Azelaic Acid: A Potential Treatment Option for Rosacea Patients
Keywords:
Acne, Azelaic acid, Clinical drug evaluation, Rosacea, Skin disorderAbstract
Azelaic Acid (AA), when administered topically, is effective in treating rosacea and acne, but there is also some evidence that it can be used to treat other dermatological disorders. AA works differently for melasma, acne, and rosacea. Azelaic acid is a naturally generated saturated dicarboxylic acid that has been used to treat rosacea, acne, and melasma. The cutaneous discomfort is usually light and temporary, and the 15% gel is highly effective and generally well tolerated. Azelaic acid possesses many dermatological pharmacological applications. Its effectiveness in treating papulopustular rosacea, acne vulgaris, and Its anti-inflammatory and antioxidant properties are thought to be connected to other cutaneous conditions. Rosacea mostly affects the face and is a chronic, recurring skin disorder. Rosacea is linked to immunological dysregulation and inflammation that is exacerbated by outside causes, despite the fact that its exact origin is unknown. For a variety of dermatological disorders, azelaic acid, either alone or in combination, may be a safe, well-tolerated first-line or alternate treatment. To do so, we performed a literature review regarding, azelaic acid's application in dermatology. The most compelling data for azelaic acid use in rosacea was discovered during this review.
References
Feng X, Shang J, Gu Z, Gong J, Chen Y, Liu Y. Azelaic acid: mechanisms of action and clinical applications. Clin. Cosmet. Investig. Dermatol. 2024; 17:2359–2371. https://doi.org/10.2147/ccid.s485237
Pasca PM, Antonescu A, Fritea L, Banica F, Vicas SI, Laslo V, et al. Novel liposomal formulation with azelaic acid: preparation, characterization, and evaluation of biological properties. Appl. Sci. 2022; 12(24):13039. https://doi.org/10.3390/app122413039
Sauer N, Oślizło M, Brzostek M, Wolska J, Lubaszka K, Karłowicz-Bodalska K. The multiple uses of azelaic acid in dermatology: mechanism of action, preparations, and potential therapeutic applications. Adv. Dermatol. Allergol. 2023; 40(6):716-24. https://doi.org/10.5114/ada.2023.133955
Anastassakis K. Androgenetic Alopecia from A to Z. Springer Int. Publ. 2022. Available: https://link.springer.com/book/10.1007/978-3-031-08057-9
Jones DA. Rosacea, reactive oxygen species, and azelaic acid. J. Clin. Aesthet. Dermatol. 2009;2(1):26–30. https://pmc.ncbi.nlm.nih.gov/articles/PMC2958186/
Powell FC. Rosacea. N. Engl. J. Med. 2005; 352(8):793-803. https://www.nejm.org/doi/abs/10.1056/NEJMcp042829
Van Zuuren EJ. Rosacea. N. Engl. J. Med 2017; 377(18):1754-64. https://www.nejm.org/doi/full/10.1056/NEJMcp1506630
Sieber MA, Hegel JK. Azelaic acid: properties and mode of action. Skin. Pharmacol. Physiol. 2013; 27(Suppl. 1):9-17. https://doi.org/10.1159/000354888
Pugliese A, Forsyth A, Davis J, Amoa L, Frasier K, Gonzalez K, Benitez C, Frye P, Kiken D. Evaluating Topical Therapies for the Management of Confluent and Reticulated Papillomatosis. J. Biosci. Med. 2025;13(3):12-26. https://doi.org/10.4236/jbm.2025.133002
King S, Campbell J, Rowe R, Daly ML, Moncrieff G, Maybury C. A systematic review to evaluate the efficacy of azelaic acid in the management of acne, rosacea, melasma, and skin aging. J. Cosmet. Dermatol. 2023; 22(10):2650-62. https://doi.org/10.1111/jocd.15923
Worcester S. Daily Application of Azelaic Acid Plus Moisturizer Soothes Rosacea. Family Practice News. 2008 5; 38(16):21. https://www.mdedge.com/familymedicine/article/30487/dermatology/daily-application-azelaic-acid-plus-moisturizer-soothes?gs=0
Panyosak A, Manosroi J, Rojanasakul Y, Manosroi A. Safety assessment of azelaic acid and its derivatives entrapped in nanovesicles. Hum. Exp. Toxicol. 2009; 28(6-7):387-92. https://doi.org/10.1177/0960327109105164
Tauber U, Weiss C, Matthes H. Percutaneous absorption of azelaic acid in humans. Exp. Dermatol. 1992;1(4):176–9. https://doi.org/10.1111/j.1600-0625.1992.tb00185.x
Breathnach AS. Pharmacological properties of azelaic acid: a rationale for clinical use. Clin Drug Investig. 1995; 10:27-33. Available from: https://doi.org/10.2165/00044011-199500102-00005
Fitton A, Goa KL. Azelaic acid: a review of its pharmacological properties and therapeutic efficacy in acne and hyperpigmentary skin disorders. Drugs. 1991; 41:780–98. https://doi.org/10.2165/00003495-199141050-00007
Hung WH, Chen PK, Fang CW, Lin YC, Wu PC. Preparation and evaluation of azelaic acid topical microemulsion formulation: in vitro and in vivo study. Pharmaceutics. 2021;13(3):410. https://doi.org/10.3390/pharmaceutics13030410
Ma H, Yu M, Tan F, Li N. Improved percutaneous delivery of azelaic acid employing microemulsion as nanocarrier: formulation optimization, in vitro and in vivo evaluation. RSC Adv. 2015; 5(37):28985–95. https://doi.org/10.1039/C5RA00713E
Burchacka E, Potaczek P, Paduszyński P, Karłowicz-Bodalska K, Han T, Han S. New effective azelaic acid liposomal gel formulation of enhanced pharmaceutical bioavailability. Biomed. Pharmacother. 2016; 83:771–5. https://doi.org/10.1016/j.biopha.2016.07.014
Pazoki-Toroudi H, Nilforoushzadeh MA, Ajami M, Jaffary F, Aboutaleb N, Nassiri-Kashani M, et al. Combination of azelaic acid 5% and clindamycin 2% for the treatment of acne vulgaris. Cutan. Ocul. Toxicol. 2011; 30(4):286–91. https://doi.org/10.3109/15569527.2011.581257
Thiboutot DM, Fleischer AB, Del Rosso JQ, Rich P. 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. J. Drugs. Dermatol. 2009; 8(7):639-48. https://pubmed.ncbi.nlm.nih.gov/19588640/
