Azelaic Acid for Rosacea
Azelaic acid is one of the most effective topical treatments for rosacea. It can reduce redness, inflammation, and acne-like bumps, and is often used as a first-line treatment for mild to moderate disease. Unlike many rosacea medications, it is also considered safe during pregnancy and breastfeeding.
Is azelaic acid worth trying?
For many patients, the answer is yes. Azelaic acid works by calming inflammation and helping to normalise skin cell turnover. It is particularly useful for papules and pustules, and some patients also notice an improvement in background redness. Most people begin to see results after 6–8 weeks of regular use.
What strength should I use?
The two most commonly prescribed formulations are:
- Finacea 15% gel
- Skinoren 20% cream
I usually recommend starting with once-daily application to a small area of skin. If it is well tolerated, you can gradually increase to treating the entire affected area.
Why does azelaic acid burn or itch?
A mild burning, stinging, or itching sensation is common when treatment is first started. This usually settles as the skin adapts.
You can reduce irritation by applying a gentle moisturiser 5–10 minutes before treatment, using only a pea-sized amount for the whole face, and avoiding application to broken or very inflamed skin. Introducing treatment gradually is often the best way to improve tolerance.
How long does azelaic acid take to work?
Rosacea treatments require patience. Most patients notice improvement after 6–8 weeks, although some begin to see benefits sooner. Continued use is often needed to maintain control of symptoms.
What if azelaic acid doesn't work?
If azelaic acid is ineffective or causes irritation, other prescription options are available. My preferred topical treatment for inflammatory rosacea is ivermectin (Soolantra), which is often more effective for papules and pustules. In some cases, azelaic acid and ivermectin can be used together.
How can I help
I see patients in person in central London. An in person consultation allows me to examine the skin directly including features that are difficult to capture in a photograph such as 3-dimensional changes and textural change. This is the better option where the diagnosis is uncertain, where previous treatment has not been effective, or where a procedure is being considered. For more straightforward conditions such as acne and rosacea a remote consultation with clear photographs can be a good option.
Related articles
- Ivermectin (Soolantra) for Rosacea
- Prescription Creams for Rosacea
- Rosacea in Pregnancy and Breastfeeding
