Yes, azelaic acid is uniquely positioned in clinical dermatology to treat both hormonal acne and persistent redness simultaneously. Unlike many other actives that target a single pathway, azelaic acid is a dicarboxylic acid that exhibits multi-modal pharmacology. It functions as a competitive inhibitor of 5-alpha reductase, the enzyme responsible for converting testosterone into dihydrotestosterone (DHT) within the sebaceous gland. By modulating this local hormonal influence, it helps reduce the sebum overproduction and follicular hyperkeratosis that drive hormonal breakouts along the jawline and chin [1], [2].
Simultaneously, azelaic acid addresses redness through potent anti-inflammatory and antioxidant mechanisms. It inhibits the production of pro-inflammatory cytokines, such as interleukin-1 (IL-1), IL-6, and tumour necrosis factor-alpha (TNF-α), while also reducing the expression of kallikrein-5 and cathelicidins. These latter proteins are key mediators in the inflammatory pathways of both acne and rosacea, which often manifest as diffuse erythema or localised redness around lesions [3]. By downregulating these pathways, azelaic acid effectively calms the skin's vascular response while clearing active blemishes [4].
From a biochemical perspective, azelaic acid (15-20%) is a saturated dicarboxylic acid naturally found in grains like barley and wheat, though it is synthetically optimised for skincare formulations to ensure stability. Its efficacy in hormonal acne is largely attributed to its bacteriostatic and bactericidal effects against Cutibacterium acnes, alongside its ability to normalise keratinisation. This prevents the formation of microcomedones, the precursors to inflammatory acne lesions [1].
Furthermore, its role in redness reduction is tied to its ability to neutralise reactive oxygen species (ROS). During an inflammatory flare, neutrophils release superoxide radicals that damage tissue and exacerbate redness; azelaic acid scavenges these radicals, providing a protective effect. Because it does not cause the same level of photosensitivity or irritation as retinoids or benzoyl peroxide, it is often favoured for patients with sensitive Australian skin who are prone to post-inflammatory erythema (PIE) [5].
For those managing the complexities of hormonal congestion, supporting the skin's natural ecosystem is essential to maintaining long-term barrier resilience. Our [Balance Biome Crème](https://auremeskin.com.au/products/balance-biome-creme) is often favoured by those with sensitised, acne-prone skin, as it utilises Bifida Ferment Lysate and Niacinamide to help stabilise the complexion and minimise visible redness. Pairing these soothing properties with a gentle, non-stripping cleanse, such as our [Surface Calm](https://auremeskin.com.au/products/surface-calm), ensures the skin remains calm and hydrated while you incorporate specialised actives like azelaic acid into your routine.
FAQ
How long does it take to see results for hormonal acne?
Clinical trials indicate that significant improvements in inflammatory acne lesions are typically observed after 4 to 8 weeks of consistent, twice-daily application. However, maximal clearance of hormonal breakouts and the associated redness often requires 12 weeks of therapy to allow for multiple skin cell turnover cycles and the stabilisation of sebaceous gland activity [2], [4].
Can azelaic acid be used alongside a retinoid?
Yes, azelaic acid and retinoids can be used together and are often synergistic. While the retinoid focuses on cellular turnover, azelaic acid provides targeted anti-inflammatory and anti-microbial support. To minimise potential irritation, many practitioners recommend using azelaic acid in the morning and a retinoid at night, ensuring a robust moisturiser is used to support the skin barrier [5].
Does azelaic acid help with post-acne marks?
Azelaic acid is highly effective for post-inflammatory hyperpigmentation (PIH) and erythema (PIE). It acts as a selective tyrosinase inhibitor, meaning it targets hyperactive melanocytes without affecting normal skin pigmentation. This makes it a superior choice for clearing the red and brown marks left behind by hormonal cystic acne [3], [6].
References:
[1] Sieber MA, Hegel JKE. Azelaic acid: Evidence-based update on mechanism of action and clinical application. Journal of Inflammation Research. 2014;7:31-39. doi:10.2147/JIR.S40373
[2] Thiboutot D, et al. Management of Acne: A Report from a Global Alliance to Improve Outcomes in Acne. Journal of the American Academy of Dermatology. 2009;60(5):S1-S50. doi:10.1016/j.jaad.2009.01.019
[3] Del Rosso JQ. The role of topical azelaic acid in the management of acne and rosacea. Journal of Clinical and Aesthetic Dermatology. 2011;4(1):34-37.
[4] Gollnick HP, Layton AM. Azelaic acid 15% gel in the treatment of acne vulgaris. Expert Opinion on Pharmacotherapy. 2008;9(15):2699-2706. doi:10.1517/14656566.9.15.2699
[5] Fitton A, Goa KL. Azelaic Acid: A Review of its Pharmacological Properties and Therapeutic Efficacy in Acne and Hyperpigmentary Skin Disorders. Drugs. 1991;41(5):780-798. doi:10.2165/00003495-199141050-00007
[6] Bandyopadhyay D. Topical treatment of melasma. Indian Journal of Dermatology. 2009;54(4):303-309. doi:10.4103/0019-5154.57602
