Azelaic Acid

Five are trial figures that link to the paper, one is an absence we searched for, three are computed from the label decode lower on the page.

1. 58% vs 40%

   Azelaic acid 15% gel, twice daily for 12 weeks, cut inflammatory rosacea lesions 58% against 40% on vehicle in the first phase III trial and 51% against 39% in the second (664 patients across the two), improved erythema in 44% and 46% of patients against 29% and 28%, and reached the investigator's "therapeutic success" in 61% and 62% against 40% and 48%. No serious adverse events. ²⁰

   Thiboutot 2003, two identical multicentre double-blind vehicle-controlled trials, 329 and 335 patients. The registration evidence behind Finacea; twice-daily dosing.

2. 73% vs 56%

   Against the other rosacea prescription, 15% azelaic acid gel reduced inflammatory lesions 72.7% to metronidazole 0.75% gel's 55.8% over 15 weeks in 251 patients, improved erythema in 56% against 42%, and was rated better on the investigator's global assessment. Neither touched telangiectasia. ¹¹

   Elewski 2003, double-blind, 13 US centres. A 40-patient split-face trial of the 20% cream against 0.75% metronidazole cream found equal lesion reduction and higher satisfaction on the azelaic side (Maddin 1999).

3. 70% · 71%

   For acne, 15% gel produced a median 70% reduction in inflamed lesions in the trial against 5% benzoyl peroxide and 71%, "similar efficacy", in the trial against 1% clindamycin, four months and 580 patients across the two, with burning and irritation "distinctly less than with BPO but more pronounced than with clindamycin". ⁹

   Gollnick 2004, two randomized double-blind comparisons (351 and 229 patients). The 2024 AAD acne guideline gives azelaic acid a conditional recommendation, a tier below benzoyl peroxide and retinoids.

4. 20% = tretinoin 0.05%

   The 20% cream reached "equivalent efficacy" to 0.05% tretinoin for comedonal acne over six months in 289 patients, "with fewer adverse effects", and beat vehicle in 92 patients over three months. A 60-patient trial of 20% gel cut total lesions 60.6% against 19.9% on placebo in 45 days. ²²

   Katsambas 1989 (the two Azelex-era studies, no numeric counts in the abstract); Iraji 2007. The comparator in both older acne trials was vehicle or tretinoin, not benzoyl peroxide, whatever the retellings say.

5. 65% = 4% hydroquinone

   For melasma, 20% cream gave a good or excellent result in 65% of 329 women over 24 weeks with no significant difference from 4% hydroquinone on improvement, lesion size or pigment intensity, and no significant allergic sensitisation or ochronosis in either arm. Against 2% hydroquinone in a smaller trial it won 73% to 19%; in a 29-woman study the MASI score fell from 7.6 to 3.8 on azelaic acid and 7.2 to 6.2 on 4% hydroquinone. ⁵

   Baliña & Graupe 1991; Verallo-Rowell 1989 (155 patients, and note the 2%); Farshi 2011. The comparator strength differs between the trials, so "beats hydroquinone" depends on which hydroquinone.

6. 0 trials at 10%

   No randomized trial indexed in PubMed tests azelaic acid at 10%, or at 12%, for any indication, against anything. Every verified trial on this page ran at 15% or 20%. The one trial of the "derivative" (potassium azeloyl diglycinate) on its own terms used 5% with hydroxypropyl chitosan for four weeks in 42 rosacea patients; the other used it, strength unstated, inside a three-active melasma emulsion. 11 of the 20 shelf products we decoded are 10% and 2 are 12%. ¹⁵

   Recorded as the page's central finding after targeted PubMed searches, not as a gap to paper over; the trial file lists each search that came back empty.

7. 4 of 22

   4 of the 22 products print no ingredient list anywhere we could find: medicube, mopayzer, TIANLUNE, VDDO; a fifth, Foundation Skincare, prints its list only as a picture, and the partial copy we could read from aggregators puts the acid sixth. 3 of the four are creams labelled 14 or 15%, the strengths of the FDA-approved prescription products, from sellers whose only storefront is Amazon. We report what the label says; we cannot say what is in the tube. ⁴⁴

   5 products in the decode are labelled 14–15% outside the prescription system (Foundation Skincare 14%, mopayzer 14%, TIANLUNE 14%, VDDO 15%, MAREE 15%). Bloomellee's 12% has a Drug Facts label filed on DailyMed (NDC 87386-003-01) by a Shenzhen trading company; a filing is a self-registration, not an FDA approval, and the Amazon storefront name is not the registrant.

8. 2 of 22

   2 of the 22 are not azelaic acid: they are potassium azeloyl diglycinate, a water-soluble salt sold as "azelaic acid derivative" (Naturium) or under a complex name (Geek & Gorgeous "Azeclair", where the 20% is the complex). Naturium sells both molecules at the same price under the same "Azelaic Acid" banner, and the derivative's trial base is one 5% combination cream and one three-active emulsion. ⁴²

   Read from the brands' own ingredient lists; the acid is "Azelaic Acid", the salt is "Potassium Azeloyl Diglycinate", and the front of the bottle does not always say which.

