23 October 2020
If you have sensitive skin and are battling acne and hyperpigmentation, here’s one skincare ingredient to add to your arsenal: Azelaic acid. Often overlooked by more popular skincare actives, Azelaic acid is now receiving more attention for its versatility in treating conditions like acne, hyperpigmentation, rosacea and hypersensitivity. Here’s what you need to know about this trending skincare ingredient before getting started on it, from how it works, how to choose a suitable product and my reviews.
Azelaic acid is an acid that is naturally produced by yeast, barley and wheat. It has anti-bacterial, anti-inflammatory, comedolytic and hyperpigmentation lightening effects on the skin.
• Reduces acne- Azelaic acid has antibacterial effects against C. acnes, the bacterial culprit in pimples. It also reduces inflammation which propagates acne lesions.
• Lightens hyperpigmentation- Azelaic acid blocks one of the key enzymes in the formation of hyperpigmentation (e.g. melasma, postinflammatory hyperpigmentation) called tyrosinase.
• Reduces inflammation- Azelaic acid reduces the redness, irritation and swelling in skin and can be used to treat rosacea.
• Skin rejuvenation and brightening- The exfoliating effects of Azelaic acid allow dead and older skin to be shed for newer and younger skin to resurface.
Azelaic acid is generally well tolerated, even for patients who may have sensitive skin. The side effects of using Azelaic acid are generally mild; such as temporary redness and skin irritation.
Yes, Azelaic acid is safe for use during pregnancy and breastfeeding. Azelaic acid is classified as US FDA pregnancy category class B, meaning it is relatively safe for use during pregnancy. This allows Azelaic acid to be used when skincare heroes for hyperpigmentation and acne such as retinoids and BHA are contraindicated in pregnancy. You can read about more pregnancy safe and unsafe skincare products in Pregnancy Skincare Guide: What’s Safe and What to Avoid.
Just like any skincare active, the concentration and formulation of the ingredients matter. There are two forms of Azelaic acid available in Singapore. Over the counter types of Azelaic acid skincare products typically contain Azelaic acid 10% or lower concentrations. Prescription strength Azelaic acid creams are available in 15% (Finacea) and 20% (Skinoren). Finacea and Skinoren can only be dispensed with a doctor’s prescription in Singapore.
Most of the studies and data that demonstrate the benefits Azelaic acid are based on studies using concentrations of 15-20%. Lower concentrations of Azelaic acid (i.e. over the counter formulations) have not been rigorously validated by studies. This does not mean that lower strengths of Azelaic acid in over the counter skincare products do not work; it merely means we cannot expect the same results with using them vis a vis prescription strength products with higher concentrations of Azelaic acid.
If you’re starting with lower concentrations of Azelaic acid, you can consider combining it with other active ingredients. Azelaic acid is a stable molecule, so it is safe to combine it with most other active ingredients. You can also use Azelaic acid in the day and night as needed.
Sharing my review of two products: The Ordinary’s Azelaic Acid Suspension 10% and Skinoren cream.
*The Ordinary’s Azelaic Acid Suspension 10% was previously reviewed in The Ordinary Skincare Review and Ingredients Decoded.
The good about The Ordinary’s Azelaic Acid Suspension 10%
The Ordinary’s Azelaic Acid Suspension 10% is a mild, non-irritating formula on the skin. It suffices as a moisturiser and dries quickly to leave a matt and dry texture. It is also very affordable product.
The bad about The Ordinary’s Azelaic Acid Suspension 10%
The Ordinary’s Azelaic Acid Suspension 10% did not do much for me. There was no noticeable improvement in my skin despite daily use for approx 4 weeks.
My verdict on The Ordinary’s Azelaic Acid Suspension 10%
Honestly, I was not impressed with The Ordinary’s Azelaic Acid Suspension 10% even though I am a fan of The Ordinary’s skincare range. The Ordinary’s Azelaic Acid Suspension 10% felt like a generic moisturiser. This might be because the concentration of Azelaic acid was low. The Ordinary’s Azelaic Acid Suspension 10% might be suitable for patients who have sensitive skin and want to try a starter Azelaic acid product.
Skinoren is a cream that contains 20% Azelaic acid. It can only be obtained with a doctor’s prescription in Singapore.
The good about Skinoren cream
Skinoren is a prescription strength retinoid and it contains 20% Azelaic acid, which has been validated in studies for treatment of various dermatological conditions. While I was suffering from mask induced acne on my chin (maskne) and irritation, I used Skinoren to reduce the inflammation. This worked fairly quickly, in about 2 weeks I noticed less irritation and maskne.
The bad about Skinoren cream
Skinoren can only be obtained with a doctor’s prescription in Singapore, making it less accessible than over the counter products. There is a stinging sensation when Skinoren is applied to the skin and it lasts for 1-2 minutes.
My verdict on Skinoren cream
The effects of Skinoren were visible for me. It is not my first line of skincare active for acne or hyperpigmentation, however if you have concomitant skin irritation or hypersensitivity (e.g. in maskne), Skinoren is a consideration.
Azelaic acid is a safe multitasking active ingredient for treating acne, hyperpigmentation, rosacea and skin rejuvenation. I find it particularly useful for treating patients with these conditions where they have coexisting skin hypersensitivity and are unable to use other active ingredients like retinoids and acids.
Although the data for Azelaic acid shows that concentrations of 15-20% are effective, these prescription strength products may not be accessible for everyone. In Singapore, Skinoren (20%) and Finacea (15%) can only be obtained with a doctor’s prescription. Nonetheless, if you would like to get started, over the counter formulations with lower concentrations may also be useful.