Azelaic acid
Rosacea, acne and pigment in one bottle
Azelaic acid has become a favourite of skincare Reddit and dermatologists on TikTok because it is one of the few actives considered usable in pregnancy and on rosacea-prone skin.
Search interest: about 3,600 searches a month in Singapore for “azelaic acid” (Ahrefs, October 2026).
For the Singapore face that is red, bumpy and marked all at once, it is often the first thing we reach for before any device.
Reviewed against the Aesthetics International standard. Category: Skincare.
Does Azelaic acid work?
Established. For the Singapore face that is red, bumpy and marked all at once, it is often the first thing we reach for before any device. Cochrane and later systematic reviews support azelaic acid for acne, with efficacy close to benzoyl peroxide and topical retinoids and better tolerability.
- Verdict
- Established Long clinical track record. Results depend on selection and technique more than on the device.
- Evidence base
- 3 PubMed-indexed studies cited below, including systematic reviews.
- Suits
- Rosacea-prone or acne-prone skin with post-inflammatory marks; pregnancy and breastfeeding with a doctor's agreement; people who cannot tolerate retinoids.
- Not for
- Anyone expecting a quick change in deep melasma or a replacement for a retinoid in photoageing. Severe nodular acne needs more than a topical.
- In Singapore
- Fifteen and twenty per cent azelaic acid preparations are prescription medicines in Singapore and are not advertised to the public; this is an editorial review, not an offer.
- Category
- Skincare · about 3,600 searches a month in Singapore for “azelaic acid”
- Reviewed
- 1 October 2026 by Aesthetics International. Revised as evidence and regulation change.
What it is
A naturally occurring dicarboxylic acid, produced by the yeast that lives on skin and made synthetically for creams. Prescription strengths are 15% gel or foam and 20% cream; cosmetic suspensions are usually 10%. It is prescribed for papulopustular rosacea and acne and used off-label for melasma and post-acne marks.
How it works
It inhibits tyrosinase in overactive melanocytes while largely sparing normal ones, reduces Cutibacterium acnes and the inflammatory signalling behind rosacea, and normalises keratinisation in the follicle. The prescription vehicles deliver it better than cosmetic suspensions, which is why a 10% cosmetic and a 15% gel are not interchangeable. It stings on application for the first week or two in most people.
What the evidence says
Cochrane and later systematic reviews support azelaic acid for acne, with efficacy close to benzoyl peroxide and topical retinoids and better tolerability. For papulopustular rosacea it is one of the few agents with consistent RCT support and sits alongside ivermectin and metronidazole in guideline recommendations. For melasma, trials from the 1990s onward show it comparable to lower-strength hydroquinone, though the trials are older and smaller. Evidence for the 10% cosmetic suspensions is thin.
What people are saying
Paraphrased from public discussion on TikTok, Instagram, Reddit and in the press. Not testimonials, and not about any one clinic. Reported in: dermnetnz.org, drrachelho.com.
What the studies show
- systematic review
Azelaic acid showed consistent benefit for acne and rosacea and moderate benefit for melasma, with a favourable safety profile across studies.
A systematic review to evaluate the efficacy of azelaic acid in the management of acne, rosacea, melasma and skin aging — J Cosmet Dermatol, 2023. PMID 37550898.
- systematic review
Low-certainty evidence suggested azelaic acid is slightly less effective than benzoyl peroxide and similar to tretinoin for acne, with fewer withdrawals for side effects.
Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha-hydroxy acid) for acne — Cochrane Database Syst Rev, 2020. PMID 32356369.
- systematic review
Azelaic acid, ivermectin and metronidazole each outperformed vehicle for papulopustular rosacea in pooled trial data.
Efficacy of Widely Used Topical Drugs for Rosacea: A Systematic Review and Meta-Analysis — Actas Dermosifiliogr, 2025. PMID 40246142.
Studies are selected for relevance and quality, not for agreement with the verdict; PubMed records are linked so the reader can check them.
Who it suits
Suits
Rosacea-prone or acne-prone skin with post-inflammatory marks; pregnancy and breastfeeding with a doctor's agreement; people who cannot tolerate retinoids.
Not for
Anyone expecting a quick change in deep melasma or a replacement for a retinoid in photoageing. Severe nodular acne needs more than a topical.
Alternatives
The two reviewed treatments most often weighed against Azelaic acid, on the same standard.
| Azelaic acid | Niacinamide | Retinoids | |
|---|---|---|---|
| Verdict | Established | Established | Established |
| What it is | A naturally occurring dicarboxylic acid, produced by the yeast that lives on skin and made synthetically for creams. | Niacinamide is vitamin B3 in its amide form, a water-soluble ingredient used at two to ten per cent in serums and moisturisers. | Retinoids are vitamin A derivatives applied to the skin. |
| Evidence base | 3 PubMed-indexed studies cited below, including systematic reviews. | 3 PubMed-indexed studies cited below, including randomised trials. | 4 PubMed-indexed studies cited below, including systematic reviews, randomised trials. |
| Suits | Rosacea-prone or acne-prone skin with post-inflammatory marks; pregnancy and breastfeeding with a doctor's agreement; people who cannot tolerate retinoids. | Almost everyone: oily, blotchy, acne-prone or barrier-compromised skin, and as a tolerable companion to retinoids and acids. | Adults with acne, fine lines, uneven texture or sun damage who will use it most nights for months; it is the base layer most clinic plans sit on. |
| In one line | For the Singapore face that is red, bumpy and marked all at once, it is often the first thing we reach for before any device. | It will not change a face, but it makes everything else in the routine easier to tolerate, which is worth more than most hero ingredients deliver. | The mistake is not choosing the wrong retinoid; it is quitting in week three. |
Risks
Stinging, itching and dryness in the first weeks; rare hypopigmentation in very dark skin with prolonged use. Otherwise one of the more forgiving actives.
In Singapore
Fifteen and twenty per cent azelaic acid preparations are prescription medicines in Singapore and are not advertised to the public; this is an editorial review, not an offer. Ten per cent cosmetic suspensions are sold as cosmetics. Confirm the product's HSA status with the provider.
“For the Singapore face that is red, bumpy and marked all at once, it is often the first thing we reach for before any device.”
Vetted protocols on the same problem
Questions
Azelaic acid or niacinamide?
Why does it sting?
Is it safe in pregnancy?
Cite this review
Aesthetics International (2026). Azelaic acid: does it work? Evidence, risks and verdict. https://aesthetics-international.org/treatments/azelaic-acid/ (reviewed 1 October 2026).
Editorial, unpaid and independent of any manufacturer. Verdict: Established. See what works and what doesn't across all 153 reviews. Spotted an error or a newer study? Suggest a correction — changes are logged on the corrections page. Terms are defined in the glossary.
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