9. $2.54–$19.93 per gram

   Among the over-the-counter products that state a percentage of the acid itself and print a readable list, a gram of azelaic acid costs $2.54 (Eva Naturals) to $19.93 (Typology); The Ordinary's 10% is $3.46 at $10.37 a bottle, Paula's Choice's 10% is $14.00 at $42.00. Among the 13 over-the-counter true-acid products with a stated strength and a readable list, 11 put the acid in the top three; the price is paying for the base and the brand. ⁴⁴

   Price ÷ (size in mL × stated %), product treated as water, from the retailer page whose list we read. Not comparable with the derivative rows, and meaningless for the rows with no list.

Azelaic acid is one molecule sold at four strengths and, under the same name, as a different molecule. The rows are ordered by the evidence at each, because that is what you are paying for.

The trials were run one condition at a time, at 15% or 20%. This is what each showed and what it did not.

• Works Papulopustular rosacea — The strongest case: 15% gel beat vehicle in two phase III trials and beat metronidazole head to head; 20% cream equalled metronidazole in a split-face trial. Lesions and redness improve; visible vessels do not. The 10% products have no rosacea trial; the derivative has one 4-week pilot at 5%. ²⁰
• Works Mild to moderate acne — 15% gel cut inflamed lesions 70% in the trial against benzoyl peroxide and 71% ("similar efficacy") in the trial against clindamycin over four months; 20% cream reached "equivalent efficacy" to 0.05% tretinoin over six. The AAD guideline's recommendation is conditional, a tier below benzoyl peroxide and retinoids, which remain first line. Tolerability sits between the two: less than peroxide, more than clindamycin. ⁹
• Works Melasma and dark marks — 20% cream over 24 weeks: as good as 4% hydroquinone in 329 women, without ochronosis or sensitisation; better than 2% hydroquinone in 155; improved hyperpigmentation against vehicle in darker skin (with more burning at weeks 4 and 12 and more stinging at week 4). Dr Bunting calls it "only second to hydroquinone". Plan on six months. ⁵
• Helps, not alone Post-acne marks (PIH) — One 16-week pilot of 15% gel in patients with acne and PIH, baseline-controlled with no comparator arm, reported efficacy on both without numbers in the abstract. Mechanistically plausible (tyrosinase and reactive-oxygen inhibition); thinly measured. ⁸
• Wrong tool Exfoliation, texture, "glow" — The panel splits on the word: Dr Idriss's page says it is not an exfoliant despite the name, Dr Bunting lists "gentle exfoliation" among its benefits, and the trials measure lesions and pigment, not texture. Its measured actions are antibacterial, anti-inflammatory, anti-keratinising in the follicle and pigment-suppressing. Texture claims on the 10% product pages have no trial behind them. ³⁶

Azelaic acid is a nine-carbon dicarboxylic acid. It inhibits bacterial growth, suppresses the oxygen radicals neutrophils release, normalises keratinisation in the follicle, and inhibits tyrosinase indirectly. It does not selectively kill melanocytes; the paper usually cited for that found the opposite.

• Study In vitro, azelaic acid at 0.5 mol/l cut the viability of most skin bacteria tested at least 40-fold within 24 hours; minimum inhibitory concentrations ran 0.03–0.25 mol/l, bactericidal at or above 0.25, and the effect fell away in the presence of nutrients. Malassezia (Pityrosporum ovale) barely responded. ¹
• Study In acne patients, 20% cream reduced follicular Micrococcaceae 2,500-fold and Propionibacterium 44-fold, reduced free fatty acids, and did not change sebum output. ²¹
• Study Azelaic acid suppressed the superoxide and hydroxyl radicals generated by neutrophils while leaving chemotaxis and phagocytosis largely intact, which the authors proposed as the common thread between its effects on acne, hyperpigmentation and lentigo maligna. ²
• Study It is a competitive inhibitor of tyrosinase, but at concentrations that would be cytotoxic; the mechanism proposed is inhibition of membrane thioredoxin reductase at 10⁻⁵ M, which regulates tyrosinase indirectly. ³
• Study The 1985 evaluation usually cited for "selective toxicity to abnormal melanocytes" found azelaic acid had "little or no visually recognizable effect on melanocytes" in pigmented guinea pigs, no significant effect on implanted melanoma in mice, and in culture was "not selectively cytotoxic to normal and proliferative melanocytes", with cytotoxicity only above 10⁻³ M. Our own dossier repeated the myth until this page corrected it. ⁴
• Review The 2015 evidence update lists the four actions together, per its abstract: normalised keratinisation in the follicle, antibacterial and anti-inflammatory effects, and tyrosinase inhibition, as the basis for one molecule treating acne, rosacea and pigmentation. ¹²

The trials that state a schedule applied twice daily, and they measured at 4, 6, 8, 12, 15, 16 and 24 weeks. Use it as they did, and judge at the week they judged.

1. Weeks 0–2 Once a day, a pea for the face, on clean dry skin. Expect tingling. Stinging, burning and itching at the site are the labelled side effects; the reviews call them transient, and across the trials on this page the 20% cream trials report more burning and stinging than the 15% gel trials. If it burns, buffer with moisturiser first or switch to the derivative.
2. Weeks 2–4 Twice daily, as the trials that state a schedule dosed it. 20% cream had significantly reduced inflamed acne lesions by one month (Cunliffe & Holland 1989); the 5% derivative cream had reduced rosacea erythema by four weeks. Sunscreen every morning: the 24-week melasma trials required it.
3. Weeks 6–8 First numbers on acne and melasma. 20% gel: total lesions −60.6% at 45 days (Iraji 2007). 20% cream: MASI 7.6 → 3.8 at two months in a 14-woman arm (Farshi 2011). Non-inflamed lesions responded by two months in the Cunliffe study.
4. Week 12–16 Judge rosacea and acne. The rosacea endpoint (Thiboutot at 12 weeks, Elewski at 15) and the acne comparisons (Gollnick at 16). If a 10% product has done nothing by here, the next step is the 15% gel, not a higher number from an unknown seller.
5. Week 24 Judge melasma and hyperpigmentation. The three 24-week melasma and hyperpigmentation trials measured then (Baliña, Verallo-Rowell, Lowe); the 29-woman Farshi study at 8. Dr Bunting: 3–6 months for established pigment, longer in melanated skin.
6. Any week Watch for lightening beyond the mark. Both prescription labels carry a hypopigmentation warning and ask patients with dark complexions to monitor for it. It is rare and it is labelled; stop and ask if the surrounding skin lightens.

