What the science says about Azelaic Acid
Peer-reviewed research on Azelaic Acid, summarised in plain language. Every study links to its record on PubMed so you can read it yourself.
Azelaic Acid for acne
Strong evidence for acne- Most studies found it helped clear acne
- It cleared acne better than a placebo in several studies
- It often worked about as well as tretinoin and some other common acne treatments
- Some studies found it worked less well than benzoyl peroxide or benzoyl peroxide with clindamycin
- Side effects were usually local and moderate, with fewer local side effects than tretinoin in one study
31 studies
Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha-hydroxy acid) for acne.
The Cochrane database of systematic reviews2020Meta-analysis3,880 participantsMixed
In a large review of 3880 people with acne, azelaic acid put on the skin worked less well than benzoyl peroxide but about the same as tretinoin.
Guidelines of care for the management of acne vulgaris.
Journal of the American Academy of Dermatology2024Systematic reviewPositive
Expert guidelines recommend azelaic acid for acne, but this abstract does not give a separate result for how well it cleared acne.
A systematic review to evaluate the efficacy of azelaic acid in the management of acne, rosacea, melasma and skin aging.
Journal of cosmetic dermatology2023Systematic review20%Positive
A large review of clinical trials found that azelaic acid used on its own helped clear acne better than a placebo, and 20% worked better than erythromycin gel.
Evidence-based topical treatments (azelaic acid, salicylic acid, nicotinamide, sulfur, zinc, and fruit acid) for acne: an abridged version of a Cochrane systematic review.
Journal of evidence-based medicine2020Systematic review3,880 participantsMixed
In a large review of 3880 people with acne, azelaic acid put on the skin worked less well than benzoyl peroxide but about as well as tretinoin.
Acne vulgaris.
BMJ clinical evidence2011Systematic reviewNeutral
This review included azelaic acid for acne, but the abstract does not say how well it cleared acne on its own.
Acne vulgaris.
BMJ clinical evidence2008Systematic reviewNeutral
This large review of acne treatments included azelaic acid put on the skin, but the abstract does not report its own acne results.
A randomized controlled double-blinded split-face prospective clinical trial to assess the efficacy, safety, and tolerability of a novel 3-step routine compared to benzoyl peroxide for the treatment of mild to moderate acne vulgaris.
Archives of dermatological research2024RCT21 participantsPositive
In a 12-week trial of 21 adults with acne, a routine with azelaic acid used together with salicylic acid and retinol cleared acne about as well as benzoyl peroxide.
The usefulness of a dermocosmetic containing Myrtus communis extract and azelaic acid for maintenance phase of adult female acne: Results from a randomized exploratory investigator-blinded comparative study.
Journal of the European Academy of Dermatology and Venereology : JEADV2023RCT53 participantsPositive
In a 16-week trial of 53 women with acne, a cream with azelaic acid used together with Myrtus communis extract helped keep acne from coming back better than a light moisturizer.
A comparison of the effectiveness of azelaic and pyruvic acid peels in the treatment of female adult acne: a randomized controlled trial.
Scientific reports2020RCT120 participantsPositive
In a clinical trial of 120 young women with acne, azelaic acid peels over 6 sessions reduced acne severity and improved skin oiliness and peeling.
Clinical and dermoscopic evaluation of combined (salicylic acid 20% and azelaic acid 20%) versus trichloroacetic acid 25% chemical peel in acne: an RCT.
The Journal of dermatological treatment2019RCT34 participants20%Mixed
In a clinical trial of 34 people with acne, a peel with 20% azelaic acid plus salicylic acid improved acne, especially red, sore spots, over 4 sessions.
A multicentre, randomized, single-blind, parallel-group study comparing the efficacy and tolerability of benzoyl peroxide 3%/clindamycin 1% with azelaic acid 20% in the topical treatment of mild-to-moderate acne vulgaris.
Journal of the European Academy of Dermatology and Venereology : JEADV2016RCT215 participants20%Positive
In a 12-week trial of 215 people with mild-to-moderate acne, 20% azelaic acid cream improved acne, but it worked less well than benzoyl peroxide with clindamycin.
