Azelaic Acid Cream by Ray Sahelian, M.D.

Azelaic acid is a natural material produced by a yeast that lives on normal skin, Malassezia furfur (also known as Pityrosporum ovale). Azelaic acid is used as a topical treatment for mild to moderate acne, and may be combined with oral antibiotics or hormonal therapy. It is useful in acne.

Azelaic acid has antibacterial properties. It helps reduce the growth of bacteria in the follicle (Proprionibacterium acnes and Staphylococcus epidermidis). Azelaic acid has keratolytic & comedolytic properties. It helps return to normal the disordered growth of the skin cells lining the follicle.

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Azelaic acid side effects
Some of the following are common azelaic acid side effects during treatment of rosacea: Slight warming of the skin, slight burning or stinging sensations, slight peeling of dry skin.

Azelaic acid and rosacea
Azelaic acid in the treatment of papulopustular rosacea: a systematic review of randomized controlled trials.
Arch Dermatol. 2006 Aug;142(8):1047-52. Liu RH, Smith MK, Basta SA, Farmer ER. Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA.
To evaluate the clinical efficacy of topical 20% azelaic acid cream and 15% azelaic acid gel compared with their respective vehicles and metronidazole gel in the treatment of papulopustular rosacea. Randomized controlled trials involving topical azelaic acid (cream or gel) for the treatment of rosacea compared with placebo or other topical treatments. Two authors independently examined the studies identified by the searches. Ten studies were identified, of which 5 were included (873 patients). Two authors independently extracted data from the included studies, then jointly assessed methodological quality using a quality assessment scale. Because standard deviation data were not available for 4 of the 5 studies, a meta-analysis could not be conducted. Four of the 5 studies demonstrated significant decreases in mean inflammatory lesion count and erythema severity after treatment with azelaic acid compared with vehicle. None of the studies showed any significant decrease in telangiectasia severity. CONCLUSIONS: Azelaic acid in 20% cream and 15% gel formulations appears to be effective in the treatment of papulopustular rosacea, particularly in regard to decreases in mean inflammatory lesion count and erythema severity. Compared with metronidazole, azelaic acid appears to be an equally effective, if not better, treatment option.