Azelaic acid

What is azelaic acid?

Azelaic acid is a natural material produced by a yeast that lives on normal skin, Malassezia furfur (also know as Pityrosporum ovale)

In New Zealand, azelaic acid is available in a 20% concentration as Skinoren™ CreamMedicated, Acne-Derm™ Lotion and Azclear Action medicated lotion. A foam preparation of azelaic acid was approved by the FDA and marked in the US in July 2015.

What is azelaic acid used for?

Azelaic acid is used as current treatment for mild to moderate acne, and can be combined with oral antibiotics or hormone therapy. It is useful for comedonal acne and inflammatory acne.

Azelaic acid is:

• Antibacterial: reduces the growth of bacteria at follicle (Proprionibacterium acnes and Staphylococcus epidermidis)
• Keratolytic and comedolytic: returns the disordered growth of the skin cells that cover the follicle to normal
• A scavenger of free radicals – that is, reduce inflammation.

Azelaic acid also helps reduce pigmentation, making it particularly useful for dark-skinned patients whose acne spots leave persistent brown marks (post-inflammatory pigmentation) or who have melasma.

Although not registered in New Zealand for other skin disorders, azelaic acid cream may also be useful in the treatment of:

• Rosacea
• Lentigo malignant, a type of precocious melanoma. Azelaic acid is not recommended for most cases of this precancerous injury; Where possible, surgery should be performed.

How do you use azelaic acid cream?

Azelaic acid cream should be applied to the acne-affected area initially daily, then if tolerated, build up to a generous application twice daily after thoroughly cleansing the skin.

Acne responds slowly to treatment. Some improvement should be seen after one month of using azelaic acid cream. Further improvement with maximum results should occur after six months of continuous use. Treatment can be continued safely for months or years if acne remains active.

Does azelaic acid cream have any side effects?

Azelaic acid is non-toxic and well tolerated by most subjects. However, those with very sensitive skin or who suffer from eczema, may be irritating to apply, resulting in a slight irritating dermatitis.

Stop applying the cream and seek medical attention if you develop serious illness:

• Redness
• Climbing
• itching
• Burning

Azelaic acid does not produce:

• Bacterial antibiotic resistance
• Reduction in tallow production
• Photosensitivity (easy sunburn)
• Skin or clothing stains.
• Whitening skin or normal clothing.