Azelaic Acid For Skin: Uses, Benefits & Risks

A pimple shows on the face, or any part of the body, and there you go opting for face acids. Be it the AHAs' or the BHAs.' You want your acne to disappear. And using acids, you get on a mission to eradicate the bumps. Also every time, these may not be acne. Rosacea, a skin condition, also has similar symptoms.

Moreover, acids or other acne treatments come with their bandwagon of side effects—the dryness and irritation, predominating. At times, they make you feel highly uncomfortable.

You may wish for an acid that is mild and gentle in its approach.

Well, your prayers have been heard! As there exists an acid, backed with research theories. For a fact, it doesn't prick your nerves much during the treatment. 

Let's familiarise ourselves more with this acid

Azelaic acid (AzA) is a multifunctional ingredient in the skincare world. It has never enjoyed much attention though. In many cases, even the dermatologists don't recommend it as their first choice, owing to the long duration of time it takes to work.

Yet, there are no doubts regarding its efficacy. According to a study, a 20% azelaic acid is as effective as a 5% benzoyl peroxide, 0.05% tretinoin and 2% clindamycin.

Azelaic acid is naturally found in grains - wheat, barley and rye. Malassezia Furfur, a yeast that is a part of our skin's biome, also produces the acid. But for skincare products, it is usually derived from a lab-engineered source.

The topical application of azelaic acid products registers their systemic absorption, at 4% in the body. This acid is available in creams, gels and foams (being the latest entry into the market). You need a definite prescription to buy higher concentrations, such as a 20% (cream) or a 15% (gel). These have sufficient data to support them. Whereas, the products having 10% azelaic acid or less, lack proper studies.

They are readily available over the counter and can play a supplemental role alongside a more potent ingredient in the therapy. 

The Many Benefits of Azelaic Acid

1) Fights mild to moderate acne 

Why is acne formed? A little revision, 

• Hyper-proliferation of the skin cells occurs, i.e., to say, the skin cells multiply at an overactive rate. 
  
• Dead skin cells and extra keratin clog the pores. 
  
• Sebum and other oils, get dumped into the pores. 
  
• C.acne (bacteria associated with acne) arrives. 
  
• Inflammation occurs. 
  

How does azelaic acid help you? 

• It is anti-keratinizing in nature. As a result, it removes the excess mass of skin cells from the pores - unplugging them. It helps you to get rid of the non-inflammatory lesions, the blackheads and whiteheads. 
  
• It is bactericidal and essentially kills acne.
  
• It inhibits the protein synthesis in microbes, and prevent them from further attacking your skin. 
  
• It dials the inflammation down and is beneficial to treat inflammatory acne, including papules, pustules, cysts, etc. 
  

2) Post-inflammatory hyperpigmentation (PIH), moderate to severe

Azelaic acid has an affinity for the abnormal (hyperactive) melanocytes, which produce an excess of melanin giving rise to dark spots, marks, or any other blotch on the skin.

Azelaic acid has cytotoxic effects on these melanocytes, i.e., it inhibits their cellular mechanisms and destroys them. It also impedes the formation of tyrosinase enzyme, which plays a key role in the conversion of tyrosine to melanin—thereby pulling the breaks on the increased formation of melanin.

Hydroquinone hits all the melanocytes. But azelaic acid goes for a selective approach, and hence, is deemed gentle and safe. It lightens the dark spots and evens the skin tone. 

3) Acne scars, or marks

Azelaic acid keeps a check on the abnormal melanocytes and suppresses their melanin activity.

It even helps to increase the process of cell turnover and promotes the growth of new cells. What you get as a result - the acne marks fade over a considerable period. 

4) Bacteria can't develop resistance to azelaic acid

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

Zineryt, which contains azithromycin, and Dalacin which contains topical clindamycin, belong to the earlier generation of skincare products meant for the treatment of acne.

After 8 weeks of use, acne becomes resistant to these ingredients and stops responding 

With most of the antibiotics, you get the same headache. Fortunately, the azelaic acid works as a bactericide without harnessing the antibiotics in the body. 

5) Rosacea, mainly the papulopustular form

"Rosacea is an upregulated, innate response of the skin's immunity system. It acts to defend us from the environment but goes off prematurely. Even the wind, sunlight, or anything but an irritant can easily trigger it, owing to its hypersensitivity," says Dr. Bunting.

How does azelaic acid help you? 

Dr. Andrea Suarez, MD, Colorado,Quotes

Natural bacteria living on the skin produces cytokines, that are chemical messengers and they usually in an attempt to alert the immune system, incite inflammation

Azelaic acid kills the bacteria, dampening all the pathways that lead to inflammation.

"It reduces the number and severity of the red bumps, that surface on the skin. However, it doesn't have much effect on the baseline redness. It may improve the appearance, but cannot help you get rid of the redness completely," clarifies Dr. Suarez.

- Azelaic acid improves the condition of the blood vessels that become apparent from under the skin. 

Minimalist tip:

If you suffer from rosacea, avoid alcoholic beverages. Hot food items, spicy dishes and drinks such as coffee, tea, etc. should not be taken.
Protect yourself from the sun, and, if possible, avoid going out during the day hours. Use a proper sunscreen anytime you step out. 

