Safety
No boxed warning. Burning, stinging or tingling is common in the first weeks (29% in the rosacea trials), along with itching and dryness. Isolated cases of skin lightening have been reported, so people with darker skin should watch for it. Allergic reactions and worsening asthma have been reported.
Talk to a licensed clinician about your health history and every medication you take before you start.
Legal status
Prescription only; FDA-approved. FDA-approved and generic. The 15% gel and 20% cream are prescription drugs.
What azelaic acid is
Using it for melasma or dark spots is off-label. Generic 15% gel is available; compounded creams often use 5% to 10%.
FDA-approved for
- Mild to moderate inflammatory acne (Azelex 20% cream)
- Bumps and pimples of mild to moderate rosacea (azelaic acid 15% gel)
Dosing
Gel (15%) or cream (20%), applied to the skin, morning and evening. A thin film twice a day on clean, dry skin. The Azelex label says most acne patients with inflammatory spots improve within 4 weeks. Your clinician sets the dose for you.
How well it works
In two 12-week rosacea trials of the 15% gel (664 adults), inflammatory bumps fell 58% and 50% on average, against 40% and 38% on the plain gel. Individual results vary.
Azelaic acid cost
None of the online providers we compare publishes a monthly price for it. For a full breakdown, read How much does an online dermatologist cost?. For the steps, read How to get a tretinoin prescription online.