Most of the pairings are tolerance questions; two are about what the trials actually combined.

Pregnancy is not a pairing but belongs here: ACOG, relayed by MotherToBaby, accepts over-the-counter topical azelaic acid in pregnancy if needed; the prescription labels say the studies do not exist. See the routing table.

In the order the trials measured it: stinging first, acne lesions by 4–8 weeks, rosacea by 12–15, melasma by 24. The strength does not move these dates; every date here is from a 15% or 20% product, except the 5% derivative pilot at week 4.

1. Weeks 1–4 Stinging, burning, itching at the site. Slightly but significantly more burning (weeks 4 and 12) and stinging (week 4) than vehicle on 20% cream in darker skin; "distinctly less" than benzoyl peroxide on 15% gel; transient in the reviews. ²⁷
2. Week 4 Inflamed acne lesions down on 20%; erythema down on the 5% derivative. 20% cream significantly reduced inflamed lesions against placebo after one month; the derivative-and-chitosan cream reduced rosacea erythema against placebo at four weeks. ²¹
3. Weeks 6–8 Acne lesion counts; melasma scores. 20% gel: total lesions −60.6% vs −19.9% on placebo at 45 days. 20% cream: MASI 7.6 → 3.8 at 8 weeks against 7.2 → 6.2 on 4% hydroquinone. ²⁴
4. Week 12 The rosacea endpoint. 15% gel: inflammatory lesions −58% and −51% vs −40% and −39% on vehicle; erythema improved in 44–46% vs 28–29%. ²⁰
5. Weeks 15–16 Rosacea against metronidazole; acne against peroxide and clindamycin. 15% gel −72.7% vs −55.8% on metronidazole at 15 weeks; median −70% and −71% inflamed lesions at 16 weeks in the trials against 5% BPO and 1% clindamycin. ¹¹
6. Week 24 Melasma and hyperpigmentation. 20% cream: 65% good or excellent, equal to 4% hydroquinone (329 women); 73% vs 19% against 2% hydroquinone (155); hyperpigmentation improved against vehicle in phototypes IV–VI; comedonal acne equivalent to tretinoin 0.05% at six months. ⁵

One rule, applied to all 22: on Amazon, the strength in the product name and on the brand's own page, an ingredient list we could read in full from the brand's or a retailer's page with the active in the first four ingredients, in stock, sold by the brand or by Amazon. 10 pass it; these six each have a job, and the other four are in the cut list with the reason. None of these has a trial at its strength; the pick is for what the label tells you and what it costs. The prescription products are the reference, not a pick; the 14–15% creams are not eligible because three print no list, one prints a partial one, and MAREE states its 15% on Amazon but not on its own page.

1. 

   The reference 10%, at the lowest price

   The Ordinary Azelaic Acid Suspension 10%

   10% · suspension · 30ml / 1 fl oz · $10.37 · $3.46/g active

   The over-the-counter product the harvested threads name most, and the cheapest bottle of a stated 10% of the acid itself in the decode: $10.37, $3.46 per gram of azelaic acid, sold by Amazon, azelaic acid 4th of 17 ingredients, fragrance-free. No trial has tested 10%; this is the one to find out on, because it costs the least to find out.

   A silicone suspension. Pilling under sunscreen is the complaint the harvested threads make about this product and the brand page does not mention it; apply thinly, let it set, and if it balls up try the INKEY serum below. Also sold as a two-pack (B0DNN8Z1PD, $18.67, about 10% less per bottle).

   Check price on Amazon

2. 

   A 10% that sits under sunscreen

   The INKEY List SuperSolutions Azelaic Acid 10% Serum

   10% · serum · 30ml / 1.01 fl oz · $20.00 · $6.67/g active

   Azelaic acid second of 17 ingredients, sold by Amazon, $20, fragrance-free, and the brand states it "sits perfectly under SPF and makeup without pilling", which is the complaint that sends people off The Ordinary's suspension. Allantoin is the only companion; a plain formula for a plain question.

   Twice The Ordinary's price for the same stated percentage. The brand's pilling claim is its own; we did not test it.

   Check price on Amazon

3. 

   The highest strength a brand states on its own page, with a readable list

   TIRTIR Azelaic Acid 12% Serum

   12% · serum · 30ml / 1.01 fl oz · $25.00 · $6.94/g active

   The only true-acid product in the decode above 10% whose brand page prints both the strength and the full ingredient list, with azelaic acid second of 28 and no fragrance, sold by the brand. 12% is still below the 15% the rosacea trials used, and no trial has tested 12% either; it is the closest a transparent label gets.

