You can get azelaic acid as a prescription or over-the-counter (OTC) treatment. Prescription medication has a concentration of 15 or 20%, while OTC versions usually have 10% or less. (In fact, prescription-strength azelaic acid is one of the most common treatments from derms for mild to moderate rosacea.) The latter can be difficult to find, though. As a lesser-known skin care ingredient, azelaic acid is only starting to gain popularity in the beauty space. Additionally, a small study2 found that azelaic acid can help regulate the sebaceous glands in women with acne-prone skin. This effect could help combat excess sebum, one of the biggest culprits behind acne breakouts and sebum plugs. For rosacea that causes acne and excess oil, the sebum-controlling effects of azelaic acid could pitch in too. This effect was observed in one study4, where azelaic acid gel significantly improved inflammatory lesions in people with rosacea. Furthermore, azelaic acid increases collagen and elastin deposits in the top layer of the skin. This is a noteworthy effect, as both collagen and elastin are needed to keep your skin healthy and resilient. And, get this: While azelaic acid suppresses overactive sebaceous glands, it also increases sebum secretion5 in super-dry areas—which boosts the skin’s natural hydration and reduces dullness. Essentially, if your sebaceous glands are out of whack, azelaic acid will help normalize them. Rarely, azelaic acid can cause hypopigmentation, or the lightening of skin pigment. According to Ciraldo, this may be more noticeable in people with deeper skin tones. “If you do have any problems, stop [using] it and apply a soothing gel like aloe to inflamed or hypopigmentated areas,” she says. And if you’re layering with other products? “Apply your other exfoliant first,” suggests Cheung, to get your skin ready to receive the azelaic acid. Then, apply your moisturizer as usual. Also, always wear sunscreen anytime you’re using exfoliating agents such as azelaic acid. “Skin is more prone to sunburn when it is exfoliated, [which] will only aggravate conditions like acne and rosacea,” notes Donat.