A randomized comparative trial of a combined oral contraceptive and azelaic acid to assess their effect on sleep quality in adult female acne patients.
Archives of dermatological research2015RCT32 participantsPositive
In a 6-month trial of 32 women with acne, azelaic acid used on its own was effective for acne and also improved sleep quality more than an oral contraceptive.
A randomized investigator-blind parallel-group study to assess efficacy and safety of azelaic acid 15% gel vs. adapalene 0.1% gel in the treatment and maintenance treatment of female adult acne.
Journal of the European Academy of Dermatology and Venereology : JEADV2015RCT55 participants15%Positive
In a 9-month trial of 55 women with adult acne, 15% azelaic acid gel worked about as well as adapalene and helped keep acne under control.
Combination of azelaic acid 5% and clindamycin 2% for the treatment of acne vulgaris.
Cutaneous and ocular toxicology2011RCT150 participants5%Positive
In a 12-week trial of 150 people with acne, 5% azelaic acid used on its own improved pimples, blackheads and whiteheads from the start of the study.
Combination of azelaic acid 5% and erythromycin 2% in the treatment of acne vulgaris.
The Journal of dermatological treatment2010RCT147 participants5% in combination gel and 20% alone gelPositive
In a 12-week clinical trial of 147 people with acne, azelaic acid gel improved acne, and azelaic acid with erythromycin cleared more pimples, blackheads and whiteheads than either alone.
A study of the efficacy of cleansers for acne vulgaris.
The Journal of dermatological treatment2010RCT13 participantsMixed
In an 8-week trial of 13 people with acne, a cleanser with azelaic acid used together with other ingredients helped red, sore spots more than a cleanser without them.
Efficacy of topical azelaic acid gel in the treatment of mild-moderate acne vulgaris.
Indian journal of dermatology, venereology and leprology2007RCT60 participants20%Positive
In a 45-day trial of 60 people with mild to moderate acne, 20% azelaic acid gel cleared acne better than a placebo gel.
Relationship between sebostatic activity, tolerability and efficacy of three topical drugs to treat mild to moderate acne.
Journal of the European Academy of Dermatology and Venereology : JEADV2007RCT65 participantsPositive
In a clinical trial of 65 people with mild to moderate facial acne, azelaic acid used on its own improved acne with moderate side effects.
[Azelaic acid 15% gel in the treatment of acne vulgaris. Combined results of two double-blind clinical comparative studies].
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG2004RCT580 participants15%Positive
In 580 people with mild-to-moderate acne, 15% azelaic acid gel used on its own for 4 months worked about as well as benzoyl peroxide or clindamycin.
Comparison of combined azelaic acid cream plus oral minocycline with oral isotretinoin in severe acne.
European journal of dermatology : EJD2001RCT85 participants20%Mixed
In an 85-person, 6-month trial for severe acne, 20% azelaic acid cream used with oral minocycline improved acne, but it cleared less than isotretinoin and maintenance results were less favorable.
Efficacy and safety of azelaic acid and glycolic acid combination therapy compared with tretinoin therapy for acne.
Clinical therapeutics1998RCT20%Positive
In a 12-week clinical trial in people with mild-to-moderate facial acne, azelaic acid used together with glycolic acid worked at least as well as tretinoin and caused fewer side effects.
The Efficacy and Safety of Azelaic Acid 15% Foam in the Treatment of Truncal Acne Vulgaris.
Journal of drugs in dermatology : JDD2017Clinical trial18 participants15%Positive
In a pilot study of 18 people with truncal acne, azelaic acid 15% foam put on the skin improved acne over the study period.
Azelaic acid 20 % cream: effects on quality of life and disease severity in adult female acne patients.
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG2016Clinical trial251 participants20%Positive
In a 12-week study of 251 women with mild to moderate acne, azelaic acid 20% cream improved acne severity and quality of life.