   $25. The "Hyal-ZIP" on the front is a branded name for one ingredient, 25th in the list, not a complex with extra actives. Sodium hydroxide fourth means the acid is partly neutralised, as in most water-based azelaic serums.

   Check price on Amazon

4. 

   A 10% with niacinamide, for tone

   Naturium Azelaic Acid Emulsion 10%

   10% · cream · 1 oz / 30ml · $19.88 · $6.63/g active

   The true-acid half of Naturium's pair: azelaic acid second of 35 ingredients, niacinamide alongside, sold by Amazon at $19.88, fragrance-free. Buy this one, not the "Derivative Complex" in the same packaging, if you want the molecule the melasma and PIH trials used.

   The trials that paired azelaic acid with pigment endpoints ran at 20% for 24 weeks (Verallo-Rowell, Baliña); a 10% emulsion is a different dose on a different timetable. The "bio-retinol" on the brand page is not a retinoid, and the ingredient list does not say what it is.

   Check price on Amazon

5. 

   A 10% for redness-prone skin

   Anua Azelaic Acid 10 Hyaluron Redness Soothing Serum

   10% · serum · 30ml / 1.01 fl oz · $19.80 · $6.60/g active

   Azelaic acid second of 35, with panthenol, niacinamide, ceramide NP and a centella complex behind it, no fragrance, $19.80, sold by the brand. The rosacea evidence is at 15%; at 10% the argument for this one is that the rest of the bottle is barrier repair.

   Contains betaine salicylate, a mild BHA, which the community pairs carefully with an acid on rosacea-prone skin. Amazon's bullets mention "Blue Tansy Oil"; the brand's printed ingredient list does not contain it. COSRX's Azelaic Acid 10 B5 is the near-identical alternative at the same price.

   Check price on Amazon

6. 

   If the acid stings: the derivative

   Naturium Azelaic Acid Derivative Complex 10% Serum

   10% · serum · 1 fl oz / 30ml · $19.88 · $6.63/g active

   Potassium azeloyl diglycinate third of 18, with niacinamide and ethyl ascorbic acid, sold by Amazon at $19.88. The water-soluble salt is the form the brand and Geek & Gorgeous sell as the gentler option, and the community reaches for when the acid burns.

   A different molecule with a thinner evidence base: the only trials of the derivative used 5% in a combination cream for four weeks (Berardesca 2012) or in a three-active melasma emulsion (Viyoch 2010). The "10%" is the derivative, not azelaic acid, so it is not comparable gram for gram with the rows above.

   Check price on Amazon

Eligible, not picked: Paula's Choice 10% Azelaic Acid Booster ($42.00, $14.00 per gram of acid, four times The Ordinary's price for the same stated strength, with a salicylate; a fine product at a brand price); Good Molecules 10% (the $11.99 cream, acid third; Ulta reviewers call the texture gritty, and INKEY's serum answers the same need at position two); COSRX Azelaic Acid 10 B5 (the near-twin of the Anua pick, same price, 40 ingredients); Eva Naturals 10% ($2.54 per gram, the cheapest with a readable list, in a 2 oz bottle with L-ascorbic acid, retinyl palmitate and honey behind the azelaic acid: too many jobs in one dropper for a first azelaic). Not eligible: medicube (no readable list, third-party seller, no ship date); Foundation Skincare 14% (list printed only as an image, acid sixth); Bloomellee 12%, mopayzer 14%, TIANLUNE 14%, VDDO 15% (third-party sellers, three with no ingredient list at all); MAREE 15% (a full list from its brand page, but the 15% is stated on Amazon, not on that page); Typology, Geek & Gorgeous and Ecological Formulas (not on Amazon); Finacea and Azelex (prescription). Prices are Amazon's on 2026-09-19. Affiliate links; we earn a commission at no cost to you.

Two of the cheapest products in the decode, at $9.99, print a strength no brand with a readable label sells and no trial has tested. Here is what stands behind the number.

Strengths of the FDA-approved prescription products

15% · 20%Finacea gel and foam; Azelex cream. Trialled and labelled; there is no OTC monograph for azelaic acid ³¹

Highest strength a brand states on its own page, with a readable list

12%TIRTIR, acid second of 28; MAREE's 15% is stated on Amazon, not on its site ⁴⁴

Over-the-counter creams labelled 14–15%

53 with no ingredient list and one with a partial one; $9.99 to $45 ⁴⁴

Trials of any 14% product

0and none of a 15% product other than the approved gel and foam ²⁰

• Seller mopayzer "Azelaic Acid 14% Acne Cream", $9.99: no ingredient list on the Amazon page and none on INCIDecoder. A DailyMed Drug Facts record for a "14% Azelaic Acid Acne" product exists under a Guangdong manufacturer; whether it is this tube is not stated by the listing. ⁴⁴
• Seller VDDO "Azelaic Acid 15% Facial Cream", $20.99, 20 g: the prescription strength, with no ingredient panel, no NDC and no brand site. ⁴⁴
• Regulator The 15% and 20% products with trials behind them are approved prescription drugs whose labels carry the pregnancy and hypopigmentation precautions; a cream labelled 15% by an unknown seller carries none of them and none of the trials. ³²
• Editorial Skincarisma, on the regulatory split: azelaic acid "is also a prescription drug in the US, but can be freely bought in the EU". The Amazon creams are the grey zone between those two sentences. ⁴³

The number on the front carries the pitch, so we checked which molecule is in the bottle, whether the percentage is stated and where, where the active falls in the list, what else is in there, and what a gram of azelaic acid costs.

