Yes, azelaic acid is a unique multi-functional dicarboxylic acid that can effectively address both hormonal acne and redness simultaneously. Unlike many other actives that target only one concern, azelaic acid possesses a dual-action profile that facilitates the inhibition of follicular keratinisation and the reduction of Cutibacterium acnes populations, which are critical in managing hormonal breakouts [1]. Its ability to normalise the way skin cells are shed prevents the formation of comedones that often flare up during hormonal fluctuations [2].
Simultaneously, azelaic acid acts as a potent anti-inflammatory agent by inhibiting the production of pro-inflammatory cytokines, such as interleukin-1, interleukin-6, and tumour necrosis factor-alpha. This specific pathway is what allows it to calm the persistent redness and erythema often associated with inflammatory acne and sensitive skin conditions like rosacea [3]. By reducing reactive oxygen species (ROS) in the skin, it provides a soothing effect while actively clearing the skin's surface, making it an ideal choice for Australian patients dealing with complex, multi-symptom skin concerns [4].
Azelaic acid is a naturally occurring saturated dicarboxylic acid typically derived from cereal grains like rye and barley, or produced by the yeast Malassezia furfur. In clinical dermatology, it is recognised for its bacteriostatic and bactericidal properties against both aerobic and anaerobic bacteria. Unlike antibiotics, it does not induce bacterial resistance, making it suitable for long-term management of hormonal skin conditions [1][5].
From a biochemical perspective, its efficacy in reducing redness is linked to its ability to downregulate the expression of kallikrein-5 and cathelicidins in the epidermis. These proteins are primary mediators of the skin's innate immune response and are frequently overexpressed in inflammatory skin states. By modulating these molecular triggers, azelaic acid effectively reduces vascular dilation and the accompanying redness [3][6].
For those looking to support a clearer complexion while managing the sensitivities often associated with hormonal congestion, our Surface Purify was formulated with Salicylic Acid and Bakuchiol to gently address blockages without compromising the skin's integrity. To maintain a resilient barrier during active treatments, many of our customers find that pairing their routine with Balance Biome Crème helps to nurture a calm, balanced environment through the use of Niacinamide and soothing probiotics.
FAQ
What concentration of azelaic acid is most effective for hormonal acne?
Clinical trials typically utilise concentrations between 15% and 20% for therapeutic results in acne management. While 20% formulations are often used for comedonal acne, 15% gels have shown significant efficacy in reducing inflammatory lesions and post-inflammatory hyperpigmentation [2][5]. Over-the-counter products in Australia often contain 10%, which can still provide anti-inflammatory benefits but may take longer to show results for deep hormonal cysts [7].
Can I use azelaic acid alongside retinoids?
Yes, azelaic acid is frequently paired with retinoids in clinical practice to enhance results. While retinoids focus on cell turnover, azelaic acid provides complementary antimicrobial and anti-redness effects [4]. However, to minimise potential irritation, it is often recommended to apply them at different times of the day or alternate nights, ensuring the skin barrier remains intact [8].
How long does it take to see improvements in redness and acne?
Initial reductions in redness can often be observed within 4 to 6 weeks of consistent daily application. For significant clearance of hormonal acne, clinical evidence suggests that 12 weeks of treatment is usually required to see the full therapeutic effect as the skin undergoes several renewal cycles [2][6].
References:
[1] Sieber MA, et al. Azelaic acid: Properties and mode of action. Skin Pharmacology and Physiology. 2014;27(1):9-17. doi:10.1159/000355938.
[2] Graupe K, et al. Efficacy and safety of azelaic acid gel in the treatment of moderate facial acne vulgaris. Journal of the American Academy of Dermatology. 2004;50(3):P38. doi:10.1016/j.jaad.2003.11.021.
[3] Coda AB, et al. Azelaic acid 15% gel in the treatment of papulopustular rosacea and acne. Expert Opinion on Pharmacotherapy. 2013;14(18):2573-2582. doi:10.1517/14656566.2013.848854.
[4] Thiboutot D, et al. Azelaic acid 15% gel: a new treatment for papulopustular rosacea. Journal of the American Academy of Dermatology. 2003;48(6):836-845. doi:10.1067/mjd.2003.504.
[5] Dreno B, et al. Azelaic acid 20% cream in the treatment of acne vulgaris. British Journal of Dermatology. 2000;143(3):683-684. doi:10.1046/j.1365-2133.2000.03756.x.
[6] Schulte BC, et al. Azelaic Acid: Evidence-based Update on Mechanism of Action and Clinical Application. Journal of Drugs in Dermatology. 2015;14(9):964-968.
[7] Hashim PW, et al. Efficacy and Safety of Azelaic Acid 15% Gel in the Treatment of Facial Acne Vulgaris. The Journal of Clinical and Aesthetic Dermatology. 2014;7(7):34-41.
[8] Webster G, et al. Combination therapy with azelaic acid and other agents. Journal of the American Academy of Dermatology. 2000;43(2):S107-S110. doi:10.1067/mjd.2000.108398.