6) Perioral dermatitis calms down

Often at times, using wrong skincare products can affect you badly. The inappropriate use of steroids or highly fluorinated toothpastes can lead to small, red, pus-filled bumps around the mouth. It can also spread to the nose, cheeks or eyes.

Azelaic acid suppresses the flare-up and goes for an in-depth cure to it. 

7) Melasma gets a relief

Azelaic acid hunts the abnormal melanocytes down and lightens the brown patches formed on the face.

8) Locally well-tolerated

Azelaic acid is milder than AHAs and BHAs. You don't have to undergo much of the irritation and dryness.
A gold bonus with the azelaic acid is that it works well with all the active ingredients. No severe drug interactions have been recorded so far.

However, before bringing the acid into your cabinet, inform your dermatologist about all the medicines you take and the courses you follow. 

9) No staining/bleaching on the skin or clothes

You can use azelaic acid hassle-free, and it will not affect the clothes you wear, your skin, or any surrounding article. 

10) A solution for alopecia

Hair loss, along with bald patches, is what alopecia looks like in real life. There is no definite evidence, which confirms azelaic acid treats the condition. Yet, few studies reveal that this compound is in connection with hair maintenance and regrowth. 

How do you apply azelaic acid? 

 Dr. Alexis Stephens, founder of Parkland Dermatology and cosmetic surgeon in Tropical Coral Springs, Florida.Says:

A morning routine for the ones having acne or rosacea-prone skin

• Use a 0.5% salicylic acid face wash to get rid of the makeup, dirt and germs.
  
• Follow it with a vitamin C serum, and pat it dry. 
  
• Put on the azelaic acid cream, gel or foam. (The foam is gentle, and is usually applied on the other parts of the body.) 
  
• Rub in any hydrating moisturizer containing vitamin B3 real quick.
  
• Back it up with a sunscreen with an SPF 30. 
  

The azelaic acid reduces the thickness of stratum corneum, the outermost layer of your skin. It makes you more sensitive to the sun," summarises Dr. Stephens.

Azelaic acid works with the ingredients - vitamin C, vitamin B3, and salicylic acid in a beneficial synergy.

NOTE:

If you have sensitive skin, start with the acid on alternate days. You can use it to an optimum twice daily. As your skin adapts to the acid, you can go for applications on an everyday basis. 

"To increase the penetration of azelaic acid into the skin, apply it on dampened skin. This way, it will be able to work more effectively," recommends Dr. Suarez.

Dermatologists can employ azelaic acid in the monotherapy for acne, or in a combination therapy involving other active ingredients, or in an authorized hormonal treatment. 

• Results 

Use it consistently, and you get to see the acne skewing off, be it the comedones or the red bumps. It may take a month or two for the first signs to appear.

The overall treatment should be carried for at least 6 months or more, to get the maximum results. 

Side effects that may affect you

Hypersensitive tendencies of the skin may develop.

Skin irritation includes pruritus (irresistible urge to scratch a body part), burning or stinging occurs in the first few weeks of treatment. However, these symptoms subside soon.

In case the irritation becomes severe and persistently grows, discontinue the applications. And visit your doctor right away.

With the azelaic acid therapy, you may, in the faintest possibility, can experience your asthma condition getting worse. If it happens for real, consult a physician on the spot.

A study states, people with a dark complexion, have large sebaceous glands. It leads to more sebum production on their skin, which makes them highly susceptible to post-inflammatory hyperpigmentation.

During the treatment with azelaic acid, they may experience an abnormal change in skin color or may suffer from rebound hyperpigmentation. Such cases are to be immediately reported to the doctor. 

It would be wise to exercise caution

"The azelaic acid reduces the thickness of stratum corneum, the outermost layer of your skin. It makes you more sensitive to the sun," summarises Dr. Stephens. The acid may not be photodynamic, but you need to wear a proper sunscreen (SPF 30).

There have been a few incidents when it has caused severe irritation in the eyes. So, avoid its contact with the eyes, nose, mouth or other mucous membranes. 

Minimalist Tip:

Avoid using astringents, abrasive soaps, harsh cleansers or exfoliants on the area undergoing the treatment. Nor, wax it. You don't need to wrap any dressing or bandage on the affected area. 

Lentigo Malignant Melanoma can give rise to several precancerous or cancerous melanocytes. They show on the skin in the form of dark spots, quite similar to sunspots.

"Azelaic acid can only lighten the dark patches erupting on the skin. But they will not impact the disease in any way. Don't satisfy yourself with false optimism, and delay diagnosis. What you are dealing with should be understood and not assumed," warns Dr. Suarez.

Lentigo Melanoma calls for specialized treatment. They are harmful to your skin, quite unlike the sunspots. 

The Bottom Line 

"Remember, azelaic acid does not affect the rate of sebum (oils) production in your skin. Nor does it address the biology of hormone signaling to the oil glands," explains Dr. Suarez.

Why is it a favorite for many? One good reason is that it is non teratogenic. It has no adverse effect on new-born babies. This also ensures that it can be used during the critical phases of pregnancy and lactation. It is still advised to check facts with your doctor, before getting started.

It works slow and takes considerable time to produce results. It is mostly combined with retinoids.

Azelaic acid has been one of the most underrated ingredients in the skincare world. But when you test its abilities, it sure retorts. And with results so positive that you don't seem to have any issues with it. You simply applaud the acid for its virtues!