Fragrance

6%1 of 17 products

Denatured alcohol

6%1 of 17 products

• 22 products: 20 over the counter and 2 prescription. 21 state a percentage: 17 in the product name, 1 on the brand page, 2 on the drug label, 1 in Amazon's bullets only (MAREE). Ecological Formulas' Melazepam states none.
• 2 are the derivative, potassium azeloyl diglycinate; 20 are azelaic acid. Naturium sells one of each at the same price.
• 18 lists were readable, 1 of them only in part (Foundation Skincare); in 16 of the 18 the active is in the top three ingredients (position 1 on the two prescription products and Bloomellee's Drug Facts label, 2 on most serums and creams, 3 on Good Molecules and the Naturium derivative, 4 on The Ordinary's suspension, 6 on Foundation Skincare's partial list). 4 have no list at all: medicube, mopayzer, TIANLUNE, VDDO.
• 5 over-the-counter products are labelled 14–15% (Foundation Skincare 14%, mopayzer 14%, TIANLUNE 14%, VDDO 15%, MAREE 15%); 3 of them have no list and one a partial one. 17 of the 22 are on Amazon; 5 of those are sold by a third-party seller rather than the brand or Amazon.
• Per gram of stated azelaic acid, over the counter with a readable list: $2.54 (Eva Naturals) to $19.93 (Typology). The Ordinary is $3.46; Paula's Choice $14.00. The derivative rows are priced per gram of derivative and are not comparable.
• 1 of the 17 with a fragrance reading carry fragrance (Bloomellee). Of the 18 readable lists, 4 contain a salicylate and 7 niacinamide.

Percentages are as the product states them; "% stated where" says where. Position = where azelaic acid or its salt falls in the ingredient list, 1-based; on a Drug Facts label the active is declared separately and the inactives are alphabetical, so position 1 there is a labelling convention, not a concentration. $/g active = price ÷ (size in mL × stated %), treating the product as water; blank where no percentage or no price. Sold by = who Amazon names as the seller on the build date.

The 2024 AAD acne guideline, the two FDA labels, MotherToBaby on pregnancy, two dermatologists and a third quoted by Marie Claire, a pharmacist, DermNet, three brand pages, an ingredient encyclopedia, two reviews (one by Bayer, which makes Finacea) and three of the trials themselves. Not in the table because they could not be fetched: Paula's Choice's ingredient dictionary (script-rendered) and INCIDecoder (redirected off-domain); the Marie Claire row is from a search summary, not the page.

Harvested from the subreddits where people ask what to buy for rosacea, acne and dark spots and what went wrong, then filtered to the comments that themselves name azelaic acid or an azelaic product (The Ordinary, Paula's Choice, Finacea, the diglycinate serums). The shares below are of those comments, not of the whole harvest. Every quote is verbatim and links to the comment.

Reddit search across 7 communities for 14 queries, then each thread's top comments read, up to the harvest's thread cap; the threads that made the cut came from r/30PlusSkinCare, r/AsianBeauty, r/SkincareAddiction. 351 threads and 5,319 comments were harvested, of which 838 azelaic acid-naming comments are the denominator here. Themes are keyword matches over that set, each one's quote being a high-scoring comment that carries both the azelaic acid term and the theme term, verbatim and linked. Harvested 2026-09-19.

• Dr Sam Bunting Cosmetic dermatologist, Harley Street, London; sells azelaic acid products
  Azelaic acid is, hands down, the best one for pigmentation in my book - I think of it as only second to hydroquinone in terms of potency. drsambunting.com, "Azelaic Acid 101" · 2026-02-08 ↗
• Dr Shereene Idriss Dermatologist, Idriss Dermatology, New York
  Azelaic acid is like the third or fourth-degree relative of AHAs and BHAs... a multi-targeted treatment. dridriss.com, "Azelaic acid benefits" · 2022-07-06 ↗
• Dr Anjali Mahto Consultant dermatologist, Self London
  The beauty of azelaic acid is that it's a one-stop shop whether you're treating acne, rosacea, sensitive skin or dark spots. Marie Claire UK (as quoted in a search summary; the page itself did not render) ↗
• Hyeong Joo Cho, PharmD Pharmacist and medical writer, WebMD; reviewed by Darrell Hulisz, PharmD
  Azelaic acid is minimally absorbed by the body and is not expected to reach the baby. WebMD, azelaic acid (Finacea) · 2024-08-21 ↗
• Zena Alani Doctor and clinical researcher, DermNet NZ; reviewed by Dr Ian Coulson, dermatologist
  Azelaic acid is nontoxic and is well tolerated by most subjects. DermNet NZ, "Azelaic acid" · 2022-11 ↗
• Fitton A and Goa KL Adis International; authors of the 1991 Drugs review
  Controlled studies demonstrate comparable efficacy to tretinoin, benzoyl peroxide, erythromycin, and oral tetracycline for acne, and equivalence to hydroquinone for melasma treatment. Drugs 1991;41(5):780-98 · 1991-05 ↗
• Thiboutot D, Thieroff-Ekerdt R and Graupe K Authors of the two phase III Finacea trials
  58% versus 40%, study 1 (P=.0001); 51% versus 39%, study 2 (P=.0208). J Am Acad Dermatol 2003;48(6):836-45 · 2003-06 ↗

Cited without a named author: the American Academy of Dermatology acne guideline (a work group), the FDA labels on DailyMed, MotherToBaby, Skincarisma, The Ordinary and Naturium. Sieber & Hegel (2014) are Bayer Consumer Care authors, and Bayer makes Finacea. This page is not medically reviewed; the credentials above belong to the people quoted.