Efficacy and safety of azelaic acid (AzA) gel 15% in the treatment of post-inflammatory hyperpigmentation and acne: a 16-week, baseline-controlled study.
Journal of drugs in dermatology : JDD2011Clinical trial15%Positive
In a 16-week baseline-controlled study, azelaic acid 15% gel used on its own twice daily reduced acne.
Effects of azelaic acid on sebaceous gland, sebum excretion rate and keratinization pattern in human skin. An in vivo and in vitro study.
Acta dermato-venereologica. Supplementum1989Clinical trial47 participants20%Positive
In 47 people, a 20% azelaic acid cream improved acne and appeared to work by changing abnormal skin cell buildup rather than oil production.
Clinical studies of 20% azelaic acid cream in the treatment of acne vulgaris. Comparison with vehicle and topical tretinoin.
Acta dermato-venereologica. Supplementum1989Clinical trial289 participants20%Positive
In 289 people with acne, azelaic acid cream used on its own worked as well as tretinoin over 6 months and caused fewer local side effects.
Long-term treatment of acne with 20% azelaic acid cream.
Acta dermato-venereologica. Supplementum1989Clinical trial130 participants20%Positive
In 130 people with acne, 20% azelaic acid cream improved acne, especially papules and pustules, and the abstract says it was well tolerated.
Clinical and laboratory studies on treatment with 20% azelaic acid cream for acne.
Acta dermato-venereologica. Supplementum1989Clinical trial20%Positive
In people with acne, 20% azelaic acid cream cleared red, sore spots after 1 month and blackheads and whiteheads after 2 months compared with a placebo.
[Azelaic acid in the treatment of acne].
Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia1989Clinical trial20%Positive
This review says azelaic acid 20% cream, put on the skin, was an effective treatment for acne and compared well with tretinoin, benzoyl peroxide, and oral tetracycline.
[National and international experiences with azelaic acid cream in the treatment of papulo-pustular acne].
Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia1989Clinical trial20%Positive
In people with papulo-pustular acne, 20% azelaic acid cream reduced red, sore spots and worked about as well as common acne treatments.
[National and international clinical experiences with azelaic acid cream in the treatment of comedo acne].
Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia1989Clinical trial92 participants20%Positive
In a 3-month trial of 92 people with acne, 20% azelaic acid cream cleared pimples, blackheads and whiteheads better than a placebo and worked as well as tretinoin.
Research context, not treatment advice. Studies are about the ingredient, not any one product.
How we grade research for acneAzelaic Acid for hyperpigmentation
Strong evidence for hyperpigmentation- Most studies found azelaic acid helped fade dark patches better than a placebo
- In melasma, it often made patches lighter and less widespread
- It worked about as well as hydroquinone in some studies, and better than weaker hydroquinone in others
- It also helped fade dark marks left after acne in one study
- The most common side effects were burning and stinging, and severe side effects were not reported
16 studies
Efficacy and safety of topical agents in the treatment of melasma: What's evidence? A systematic review and meta-analysis.
Journal of cosmetic dermatology2023Meta-analysis4,539 participantsPositive
In a large review of many clinical trials in people with melasma, azelaic acid put on the skin reduced melasma scores and had a lower rate of skin irritation.
A systematic review to evaluate the efficacy of azelaic acid in the management of acne, rosacea, melasma and skin aging.
Journal of cosmetic dermatology2023Systematic review20%Positive
In a large review of many clinical trials, azelaic acid put on the skin improved redness and bumps in rosacea, acne severity, and melasma more than a placebo.
Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials.
Frontiers in medicine2021Systematic reviewPositive
In a large review of many clinical trials in people with melasma, azelaic acid put on the skin worked better than a placebo.
Topical Treatments for Melasma: A Systematic Review of Randomized Controlled Trials.
Journal of drugs in dermatology : JDD2019Systematic reviewNeutral
A large review of many clinical trials on melasma included azelaic acid, but the abstract did not report a separate result for it.
Acupuncture for melasma in women: a systematic review of randomised controlled trials.
