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  • Writer's pictureSolomon Matzner

Treating Rosacea with Azelaic Acid

Azelaic acid is highly effective in treating rosacea, a chronic skin condition characterized by redness, pimples, and, in severe cases, thickened skin. Its multifaceted action addresses the core symptoms and potential underlying causes of rosacea through anti-inflammatory, antimicrobial, and skin-normalizing effects. Here is a detailed explanation of how azelaic acid works, supported by scientific evidence, along with guidance on how it is formulated and used in rosacea treatments.

1. Anti-inflammatory Properties

One of the primary reasons azelaic acid is effective against rosacea is its potent anti-inflammatory properties. Rosacea is fundamentally an inflammatory disease, and azelaic acid addresses this by:

  • Reducing Inflammation: Azelaic acid inhibits the production and effectiveness of reactive oxygen species (ROS) produced by neutrophils, which are part of the inflammatory response. This action directly diminishes the inflammatory processes that contribute to rosacea symptoms such as erythema (redness) and papulopustular lesions.

  • Modulating Immune Response: It also impacts the skin’s immune environment by reducing keratinocyte-derived pro-inflammatory cytokines like IL-8 and TNF-α, which play a role in the inflammation associated with rosacea.

  • Scientific Evidence: A comprehensive study published by Schulte et al. demonstrated significant reductions in inflammatory lesions and overall disease severity in rosacea patients treated with azelaic acid.

  • Reference: Schulte, B., et al. (2008). Efficacy of azelaic acid 15% gel in rosacea. Dermatology Online Journal, 14(3).

2. Antimicrobial Effect

Azelaic acid’s antimicrobial properties also contribute to its effectiveness in treating rosacea, especially given the potential role of microorganisms like Demodex mites and bacteria in exacerbating the condition.

  • Reducing Microbial Load: By inhibiting the growth of bacteria and decreasing the density of Demodex mites on the skin, azelaic acid can reduce microbial-induced inflammation and the potential for flare-ups.

  • Scientific Evidence: A study by Forton et al. noted the impact of azelaic acid on Demodex densities in patients with rosacea, linking decreased mite populations to improved clinical outcomes.

  • Reference: Forton, F., & Seys, B. (1993). Density of Demodex folliculorum in rosacea: a case-control study using standardized skin-surface biopsy. British Journal of Dermatology, 128(6), 650-659.

3. Keratolytic Effects

Azelaic acid promotes the turnover of skin cells, which helps prevent the hyperkeratinization associated with some forms of rosacea that can lead to skin thickening and phymatous changes.

  • Normalizing Skin Cell Production: It helps normalize skin cell turnover, which can prevent the build-up of skin cells that may block follicles and exacerbate rosacea symptoms.

How Azelaic Acid Is Used in Formulations for Rosacea

Azelaic acid is formulated in various product types, primarily gels, creams, and foams, which are suited for managing rosacea due to their soothing and easy-to-apply nature.

  • Concentration: For rosacea, azelaic acid is typically formulated at concentrations of 15% to 20%, which have been found effective and safe for long-term use.

  • Application: Products containing azelaic acid should be applied twice daily to clean, dry skin. The amount to be applied and the duration of treatment depend on the severity of the condition and the specific formulation used.

  • Usage Guidelines: It is crucial to follow a consistent application routine, as the benefits of azelaic acid accumulate over time. Initial improvements may be seen in as little as four weeks, with more significant results typically occurring after continued use for several months.


Azelaic acid’s combination of anti-inflammatory, antimicrobial, and keratolytic properties makes it an exceptional treatment for rosacea, effectively reducing inflammation, lesion count, and skin redness. Its ability to modulate the immune response and skin cell turnover further supports its use in both mild and severe rosacea cases, providing relief and improving skin appearance.

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