Azelex is an acne cream containing the active drug azelaic acid. It’s a chemical exfoliator that can remove debris from blocked pores, kill acne-causing bacteria and reduce excess oil production, which contributes to acne. [1]
Azelex can treat mild to moderate acne, as well as many other skin conditions, such as psoriasis and keratosis pilaris (as an off-label treatment). It’s also one of the few acne treatments suitable for pregnant women.
How does Azelex work?
Acne is a multifactorial condition, meaning it usually has multiple causes. This can make treating it tough, because you’ll need to use a comprehensive approach. Azelex has multiple properties to tackle acne from various angles, meaning it can work against most forms of acne. Some ways it treats acne include:
Killing bacteria Acne-causing bacteria can clog your pores, resulting in infection and inflammation. This can cause a deep pimple to form on the surface of your skin (and sometimes under).[2] Azelex can treat this because it has both bacteriostatic (stops bacterial growth) and bactericidal (bacteria killing) properties. [1]
Exfoliating the skin Hyperkeratinization is a condition that causes the overgrowth of skin in some places, resulting in pimples and acne. Azelex has keratolytic properties, which means it can break down excessive skin growth, therefore reducing pimples. [1]
Decreasing free fatty acids Fatty acids are healthy for the skin, but too many can create a breeding ground for bacteria, which can cause acne.[2] Azelex can decrease free fatty acid on the skin, helping to stop acne from developing.[3]
Reducing oil production Excess oil on the skin can clog your pores. This can block the pore, causing debris and bacteria to build up, resulting in acne. According to one study, Azelex can reduce excess oil production on the face by more than 10%. [1]
Often, pimples leave a red mark — even after they’re healed. This is known as post-inflammatory hyperpigmentation (PIH) and can last from a couple of months to several years. Azelex can reduce PIH by inhibiting the pigment tyrosinase, which causes redness.[1] (Don’t worry, this won’t affect the color of your healthy skin.)
What doses of Azelex are there?
Azelex is only available in a 20% dose. You’ll generally apply a small amount twice a day, morning and evening.
If you find Azelex is too strong for you, or you have sensitive skin, Finacea Gel contains the same active ingredient but at a lower dose of 15%.
This page was written by The Treated Content Team.
This page was medically reviewed by Dr. Joseph Palumbo on August 28, 2024. Next review due on August 28, 2026.
How we source info.
When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.
AzelexAzelaic acid
How to use Azelex
Before using Azelex, wash your face clean and pat it dry. Squeeze out a small amount of Azelex and apply it gently to the affected area. Use it twice a day, in the morning and evening. Wash your hands after application.
How long does Azelex take to work?
Most patients will start to see improvement within four weeks of use. In some cases, you might find your acne worsening before it gets better.[1] This is called ‘skin purging’, and it’s the process of removing excess oil and debris from your skin, so you might notice more pimples, blackheads and other blemishes in the short-term. After this process, though, your skin should start to clear. It’s completely normal for your skin to purge, but if you’re concerned about it, you can reach out to our clinicians any time.
This page was written by The Treated Content Team.
This page was medically reviewed by Dr. Joseph Palumbo on August 28, 2024. Next review due on August 28, 2026.
How we source info.
When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.
AzelexAzelaic acid
Azelex isn’t suitable for everyone, and there are some things that you need to be aware of when using it.
Here’s all the official info on it. If anything is unclear, let our clinician know, and they can talk with you about it.
AzelexAzelaic acid
Azelex: FAQ
Have something specific you want to know? Search our info below, or ask our experts a question if you can’t find what you’re looking for.
Is Azelex the best acne treatment for me?
Answer:
We can't say for sure what treatment will work best for you. Each person will react differently to Azelex, so we can’t guarantee it will treat your acne. That being said, studies have shown that it’s generally effective for most people.[3]
If you’re unsure about Azelex, though, there are plenty of different treatments you can choose from, like:
Doxycycline, Erythromycin or Tetralysal - All three are oral antibiotics, and tend to be first-line (go to) treatments for acne.
Zindaclin - A topical antibiotic.
Differin - A topical retinoid. Retinoids increase the rate at which your skin grows and sheds.
Additionally, you can get a treatment with two different active ingredients for a wider approach. Treclin Gel, for example, contains an antibiotic and retinol, and Duac Gel contains both benzoyl peroxide and an antibiotic (clindamycin).
How effective is Azelex?
Answer:
Azelaic acid (the active ingredient in Azelex) is an effective treatment for acne, with the European Academy of Dermatology and Venereology approving it as a treatment for mild to moderate acne. [1]
In one study, 55 women with acne were split into three groups:
Group 1 used an Azelaic acid (AA) gel twice daily for 9 months;
Group 2 used an AA gel twice daily for 3 months, followed by 6 months without treatment; and:
Group 3 used 0.1% adapalene once daily for 9 months.
All three groups experienced improvement in their acne. However, group 1 had fewer instances of scaling and dryness than group 3. Additionally, AA was found to have been more effective at controlling inflammation and preventing damage at week 24. The study concluded that AA is an effective and well-tolerated long-term acne treatment. [2]
Is there a generic version of Azelex?
Answer:
Yes, Azelex is a branded version of Azelaic acid. Usually, you can get the generic version cheaper. There isn't much difference between the two treatments – both are equally effective. The main differences tend to be packaging, price and appearance.
There’s also another treatment similar to Azelex, called Finacea. It contains the same active drug — but at a lower concentration of 15%. This might be better for you if you’ve got sensitive skin or milder acne.
Can I buy Azelex over the counter?
Answer:
No, you’ll need a prescription for Azelex. This is so they can make sure it’s safe for you to use.
What else is Azelex used for?
Answer:
Azelex cream is only licensed for acne, but it’s sometimes used off-label for conditions like hyperpigmentation, rosacea and psoriasis too.
‘Off-label’ means the drug isn't officially approved for treating the condition, but it can still be prescribed if your clinician thinks it's safe and effective for you.
Thielitz, A., Lux, A., Wiede, A., Kropf, S., Papakonstantinou, E., & Gollnick, H. (2015). A randomized investigator-blind parallel-group study to assess efficacy and safety of azelaic acid 15% gel vs. Adapalene 0.1% gel in the treatment and maintenance treatment of female adult acne. Journal of the European Academy of Dermatology and Venereology, 29(4), 789-796.
Disclaimer: The information provided on this page is not a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns about your health, please talk to a doctor.
Dr. Joseph Palumbo
Senior Medical Adviser
Joseph joined Treated in 2023, and is one of the lead doctors providing prescribing services for the platform.
When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.
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