Acupuncture in medicine : journal of the British Medical Acupuncture Society2015Systematic review587 participants20%Neutral
In a large review of 587 women with melasma, one trial compared acupuncture with 20% azelaic acid, but the review did not report a separate result for azelaic acid.
Interventions for melasma.
The Cochrane database of systematic reviews2010Systematic review2,125 participants20%Mixed
In a large review of many clinical trials with 2125 people, 20% azelaic acid lightened melasma better than 2% hydroquinone, but it was not better than 4% hydroquinone.
Comparative study of therapeutic effects of 20% azelaic acid and hydroquinone 4% cream in the treatment of melasma.
Journal of cosmetic dermatology2011RCT29 participants20%Positive
In a 2-month trial of 29 women with melasma, azelaic acid cream reduced melasma more than hydroquinone cream.
Effects of Chinese herbal medicine combined with He-Ne laser on lipoperoxide and superoxide dismutase in chloasma patients.
Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan2009RCT90 participants20%Negative
In a trial of 90 people with chloasma, 20% Azelaic Acid cream used with vitamins by mouth worked less well than Chinese herbal treatment with ligustrazin injection and He-Ne laser.
Assessment of topical hypopigmenting agents on solar lentigines of Asian women.
Dermatology (Basel, Switzerland)2002RCT50 participants20%Neutral
In a pilot study of 50 women with solar lentigines, azelaic acid put on the skin for 2 or 3 months did not lighten the spots.
Azelaic acid and glycolic acid combination therapy for facial hyperpigmentation in darker-skinned patients: a clinical comparison with hydroquinone.
Clinical therapeutics1998RCT20%Positive
In a 24-week trial, azelaic acid used with glycolic acid worked about as well as hydroquinone for facial dark patches, with slightly more mild skin irritation.
Azelaic acid 20% cream in the treatment of facial hyperpigmentation in darker-skinned patients.
Clinical therapeutics1998RCT20%Positive
In a 24-week trial, azelaic acid cream reduced facial dark patches more than a placebo, but caused slightly more burning and stinging.
The treatment of melasma. 20% azelaic acid versus 4% hydroquinone cream.
International journal of dermatology1991RCT329 participants20%Mixed
In a 24-week trial of 329 women with melasma, azelaic acid cream improved dark patches and worked about as well as hydroquinone, with no severe side effects reported.
Double-blind comparison of azelaic acid and hydroquinone in the treatment of melasma.
Acta dermato-venereologica. Supplementum1989RCT155 participants20%Positive
In a 24-week trial of 155 people with melasma, azelaic acid cream faded dark patches and shrank affected areas more than hydroquinone cream.
Efficacy and safety of azelaic acid (AzA) gel 15% in the treatment of post-inflammatory hyperpigmentation and acne: a 16-week, baseline-controlled study.
Journal of drugs in dermatology : JDD2011Clinical trial15%Positive
In a 16-week study, azelaic acid gel put on the skin twice daily reduced acne and post-inflammatory dark marks from acne.
Unraveling the patterns of subclinical pheomelanin-enriched facial hyperpigmentation: effect of depigmenting agents.
Dermatology (Basel, Switzerland)2000Clinical trialPositive
Azelaic acid put on the skin lightened facial pigmentation after 3 weeks.
[Double-blind clinical study of the treatment of melasma with azelaic acid versus hydroquinone].
Medicina cutanea ibero-latino-americana1988Clinical trial60 participants20%Mixed
In a 24-week trial of 60 people with melasma, azelaic acid worked about as well as hydroquinone, and the abstract also says researchers checked side effects.
Research context, not treatment advice. Studies are about the ingredient, not any one product.
How we grade research for hyperpigmentationAzelaic Acid for rosacea
Strong evidence for rosacea- Most studies found it helped rosacea more than a placebo
- It often reduced red bumps and redness
- It worked about as well as metronidazole, and some studies found it worked better
- Some studies found better overall skin ratings and quality of life
- The most common side effects were mild stinging and other mild local skin reactions, with no serious treatment-related side effects reported
20 studies
Efficacy of Widely Used Topical Drugs for Rosacea: A Systematic Review and Meta-Analysis.
