialis (infection with the herpes simplex virus around the border of the lips). 

Azelaic acid has not been studied well in people having dark complexions.

There have been individual cases wherein some patients have registered hypopigmentation after the use of azelaic acid. It is characterized by abnormal loss (or change) in skin color. At the same time, some get to suffer from rebound hyperpigmentation. In either of the above, people should immediately report their symptoms to the doctor. 

The Bottom Line 

A few incidents reveal that azelaic acid causes severe irritation to the eyes. So, make sure that the acid doesn't reach your eyes or comes in contact with your nose or other mucous membranes.

Dermatologists highly recommend avoiding using harsh cleansers, exfoliants, astringents, or abrasive soaps, while undergoing a treatment involving azelaic acid. Either concerning the particular parts, where you apply the acid or on the whole. Even waxing the part can lead to problems.

"You should know that azelaic acid does not affect the rate of sebum (oils) production in the skin. It doesn't address the biology of hormones signaling to the oil glands," clarifies Dr. Suarez.

Azelaic acid works slow, and hence takes a considerable amount of time to give results; probably, it is one of its most notable caveats. It fails to secure a place for itself in the first choice of medications suggested by a dermatologist for acne.

Yet, it remains a reliable skincare ingredient with sufficient research data and trials to back it up. In the skincare world, it never quite gets the attention that it deserves. But it is still one of the humblest and most patient ingredients and is definitely worth giving a try. 

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