A Dermatologist-Approved Beginner’s Guide to Using Azelaic Acid for Acne
Everything you need to know about how to use it safely and effectively
Key Takeaways:
Azelaic acid is a multi-functional active that targets inflammation, clogged pores, post-acne marks, and bacterial growth.
It’s stronger than mild exfoliating acids but less potent and harsh than stronger treatments like retinoids.
It is generally well tolerated and suitable for long-term use in acne-prone skin.
Visible improvements in redness, texture, and post-acne marks typically take 1–3 months of consistent use.
While effective, azelaic acid does not “cure” acne; long-term management requires addressing root causes beyond topical treatment.
Disclaimer: I am not a dermatologist. All information in this newsletter is based on scientific research and approved by our in-house board-certified dermatologist. Any advice shouldn’t be treated as prescriptive for your acne, since acne treatment depends on individual context. Kindly consult a dermatologist to understand your skin condition and the severity of your acne before using potent skincare actives.
If you would like to consult our dermatologist, comment or DM us.
The last time I wrote a dermatologist-approved guide to benzoyl peroxide for acne, many of you wrote to me (and even commented) saying it was helpful. A lot of you also asked for more such derm-approved guides for acne-prone skin - so here I am, with another one.
If you’ve had (or currently have) acne, chances are you’ve heard of ‘azelaic acid’ or seen people use it in some shape or form on your Instagram explore page. Some years ago, this skincare active was mostly limited to dermatology clinics and pharmacy prescriptions. OTC formulations were rare, and people were unaware of its benefits.
But today, it is one of the most consistently recommended active ingredients to fight redness, post-acne marks and acne-causing bacteria. If you’ve ever wondered why dermatologists keep coming back to ‘azelaic acid’ when treating acne-prone skin – although stronger acne treatments are available - this derm-approved guide is for you.
What is Azelaic Acid?
Azelaic acid is a dicarboxylic acid known for its anti-microbial, anti-inflammatory, and pore unclogging activity in the case of acne. Though it is a naturally occurring acid found in wheat, barley, and rye, the lab-synthesised version is the one that makes it to all skincare formulations owing to its superior stability and efficacy.
Why Do Dermatologists Love Azelaic Acid?
Azelaic acid is a multi-functional active that’s not as strong or harsh as retinoids and not as weak as PHAs (mild exfoliating acids). If you were to imagine a spectrum of harshness, azelaic acid would lie somewhere in between.
Dermatologists love it because azelaic acid can be used consistently and long-term. It has several uses for acne-prone skin:
Helps fade post-acne marks and uneven skin tone.
Calms inflammation and redness caused by acne lesions.
Helps prevent clogged pores by reducing the buildup of dead skin cells.
Helps inhibit the growth of acne-causing bacteria, reducing the occurrence of acne.
NOTE: Azelaic acid is available in both OTC and prescription strengths. OTC formulations typically contain < 10% azelaic acid and are used for mild acne, redness, and post-acne marks. Prescription formulations contain > 10% and are used for more persistent acne or pigmentation under medical supervision ONLY. Higher strength does not equal to better results, the type of formulation, consistency of use and other factors matter.
To truly tackle acne, it needs to be addressed at the root.
So far, we’ve helped 30+ people get rid of their stubborn acne in under 5 weeks through our Cohort 1.0 by following an inside-out approach.
✅ We’ve now opened 10 more slots in our second cohort!
How Does Azelaic Acid Work?
Here’s what happens when you use azelaic acid:
It reduces inflammation by lowering the chemical signals in the skin that cause redness and swelling associated with acne bumps.
Helps dead skin cells shed properly instead of sticking together and clogging pores.
Inhibits an enzyme called tyrosinase, which is involved in melanin production. Melanin is the natural, dark skin pigment that gives post-acne marks their dark colour. By reducing excess melanin production, azelaic acid helps fade post-acne marks and uneven skin tone over time.
Limits the growth of C. acnes - the acne-causing bacteria, this anti-microbial activity helps prevent acne breakouts from worsening.
How long does it take azelaic acid to work? Like most bioactive ingredients, azelaic acid cannot drastically change your skin overnight. Its activity begins from the first application, but visible results in skin texture, post-acne marks, and redness could be noticed after anywhere between a few weeks to 1-3 months of use. Consistent and daily use of SPF 50+ is critical to see optimum results.
How To Use Azelaic Acid Safely And Effectively
To get the best results from using a skincare active, you need to ensure you’re using it correctly, in the right amount and at the right time. Here’s a dermatologist-approved checklist to use azelaic acid, without irritating your skin:
Do’s
Always apply azelaic acid on clean, dry skin.
Use a pea-sized amount for the entire face.
Use a non-comedogenic moisturiser after application to support the skin barrier. Ideally, one that contains barrier-supporting ingredients like panthenol, ceramides, and squalene.
Wear SPF 50+ daily, this is a non-negotiable.
Consistency is key - azelaic acid works best with regular, long-term use.
Important instructions:
Start with once daily use in the evening. If your skin tolerates it well, you can gradually increase to twice daily. If you have sensitive or reactive skin, consult a dermatologist before increasing frequency.
if you have very sensitive, irritated skin - you can apply azelaic acid after a layer of moisturiser to cut down the irritation. But always wait for the moisturiser to get absorbed / dry before applying azelaic acid.
Don’ts
Do not overapply, more product ≠ faster results. Instead, it will irritate and can potentially damage your skin barrier.
Do not layer multiple strong actives at once.
Do not apply to broken, irritated, or actively peeling skin.
Do not apply to bleeding pimples.
Who can safely use azelaic acid? Azelaic acid is safe for most people with mild to moderate acne, especially those dealing with redness, sensitivity, or post-acne marks. It is generally well tolerated across skin types, including sensitive and melanin-rich skin. The American Academy of Dermatology considers it safe during pregnancy, but always confirm with your obstetrician-gynaecologist + dermatologist before starting any active.
Azelaic Acid And Compatibility With Other Actives
Important note:
There are combination formulations of retinoids + azelaic acid available, but this might pose a higher risk of irritation.
AHAs / BHAs / Sulfur / Benzoyl peroxide / Retinoids, although they work well with azelaic acid, caution is advised because they can trigger irritation and dryness.
Azelaic Acid Is An Underrated Active Loved By Dermats For A Reason
Azelaic acid is one of the most effective skincare actives (and dare I say… even underrated) which targets multiple drivers of acne together, like inflammation, clogged pores, post-acne marks and bacterial growth, without aggressively irritating or compromising the skin barrier.
When used consistently and at the right strength, it is a safe and long-term treatment for managing acne + acne-prone skin.
Yes, it won’t ‘cure’ acne on its own - you cannot tackle acne completely by just using topical products. To truly tackle acne, you need to address it inside-out [we’ve written more about this before]. But azelaic acid helps calm redness, inflammation and reduce breakouts effectively and safely, and is well tolerated by most individuals, and that’s exactly why dermatologists keep coming back to it.
To truly tackle acne, it needs to be addressed at the root.
So far, we’ve helped 30+ people get rid of their stubborn acne in under 5 weeks through our Cohort 1.0 by following an inside-out approach.
✅ We’ve now opened 10 more slots in our second cohort!