Actas dermo-sifiliograficas2025Meta-analysisPositive
In a review of 21 clinical trials, azelaic acid used on its own worked better than metronidazole for rosacea and was reported as well tolerated and safe.
Efficacy of topical ivermectin and impact on quality of life in patients with papulopustular rosacea: A systematic review and meta-analysis.
Dermatologic therapy2020Meta-analysisNeutral
This large review of many clinical trials compared ivermectin with azelaic acid and other options for rosacea, but it did not report a separate result for azelaic acid.
Efficacy of Treatments in Reducing Inflammatory Lesion Count in Rosacea: A Systematic Review.
Journal of cutaneous medicine and surgery2024Systematic review18,347 participantsPositive
In a large review of clinical trials in 18,347 people with rosacea, azelaic acid was listed among treatments studied for reducing red spots and pus-filled spots, but no separate result was reported for it.
A systematic review to evaluate the efficacy of azelaic acid in the management of acne, rosacea, melasma and skin aging.
Journal of cosmetic dermatology2023Systematic review20%Positive
In a large review of many clinical trials, azelaic acid put on the skin improved acne, rosacea, and melasma more than a placebo, with similar side effects to other treatments.
Systematic review of rosacea treatments.
Journal of the American Academy of Dermatology2007Systematic reviewPositive
In a review of 29 studies in people with rosacea, azelaic acid put on the skin worked better than a placebo.
Azelaic acid in the treatment of papulopustular rosacea: a systematic review of randomized controlled trials.
Archives of dermatology2006Systematic review873 participants20% cream; 15% gelPositive
In a review of 873 people, azelaic acid used on the skin lowered red bumps and redness better than a placebo and worked at least as well as metronidazole.
A phase 3 randomized, double-blind, vehicle-controlled trial of azelaic acid foam 15% in the treatment of papulopustular rosacea.
Cutis2015RCT15%Positive
In this clinical trial, azelaic acid foam 15% worked better than a placebo for papulopustular rosacea, reducing red bumps and improving overall skin ratings, with mostly mild local side effects.
Azelaic acid foam 15% in the treatment of papulopustular rosacea: a randomized, double-blind, vehicle-controlled study.
Cutis2013RCT15%Positive
Over 12 weeks, azelaic acid foam worked better than a placebo for papulopustular rosacea and was well tolerated.
A multicenter study of topical azelaic acid 15% gel in combination with oral doxycycline as initial therapy and azelaic acid 15% gel as maintenance monotherapy.
Journal of drugs in dermatology : JDD2009RCT172 participants15%Positive
In a study of 172 people, azelaic acid gel used with doxycycline first and then used alone helped keep rosacea under control better than a placebo over 24 weeks.
Comparative study of some treatment modalities of rosacea.
Journal of the European Academy of Dermatology and Venereology : JEADV2009RCT24 participants20%Positive
In a 15-week trial of 24 people with rosacea, azelaic acid cream improved facial spots more than metronidazole or permethrin, but redness and side effects were similar.
Azelaic acid 15% gel once daily versus twice daily in papulopustular rosacea.
Journal of drugs in dermatology : JDD2008RCT72 participants15%Positive
In a 12-week trial of 72 people with papulopustular rosacea, azelaic acid gel used once daily worked about as well as using it twice daily and was well accepted.
Efficacy and safety of once-daily metronidazole 1% gel compared with twice-daily azelaic acid 15% gel in the treatment of rosacea.
Cutis2006RCT160 participants15%Positive
In a trial of 160 people with rosacea, azelaic acid gel improved spots, overall severity, and redness about as well as metronidazole.
A comparison of 15% azelaic acid gel and 0.75% metronidazole gel in the topical treatment of papulopustular rosacea: results of a randomized trial.
Archives of dermatology2003RCT251 participants15%Positive
In a 15-week trial of 251 people with papulopustular rosacea, Azelaic Acid gel reduced red bumps and redness more than metronidazole gel, with no serious treatment-related side effects.
