Is Azelaic Acid Effective For Melasma Treatment?

You may feel insecure about your skin if you live with melasma since it can be difficult to feel confident about a condition that compromises your natural skin glow. Dermatologists have a wide range of treatments that can be used to treat melasma, one of which is an ingredient called azelaic acid.

What Is Azelaic Acid?

Azelaic acid is a substance that naturally occurs in barley, wheat, and rye. This ingredient is generally applied in a cream formulation at a strength of about 20%.

Azelaic acid works to improve melasma in two ways. First, it encourages cell turnover to exfoliate the skin and promote new, healthy skin growth. Second, azelaic acid also has antioxidant properties that help remove free radicals that can contribute to dull skin for a naturally brighter complexion.

As with all types of melasma treatment, it’s important to use UV-protective measures such as daily sunscreen use, avoiding the sun at peak hours (10 am – 2 pm), and wearing broad-brimmed hats and other sun-protective clothing.

Is It Effective?

Yes, azelaic acid creams can be an effective treatment for melasma. One review of this ingredient found that azelaic acid can effectively treat certain dermatologic conditions, has a good safety profile, and also has few side effects (Graupe). One study found that azelaic acid was effective at least as hydroquinone, the gold standard ingredient in topical creams, without the side effects of hydroquinone (Baliña).

A study in the Journal of Clinical and Aesthetic Dermatology reports that a new combination of ingredients that includes azelaic acid is a safe and effective treatment for moderate to severe melasma cases (Brandon).

What Are The Side Effects Of Azelaic Acid?

Although azelaic acid is generally well-tolerated, some people may experience side effects nonetheless. The most common side effects of azelaic acid include:

• A burning or tingling sensation
• Skin peeling
• Redness or dryness at the application site

These side effects are considered normal and indicate that your medication is working. If you experience other side effects, such as fever or difficulty breathing, it’s important to stop using the medication and contact your dermatologist immediately, as these may be signs of an allergic reaction.

Azelaic acid is also known to thin the skin, which may expose your skin to sunburn and harmful UV ray effects like sun damage and sunspots. Since the sun is a well-known trigger of melasma, it’s that much more important to protect your skin from the sun when you use azelaic acid.

Should I Try Azelaic Acid For Melasma Treatment?

Azelaic acid is most often used in conjunction with other ingredients in order to effectively treat melasma. Since everyone’s melasma responds to treatment differently, the best way to achieve clear skin is a prescription-strength cream tailored to your unique needs.

References

• Baliña LM, Graupe K. The treatment of melasma. 20% azelaic acid versus 4% hydroquinone cream. International journal of dermatology. https://www.ncbi.nlm.nih.gov/pubmed/1816137/. Published December 1991.
• Brandon K, Hoesly PM, Jambusaria A, Heckman MG, Diehl NN, Sluzevich JC. Evaluating the Efficacy, Safety, and Tolerability of the Combination of Tazarotene, Azelaic Acid, Tacrolimus, and Zinc Oxide for the Treatment of Melasma: A Pilot Study. JCAD. https://jcadonline.com/melasma-may-2019/. Published May 1, 2019.
• Graupe K, Cunliffe WJ, Gollnick HP, Zaumseil RP. Efficacy and safety of topical azelaic acid (20 percent cream): an overview of results from European clinical trials and experimental reports. Cutis. https://www.ncbi.nlm.nih.gov/pubmed/8654128.

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Brandon Kirsch, MD

Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the Naples Community Hospital.