Azelaic Acid: An Emerging Option for Skin Conditions

Azelaic Acid

Azelaic acid is a naturally occurring dicarboxylic acid that exists in various grains such as wheat and rye. It works to reduce inflammation and eliminate bacteria, fungi and acne-causing microorganisms from clogged hair follicles. Dicarboxylic acid is produced by yeast-like fungi called Malassezia and is part of the natural skin barrier. Commercially, dicarboxylic acid used as an active ingredient in various topical creams and gels for the treatment of inflammatory skin conditions such as rosacea and acne.

Mechanism of Action

This Azelaic Acid works through multiple mechanisms to treat inflammatory skin conditions. It acts as an antibiotic by inhibiting protein synthesis in bacteria and yeasts. This helps to reduce the population of cutaneous microorganisms that often contribute to inflammatory acne lesions. Dicarboxylic acid also has keratolytic properties that help clear away dead skin cells from follicles and efficiently unblock pores. Furthermore, it exerts anti-inflammatory effects by inhibiting the activity of cyclooxygenase and 5-lipoxygenase enzymes. This effectively reduces the production of inflammatory mediators such as prostaglandin E2. Overall, these multitarget mechanisms help azelaic acid to clear bacteria, reduce inflammation and exfoliate dead skin cells.

Uses of Azelaic Acid

Rosacea - It is commonly prescribed as a prescription-strength gel or cream to treat papulopustular rosacea. This acid helps reduce inflammatory lesions and erythema associated with the condition.

Acne - Both over-the-counter and prescription formulation of dicarboxylic acid creams and gels are used to treat mild to moderate acne. It works effectively to unclog pores and reduce new lesion formation.

Hyperpigmentation - This acid is able to inhibit abnormal melanin production in hyperpigmentation disorders like melasma and post-inflammatory hyperpigmentation. Regular application helps fade dark spots and even out skin tone.

Preventing acne recurrence - It is prescribed as a maintenance therapy after acne treatment to prevent new acne blemishes from forming. Dicarboxylic acid controls excess sebum and keeps inflammation in check.

General skin lightening - Some formulations also purportedly work as a natural skin lightening agent to produce an overall fairer and brighter complexion over time with regular use.

Side Effects and Precautions

Azelaic acid is generally well-tolerated when used as directed. Common mild side effects may include skin irritation, redness, stinging, burning and flaking in the initial weeks of application. These usually diminish as the skin adjusts to the active ingredient. Sun sensitivity is also a possibility if dicarboxylic acid cream or gel is applied to unprotected skin. Hence, it is advisable to use a broad-spectrum sunscreen along with the topical treatment. This acid is also not recommended for use during pregnancy or breastfeeding until more safety data is available. Individuals taking oral isotretinoin should avoid supplemental skin treatments containing azelaic acid. Those allergic to other carboxylic acid derivatives need to patch test dicarboxylic acid beforehand. Caution is advised when combining topical dicarboxylic acid with other keratolytic and anti-inflammatory agents due to an increased irritancy potential. Overall, azelaic acid is considered reasonably safe for topical application when used as directed under medical guidance.

Formulations and Dosage

Both over-the-counter and prescription-strength concentrations of azelaic acid are available in various formulations:

- OTC gels and creams containing 5-15% dicarboxylic acid are effective for mild acne and hyperpigmentation. These can be applied once or twice daily.

- 15-20% prescription gels and creams are recommended for moderate rosacea and acne-prone skin. Starting slowly with once daily application, the frequency can be gradually increased based on tolerability.

- Finacea gel containing 15% azelaic acid is approved as monotherapy for rosacea. Application instructions are provided along with the prescription.

- Some skin lightening serums and lotions incorporate lower azelaic acid levels around 2-5% along with other actives like niacinamide, kojic acid etc.

- Makeup containing dicarboxylic acid is also available which provides treatment during the day.

Regular consistent use over 6-8 weeks is needed to experience the full anti-inflammatory, antibacterial and pore clearing benefits of dicarboxylic acid. Results continually improve with longer-term use of 2-3 months or more.

Azelaic acid is an efficacious yet well-tolerated treatment option for various inflammatory dermatological conditions like rosacea, acne and hyperpigmentation disorders. Its multiple mechanisms impart diverse anti-acne and antioxidant properties prized by both consumers and dermatologists. Continued research on dicarboxylic acid formulation science and efficacy promise further optimized topical treatment in the future.

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