From the Guidelines
The recommended treatment protocol for acne using azelaic acid gel involves applying a thin layer of 20% azelaic acid gel to clean, dry skin twice daily, in the morning and evening, as it is mildly effective as a comedolytic, antibacterial, and anti-inflammatory agent 1.
Key Considerations
- Azelaic acid is particularly useful for patients with sensitive skin or of Fitzpatrick skin types IV or greater due to its lightening effect on dyspigmentation 1.
- It is recommended to start with once-daily application for the first week to minimize irritation, then increase to twice daily if tolerated well.
- Patients should gently massage the gel into affected areas, avoiding contact with eyes, mouth, and mucous membranes.
- Most patients should continue treatment for at least 12 weeks to see optimal results, as improvement typically begins after 4 weeks but full benefits may take longer.
- Azelaic acid works by reducing inflammation, killing acne-causing bacteria (P. acnes), and normalizing follicular hyperkeratinization that leads to clogged pores.
- It's particularly effective for mild to moderate inflammatory acne and can help reduce post-inflammatory hyperpigmentation.
- Patients should use sunscreen during daytime as skin may be more sensitive to UV radiation.
- Common side effects include mild burning, stinging, or redness upon application, which typically diminish with continued use.
- If severe irritation occurs, reducing application frequency or discontinuing temporarily may help.
Additional Recommendations
- According to the most recent guidelines, azelaic acid is conditionally recommended for the treatment of acne 1.
- Combining topical therapies with multiple mechanisms of action is recommended as a good practice statement 1.
- Limiting systemic antibiotic use and combining systemic antibiotics with topical therapies are also recommended as good practice statements 1.
From the FDA Drug Label
After the skin is thoroughly washed and patted dry, a thin film of AZELEX® cream should be gently but thoroughly massaged into the affected areas twice daily, in the morning and evening. The recommended treatment protocol for acne using azelaic acid gel is to apply a thin film to the affected areas twice daily, in the morning and evening 2.
- Key points:
- Apply after washing and drying the skin
- Massage gently into affected areas
- Wash hands after application Note that the provided information refers to azelaic acid cream, not gel, but it is assumed that the treatment protocol may be similar 2.
From the Research
Azelaic Acid Gel for Acne Treatment
The recommended treatment protocol for acne using azelaic acid gel is as follows:
- Apply azelaic acid 15% gel twice daily to affected areas 3, 4
- The treatment can be used as monotherapy or in combination with other agents 3
- Azelaic acid 15% gel has been shown to be effective in reducing inflammatory papules and pustules, with a median reduction of 70-71% 3, 4
- The gel is well-tolerated, with local irritation (burning, stinging, itching, and scaling) being typically mild and transient 5
Efficacy and Safety
- Azelaic acid 15% gel has been compared to other topical treatments, such as benzoyl peroxide 5% and clindamycin 1%, and has been shown to be as effective 3, 4
- The gel has also been shown to be effective in maintaining treatment response over a 6-month period 6
- Azelaic acid 15% foam has also been shown to be effective in treating moderate truncal acne and facial acne 7