Azelaic Acid: The Redness and Dark Spot Fighter Everyone's Searching

Written By Jilan Wise

Azelaic acid is having a moment. Searches for it have jumped over the past year, and clients ask me about it more and more, usually because they saw it on social media as the answer for redness, breakouts and dark spots. The good news is that this is one trending ingredient with real research behind it. Here's what it does, who it's best for, and how it fits with the treatments I offer in Henderson.

What is azelaic acid?

Azelaic acid is a naturally occurring acid that's been used in dermatology for decades. It's unusual because it works on several skin concerns at once. Research shows it has anti-bacterial and anti-inflammatory effects, helps keep pores from clogging by normalizing how skin cells shed inside the follicle, and slows down excess pigment production (Schulte et al., 2015).

That combination is why it shows up in conversations about acne, rosacea and hyperpigmentation alike.

What the research says it helps

Redness and rosacea. Azelaic acid is best studied for papulopustular rosacea, the type with redness and bumps. In two large randomized trials with more than 600 people, a 15% azelaic acid gel reduced bumps and improved redness significantly more than a placebo gel (Thiboutot et al., 2003). A 2023 systematic review of 43 randomized trials confirmed it improves rosacea redness and lesions compared with placebo (King et al., 2023).

Breakouts. The same review found azelaic acid more effective than placebo for improving acne severity (King et al., 2023). A Cochrane review of topical acne treatments also includes it among the options studied for mild to moderate acne (Liu et al., 2020).

Dark spots and melasma. This is where azelaic acid gets really interesting. In a 24-week study of 329 women with melasma, 20% azelaic acid cream performed comparably to 4% hydroquinone, the long-standing standard, when both were paired with sunscreen (Baliña & Graupe, 1991). A 2023 meta-analysis of randomized trials found azelaic acid may even reduce melasma severity scores more than hydroquinone, though the authors note larger, longer studies are still needed (Albzea et al., 2023).

Marks left behind by breakouts. For people with darker skin tones, the dark marks after a breakout (post-inflammatory hyperpigmentation) can be more frustrating than the acne itself. Azelaic acid has been studied for treating both at the same time (Kircik, 2011), and reviews support it as a safe, helpful option in skin of color (Woolery-Lloyd et al., 2013).

What it won't do

Azelaic acid isn't an anti-aging ingredient. The 2023 systematic review found no randomized trials showing it improves wrinkles or skin aging (King et al., 2023). If fine lines are your main concern, a retinoid is a better fit. My AlphaRet guide explains the options.

Why I like it

I love azelaic acid for clients who have more than one thing going on, like redness plus breakouts, or breakouts plus the dark marks they leave behind. It's one of the few ingredients that addresses all of those at once, and it tends to be a good fit for people whose skin doesn't tolerate stronger actives well.

That said, it can tingle or sting when you first start. Researchers have even identified the skin receptor behind that irritation (Rawal et al., 2026). Starting slowly and keeping your skin barrier healthy makes a big difference. If your skin is already stinging or tight, read my guide to repairing a damaged skin barrier first.

How to use azelaic acid

  • Start slowly. Apply a thin layer every other day at first, then build up as your skin adjusts.

  • Apply to clean, dry skin, then follow with moisturizer.

  • Be consistent. The studies above ran 12 to 24 weeks, so give it time.

  • Wear sunscreen every day. Every pigment study above paired azelaic acid with sunscreen. In the Las Vegas sun this isn't optional. I like Skinbetter Tone Smart SPF 75 for daily wear and EltaMD UV Skin Recovery SPF 50 for sensitive or reactive skin.

  • Support your barrier. A calming serum like EltaMD Skin Recovery Serum helps if you notice tingling or dryness.

The prescription strengths used in most of these studies (15% gel and 20% cream) come from a physician. If you have rosacea or melasma, check with your doctor about whether a prescription is right for you.

Pairing azelaic acid with professional treatments

At-home products work best alongside professional care. In my Henderson studio, I combine a smart home routine with treatments built for your skin:

  • For redness and congestion: my all-inclusive curated facials include calming add-ons like LED and oxygen infusion and cold plasma at no extra cost.

  • For dark spots and melasma: a Curated Peel or the Advanced Custom Facial speeds up results. My guide to the best dark spot serums covers the brightening products I carry.

Not sure if azelaic acid belongs in your routine? Book a consultation at my Henderson studio and I'll look at your skin and build a plan with you.

References

  • Albzea W, AlRashidi R, Alkandari D, et al. (2023). Azelaic acid versus hydroquinone for managing patients with melasma: systematic review and meta-analysis of randomized controlled trials. Cureus, 15, e41796. doi:10.7759/cureus.41796

  • Baliña LM, Graupe K. (1991). The treatment of melasma. 20% azelaic acid versus 4% hydroquinone cream. International Journal of Dermatology, 30, 893–895. doi:10.1111/j.1365-4362.1991.tb04362.x

  • King S, Campbell J, Rowe R, Daly ML, Moncrieff G, Maybury C. (2023). A systematic review to evaluate the efficacy of azelaic acid in the management of acne, rosacea, melasma and skin aging. Journal of Cosmetic Dermatology, 22, 2650–2662. doi:10.1111/jocd.15923

  • Kircik LH. (2011). 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, 10, 586–590. PubMed 21637899

  • Liu H, Yu H, Xia J, et al. (2020). Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha-hydroxy acid) for acne. Cochrane Database of Systematic Reviews, CD011368. doi:10.1002/14651858.CD011368.pub2

  • Rawal D, Lee WJ, Shim WS. (2026). Azelaic acid potentiates TRPV3 activity as a mechanism for skin irritation. Journal of Investigative Dermatology, 146, 1693–1697. doi:10.1016/j.jid.2026.01.022

  • Schulte BC, Wu W, Rosen T. (2015). Azelaic acid: evidence-based update on mechanism of action and clinical application. Journal of Drugs in Dermatology, 14, 964–968. PubMed 26355614

  • Thiboutot D, Thieroff-Ekerdt R, Graupe K. (2003). 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 Dermatology, 48, 836–845. doi:10.1067/mjd.2003.308

  • Woolery-Lloyd HC, Keri J, Doig S. (2013). Retinoids and azelaic acid to treat acne and hyperpigmentation in skin of color. Journal of Drugs in Dermatology, 12, 434–437. PubMed 23652891

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