Does 10% azelaic acid work?

No published trial has tested it. Every trial we could verify ran at 15% (gel and foam) or 20% (cream); there is no randomized trial at 10% or 12% for rosacea, acne or pigmentation, against vehicle or anything else. 10% is two-thirds of the lowest strength with a result, usually in a different base. It is a reasonable first try for redness and a starting rung both dermatologists in the panel accept; it is not a strength with evidence, and if it does nothing by 12 weeks the next step is the 15% gel on prescription. ²⁰⁹³⁵

Azelaic acid 10% vs 15% vs 20%: what is the difference?

15% is the gel and foam (Finacea) trialled for rosacea and acne: 51–58% fewer inflammatory lesions than vehicle, better than metronidazole, a median 70% reduction in inflamed acne lesions in the trial against 5% benzoyl peroxide (with less irritation) and "similar efficacy" to clindamycin. 20% is the cream (Azelex, Skinoren) trialled for acne (equal to 0.05% tretinoin) and melasma (equal to 4% hydroquinone). Both are FDA-approved prescription drugs; there is no over-the-counter monograph for azelaic acid. 10% is what the cosmetics shelf sells, and it has no trial. Across the trials on this page, the 20% cream trials report more burning and stinging than the 15% gel trials. ^2022529

Is azelaic acid good for rosacea?

It is the indication with the best evidence. 15% gel twice daily cut inflammatory lesions 58% and 51% against 40% and 39% on vehicle over 12 weeks in 664 patients, and 72.7% against 55.8% on 0.75% metronidazole over 15 weeks in 251; erythema improved in about half of patients. Neither treatment changed visible vessels; a 40-patient split-face trial of the 20% cream against metronidazole cream found equal lesion reduction. Expect stinging in the first weeks. The over-the-counter 10% products have no rosacea trial. ²⁰¹¹²⁵

Azelaic acid or hydroquinone for melasma?

20% azelaic acid cream matched 4% hydroquinone in the largest trial (329 women, 24 weeks, 65% good or excellent, no significant difference) with no ochronosis or sensitisation in either arm, and beat 2% hydroquinone 73% to 19% in a 155-patient trial. In a 29-woman study the MASI score fell further on azelaic acid. Which hydroquinone it is compared with matters. Both 24-week trials ran with sunscreen. ⁵⁶²⁶

Does azelaic acid help acne?

At 15–20%, yes, in head-to-head trials: 15% gel cut inflamed lesions a median 70% in the trial against 5% benzoyl peroxide and 71% ("similar efficacy") in the trial against 1% clindamycin over four months, 580 patients in all, with less irritation than the peroxide; 20% cream equalled 0.05% tretinoin for comedonal acne over six months in 289. The 2024 AAD guideline still gives it a conditional recommendation, a tier below benzoyl peroxide and retinoids, which are first line. It reduces follicular bacteria without changing sebum. ^9223021

What is "azelaic acid derivative" (potassium azeloyl diglycinate)?

A water-soluble salt of azelaic acid and glycine, sold by Naturium as "Azelaic Acid Derivative Complex 10%" and by Geek & Gorgeous as "Azeclair" (the 20% is the complex). It is a different molecule with a much thinner record: one 42-patient, 4-week pilot of 5% in a cream with hydroxypropyl chitosan reduced rosacea erythema against placebo, and one melasma trial used it inside a three-active emulsion. Nothing isolates the salt at 3–10%. Buy it as the gentler step if the acid stings, not as azelaic acid. ¹⁵¹⁶⁴²

Can I use azelaic acid while pregnant?

MotherToBaby relays ACOG: over-the-counter topical products containing azelaic acid "may be used during pregnancy, if needed". The Finacea label says there are no adequate studies in pregnant women and it should be used only if the benefit justifies the risk; the Azelex label is Pregnancy Category B, with embryotoxic effects in rats at 2,500 mg/kg a day and no teratogenic effects (the Finacea label adds that animal embryotoxicity appeared only at doses that harmed the mother). WebMD's pharmacist calls it minimally absorbed and not expected to reach the baby. In a 2025 retrospective of 197 pregnant acne patients, the 26 on 20% azelaic acid did better than the 171 on topical erythromycin or clindamycin, with no difference in side effects. It is one of four over-the-counter topical acne actives (with benzoyl peroxide, salicylic acid and glycolic acid) that ACOG, relayed by MotherToBaby, says may be used if needed; the decision is still yours and your clinician's. ^33313213

Why does The Ordinary's azelaic acid pill?

It is a 10% suspension in a silicone base (dimethicone, isohexadecane, polysilicone-11), and pilling under sunscreen and makeup is the complaint the harvested threads make about it; the brand's page does not mention it. Apply it thinly on dry skin and let it set before anything else, or use a water-based serum with the acid second in the list (INKEY, Anua, TIRTIR), which is why those are picks. The Ordinary's is still the cheapest bottle of a stated 10% of the acid itself. ⁴⁰⁴⁴

Are the $9.99 "azelaic acid 14%" creams on Amazon real?