Efficacy and safety of azelaic acid (15%) gel as a new treatment for papulopustular rosacea: results from two vehicle-controlled, randomized phase III studies.
Journal of the American Academy of Dermatology2003RCT664 participants15%Positive
In 2 trials of 664 people, azelaic acid gel reduced red bumps and redness better than a placebo, with no serious treatment-related side effects reported.
A comparison of topical azelaic acid 20% cream and topical metronidazole 0.75% cream in the treatment of patients with papulopustular rosacea.
Journal of the American Academy of Dermatology1999RCT40 participants20%Positive
In a 15-week trial of 40 people with papulopustular rosacea, azelaic acid cream reduced bumps as well as metronidazole and gave better overall improvement ratings, with slight stinging.
Double-blind comparison of azelaic acid 20% cream and its vehicle in treatment of papulo-pustular rosacea.
Acta dermato-venereologica1999RCT116 participants20%Positive
In a 3-month trial of 116 people with papulo-pustular rosacea, azelaic acid cream reduced red bumps and redness more than a placebo, with similar side effects.
A novel azelaic acid formulation for the topical treatment of inflammatory rosacea: A multicentre, prospective clinical trial.
Journal of cosmetic dermatology2021Clinical trial44 participants15%Positive
In an 8-week trial of 44 people with inflammatory rosacea, a cream with Azelaic Acid and dihydroavenanthramide D reduced redness and inflammatory spots, with no relevant side effects.
Real-World Efficacy of Azelaic Acid 15% Gel for the Reduction of Inflammatory Lesions of Rosacea.
Skin therapy letter2017Clinical trial15%Positive
In a small trial, azelaic acid 15% gel reduced red, inflamed rosacea spots, and the improvement lasted beyond the treatment period.
The face and mind evaluation study: an examination of the efficacy of rosacea treatment using physician ratings and patients' self-reported quality of life.
Journal of drugs in dermatology : JDD2005Clinical trial583 participantsPositive
In a study of 583 people with rosacea, azelaic acid gel improved doctor ratings and quality of life, and it worked better when used together with other treatments.
Noxious sensory perceptions in patients with mild to moderate rosacea treated with azelaic acid 15% gel.
Cutis2004Clinical trial40 participants15%Neutral
In a 2-week study of 40 women with rosacea, azelaic acid gel did not damage the skin barrier, and lactic acid stinging did not predict stinging with the gel.
Research context, not treatment advice. Studies are about the ingredient, not any one product.
How we grade research for rosaceaProducts with Azelaic Acid
Products we have confirmed contain Azelaic Acid, from their ingredient lists.
- 10% Azelaic Acid Booster · Paula's Choice · 10%
- 10% Azelaic Acid Serum · The Inkey List · 10%
- 10% Azelaic Acid Treatment · Good Molecules · 10%
- A-Control 10% Azelaic Acid Serum · Nineless · 10%
- Action Medicated Lotion Contains 20% w/w Azelaic Acid · Azclear · 20%
- Azéane Cream 15% Azelaic Acid · ACM · 15%
- Azelaic Acid 10 Ampoule · Skin1004 · 10%
- Azelaic Acid 10 Kojic Tea Tree Serum · Purito · 10%
- Azelaic Acid 12% Serum · TIRTIR · 12%
- Azelaic Acid 3 Cica Skin Clarifying Toner · Anua
- Azelaic Acid Emulsion 10% · Naturium · 10%
- Azelaic Acid Face Cream · Kisocare · 15%
- Azelaic Acid Facial Serum 8% · Q+A · 8%
- Azelaic Acid Hyaluron Redness Soothing Serum · Anua · 10%
- Azelaic Acid Serum (AZ15) · Cos De BAHA · 15%
- Azelaic Acid Suspension 10% · The Ordinary · 10%
- Azelaic Advanced · Regimen Lab · 10%
- Redness Relief 10% Azelaic Acid Serum · Peach Slices · 10%
- Ruboril Metroruboril A.Z · ISISPHARMA · 15%