We can tell you what the label says and not what is in the tube. 5 products in the decode are labelled 14 or 15% outside the prescription system; 3 of them print no ingredient list and one prints only a partial one. 15% and 20% are the strengths of the FDA-approved prescription products, and the trials were run on those products in their own bases; there is no over-the-counter monograph for azelaic acid at any strength. Bloomellee's 12% has a Drug Facts label filed on DailyMed by a Shenzhen trading company, which is a self-registration, not an approval. A higher number with no list is less information, not more; if 10% is not enough, the trialled route is the 15% gel on prescription. ⁴⁴³¹

How long does azelaic acid take to work?

In the trials: inflamed acne lesions down by four weeks on 20% cream, total lesions −60.6% at 45 days on 20% gel; rosacea judged at 12 and 15 weeks; melasma and hyperpigmentation at 24 weeks. Stinging and tingling come first; the reviews call them transient. The trials that state a schedule dosed twice daily. Judge rosacea and acne at three months and pigment at six; nothing on this page reports a result before week four. ^2124205

1. 1

   The in vitro antimicrobial effect of azelaic acid

   Leeming JP, Holland KT, Bojar RA · Br J Dermatol 115(5):551-6 · 1986

2. 2

   Inhibitory effect of azelaic acid on neutrophil functions: a possible cause for its efficacy in treating pathogenetically unrelated diseases

   Akamatsu H, Komura J, Asada Y, et al · Arch Dermatol Res 283(3):162-6 · 1991

3. 3

   A possible mechanism of action for azelaic acid in the human epidermis

   Schallreuter KU, Wood JW · Arch Dermatol Res 282(3):168-71 · 1990

4. 4

   An evaluation of the effectiveness of azelaic acid as a depigmenting and chemotherapeutic agent

   Pathak MA, Ciganek ER, Wick M, et al · J Invest Dermatol 85(3):222-8 · 1985

5. 5

   The treatment of melasma. 20% azelaic acid versus 4% hydroquinone cream

   Balina LM, Graupe K · International Journal of Dermatology 30(12):893-5 · 1991

6. 6

   Double-blind comparison of azelaic acid and hydroquinone in the treatment of melasma

   Verallo-Rowell VM, Verallo V, Graupe K, Lopez-Villafuertes L, Garcia-Lopez M · Acta Dermato-Venereologica Supplementum 143:58-61 · 1989

7. 7

   Azelaic Acid Versus Hydroquinone for Managing Patients With Melasma: Systematic Review and Meta-Analysis of Randomized Controlled Trials

   Albzea W, AlRashidi R, Alkandari D, et al · Cureus 15(7):e41796 · 2023

8. 8

   Efficacy and safety of azelaic acid (AzA) gel 15% in the treatment of post-inflammatory hyperpigmentation and acne: a 16-week, baseline-controlled study

   Kircik LH · Journal of Drugs in Dermatology 10(6):586-90 · 2011

9. 9

   [Azelaic acid 15% gel in the treatment of acne vulgaris. Combined results of two double-blind clinical comparative studies]

   Gollnick HP, Graupe K, Zaumseil RP · J Dtsch Dermatol Ges 2(10):841-7 · 2004

10. 10

    A phase 3 randomized, double-blind, vehicle-controlled trial of azelaic acid foam 15% in the treatment of papulopustular rosacea

    Draelos ZD, Elewski BE, Harper JC, Sand M, Staedtler G, Nkulikiyinka R, Shakery K · Cutis 96(1):54-61 · 2015

11. 11

    A comparison of 15% azelaic acid gel and 0.75% metronidazole gel in the topical treatment of papulopustular rosacea: results of a randomized trial

    Elewski BE, Fleischer AB Jr, Pariser DM · Arch Dermatol 139(11):1444-50 · 2003

12. 12

    Azelaic Acid: Evidence-based Update on Mechanism of Action and Clinical Application

    Schulte BC, Wu W, Rosen T · J Drugs Dermatol 14(9):964-8 · 2015

13. 13

    Retrospective Analysis of Efficacy and Side Effects of Topical 4% Erythromycin Versus 1% Clindamycin Versus 20% Azelaic Acid During Pregnancy

    Hasanbeyzade S · Journal of Cosmetic Dermatology · 2025

14. 14

    A Comprehensive Review of Azelaic Acid Pharmacological Properties, Clinical Applications, and Innovative Topical Formulations

    Petrovici AG, Spennato M, Bîtcan I, Péter F, et al. · Pharmaceuticals (Basel) 18(9):1273 · 2025

15. 15

    Clinical and instrumental assessment of the effects of a new product based on hydroxypropyl chitosan and potassium azeloyl diglycinate in the management of rosacea

    Berardesca E, Iorizzo M, Abril E, et al · J Cosmet Dermatol 11(1):37-41 · 2012

16. 16

    Effects of trans-4-(aminomethyl) cyclohexanecarboxylic acid/potassium azeloyl diglycinate/niacinamide topical emulsion in Thai adults with melasma: a single-center, randomized, double-blind, controlled study

    Viyoch J, Tengamnuay I, Phetdee K, et al · Curr Ther Res Clin Exp 71(6):345-59 · 2010

17. 17

    Final Report of the Cosmetic Ingredient Review Expert Panel on the Safety Assessment of Dicarboxylic Acids, Salts, and Esters

    Fiume MM, Eldreth HB, Bergfeld WF, Belsito DV, Hill RA, Klaassen CD, Liebler D, Marks JG, Shank RC, Slaga TJ, Snyder PW, Andersen FA · 2012

18. 18

    AZELEX (azelaic acid) Cream, 20% — FDA-Approved Prescribing Information

    Allergan · 2024

19. 19

    Finacea (azelaic acid) Gel, 15% — FDA-Approved Prescribing Information

    Bayer Healthcare Pharmaceuticals · 2010

20. 20

    Efficacy and safety of azelaic acid (15%) gel as a new treatment for papulopustular rosacea: results from two vehicle-controlled, randomized phase III studies

    Thiboutot D, Thieroff-Ekerdt R, Graupe K · J Am Acad Dermatol 48(6):836-45 · 2003

21. 21

    Clinical and laboratory studies on treatment with 20% azelaic acid cream for acne

    Cunliffe WJ, Holland KT · Acta Derm Venereol Suppl (Stockh) 1989;143:31-4 · 1989

22. 22

    Clinical studies of 20% azelaic acid cream in the treatment of acne vulgaris. Comparison with vehicle and topical tretinoin

    Katsambas A, Graupe K, Stratigos J · Acta Derm Venereol Suppl (Stockh) 1989;143:35-9 · 1989

23. 23

    Azelaic acid for the treatment of acne. A clinical comparison with oral tetracycline

    Hjorth N, Graupe K · Acta Derm Venereol Suppl (Stockh) 1989;143:45-8 · 1989

24. 24

    Efficacy of topical azelaic acid gel in the treatment of mild-moderate acne vulgaris

    Iraji F, Sadeghinia A, Shahmoradi Z, et al. · Indian J Dermatol Venereol Leprol 2007;73(2):94-6 · 2007

25. 25

    A comparison of topical azelaic acid 20% cream and topical metronidazole 0.75% cream in the treatment of patients with papulopustular rosacea

    Maddin S · J Am Acad Dermatol 1999;40(6 Pt 1):961-5 · 1999

26. 26

    Comparative study of therapeutic effects of 20% azelaic acid and hydroquinone 4% cream in the treatment of melasma

    Farshi S · J Cosmet Dermatol 2011;10(4):282-7 · 2011

27. 27

    Azelaic acid 20% cream in the treatment of facial hyperpigmentation in darker-skinned patients

    Lowe NJ, Rizk D, Grimes P, et al. · Clin Ther 1998;20(5):945-59 · 1998

28. 28

    Azelaic acid. A review of its pharmacological properties and therapeutic efficacy in acne and hyperpigmentary skin disorders

    Fitton A, Goa KL · Drugs 1991;41(5):780-98 · 1991

29. 29

    Azelaic acid: Properties and mode of action

    Sieber MA, Hegel JK · Skin Pharmacol Physiol 2014;27 Suppl 1:9-17 · 2014

30. 30

    Guidelines of care for the management of acne vulgaris

    Reynolds RV, Yeung H, Cheng CE, et al. · J Am Acad Dermatol 2024;90(5):1006.e1-1006.e30 · 2024

31. 31

    FINACEA (azelaic acid) Gel, 15% — prescribing information, sections 5 and 8.1

    Bayer HealthCare Pharmaceuticals (FDA-approved label, DailyMed) · dailymed.nlm.nih.gov, read 2026-09-19 · 2024

32. 32

    AZELEX (azelaic acid cream) 20% — prescribing information, precautions and pregnancy

    Allergan (FDA-approved label, DailyMed) · dailymed.nlm.nih.gov, read 2026-09-19 · 2024

33. 33

    Topical acne treatments — fact sheet

    MotherToBaby (OTIS) · mothertobaby.org, read 2026-09-19 · 2026

34. 34

    Safety assessment of dicarboxylic acids, salts, and esters as used in cosmetics

    Fiume MM, et al. (Cosmetic Ingredient Review Expert Panel) · Int J Toxicol 2012;31(4 Suppl):5S-76S · 2012

35. 35

    Azelaic acid 101: how to use it, what are the benefits

    Dr Sam Bunting · drsambunting.com, read 2026-09-19 · 2026

36. 36

    Azelaic acid benefits

    Dr Shereene Idriss · dridriss.com, read 2026-09-19 · 2022

37. 37

    Azelaic acid: the skin calming ingredient loved by acne, rosacea and pigmentation-sufferers (quoting Dr Anjali Mahto)

    Marie Claire UK · marieclaire.co.uk, search summary only, 2026-09-19 · 2026

38. 38

    Azelaic acid (Finacea): uses, side effects, interactions, warnings and dosing

    Hyeong Joo Cho, PharmD; reviewed by Darrell Hulisz, PharmD (WebMD) · webmd.com, read 2026-09-19 · 2024

39. 39

    Azelaic acid

    Zena Alani; reviewed by Dr Ian Coulson (DermNet NZ) · dermnetnz.org, read 2026-09-19 · 2022

40. 40

    Azelaic Acid Suspension 10% (product page)

    The Ordinary (DECIEM) · theordinary.com, read 2026-09-19 · 2026

41. 41

    Azelaic Acid Emulsion 10% (product page)

    Naturium · naturium.com, read 2026-09-19 · 2026

42. 42

    Azelaic Acid Derivative Complex 10% (product page)

    Naturium · naturium.com, read 2026-09-19 · 2026

43. 43

    Guide to azelaic acid

    Skincarisma · skincarisma.com, read 2026-09-19 · 2026

44. 44

    Label decode of 22 retail azelaic acid products (this page)

    Verified Beauty Data · verifiedbeautydata.com · 2026