Azelaic Acid

[Guide]

Ball-and-stick model of the azelaic acid molecule, Image courtesy of Wikimedia Commons

What is Azelaic Acid (AZA)?
It is a saturated dicarboxylic acid produced as a white powder found in wheat, rye, and barley. It is an organic compound and is also a precursor to diverse industrial products including polymers and plasticizers, as well as being a component of a number of hair and skin conditioners. Even though it is initially organic or biologic, it is industrially produced by the ozonolysis of oleic acid. [1]

What is odd is that when industrially produced, one of the side products is nonanoic acid which "is produced naturally by Malassezia furfur (also known as Pityrosporum ovale), a yeast that lives on normal skin. The bacterial degradation of nonanoic acid gives azelaic acid." [1]

"Its anti-inflammatory, antioxidant and antimicrobial properties against Propionibacterium acne are currently used in the treatment of various types of acne such as rosacea and acne vulgaris." [16]

Brand Names for Rosacea Treatment

Finacea (USA) and Azelex (Europe) are two brand name prescription azelaic acid formulas that rosaceans are reporting works to control rosacea. Finacea 15% comes in a gel or a foam is made by Leo Pharma. Azelex 20% cream is made by Allergan who was bought by AbbVie (Allergan Savings Card).  According to OptumRx "Sandoz launched an authorized generic version" which is a gel and there are other manufacturers as well. [2] Skinoren, made by Bayer, is Azelaic Acid 20% used to treat acne. [4]

LeoPharma Connect is offering a savings coupon for Finacea by clicking here (For US audiences only).

Generic Azelaic Acid
There are now generic azelaic acid topicals available. 

How Does It Work?
"Azelaic acid is in a class of medications called dicarboxylic acids. It works to treat rosacea by decreasing the swelling and redness of the skin. It works to treat acne by killing the bacteria that infect pores and by decreasing production of keratin, a natural substance that can lead to the development of acne." [3] 

"For acne, it works by killing the bacteria that cause acne and by keeping the skin pores clean." [5]

"Azelaic acid is a naturally occurring acid found in grains such as barley, wheat, and rye. It has antimicrobial and anti-inflammatory properties, which make it effective in the treatment of skin conditions like acne and rosacea. The acid can prevent future outbreaks and clean bacteria from your pores that causes acne." [6]

"It can help in both acne vulgaris and acne rosacea as an antimicrobial, antiinflammatory, and comedolytic. It can also be used for postinflammatory hyperpigmentation." [7]

"Our results indicated a potential role for azelaic acid in the protection of bulge cells from UVB damage and its combination with minoxidil may activate hair growth through overexpression of Shh protein." [9]

"Azelaic acid 15% foam used off-label might be a useful treatment or adjunctive therapy for folliculitis." [11]

" It decreases enzyme activity and immune system activation, and it has anti-inflammatory, antimicrobial, and antioxidant benefits." [14]

"Chronic applicability of AZA has been evidenced with the effects like itching, burning, stinging, redness, etc." [15]

AZA Nanocrystal Suspension
A "a topical nanocrystal AZA-loaded hydrogels composed of Pluronic® F127 and hyaluronic acid mixture that are able to deliver AZA into the stratum corneum and deeper skin layers" has been studied in one paper that concluded that this formulation "possessed the rheological and drug delivery properties desirable for an in situ gelling platform for dermal application." [8]

Does it Work?
"Head-to-head trials show that azelaic acid and ivermectin might be slightly better than metronidazole." [10]

"Topical azelaic acid, 15% gel and 20% cream, has been shown to decrease the expression of kallikrein 5 and cathelicidin, two important components of the inflammatory cascade in rosacea. Studies showed that 70-80% of patients using azelaic acid reported complete remission or marked improvement in their rosacea symptoms, in both erythema and inflammatory lesion counts. Once daily application of azeliac acid is effective and generally well tolerated." [12]

"Twice-daily use of azelaic acid 15% gel is well tolerated, safe, and efficacious in the treatment of papulopustular rosacea, but once-daily application is economical and comparably as safe and efficacious. Various azelaic acid formulations with comparable efficacy are available and provide patients with medication vehicle options. Combination therapy with oral doxycycline 100 mg BID and azelaic acid 15% gel BID was successful in achieving >75% reduction in inflammatory lesion counts in the majority of study subjects. Subsequent remission maintenance with azelaic acid 15% gel BID alone was successful in 75% of subjects." [13]

Over the Counter Non Prescription

There are a number of over the counter azelaic acid treatments:

Azelaic Acid Fine Powder 25 Grams

Azelaic Acid Micro Powder 150 Grams 99%

Ecological Formulas Strata Melazepam Emollient Cream

GIGI Bioplasma Azelaic Cream 15% For Oily Skin

Paula's Choice 10% Azelaic Acid Booster

The Ordinary Azelaic Acid Suspension 10%

Etcetera

Rosacea 101 page 53-4
by permission of author

--------------begin quote from Rosacea 101

Clinical Papers

“Results of this study demonstrated a significantly greater potential for irritation from azelaic acid compared with metronidazole gel.” [275]
With this report done in August 2006:

“Azelaic acid in 20% cream and 15% gel formulations appears to be effective in the treatment of papulopustular rosacea, particularly in regard to decreases in mean inflammatory lesion count and erythema severity. Compared with metronidazole, azelaic acid appears to be an equally effective, if not better, treatment option.” [276]

However, some rosaceans may report irritation with azelaic acid while others report it is effective in controlling rosacea. Azelaic acid appears to be an accepted treatment so you should be aware of its use in rosacea.

“Data pooled from three between-patient trials showed a clear improvement in the azelaic acid group.” [277]

“Azelaic acid (AzA) initially was released in a 20% cream formulation, which has been shown to be effective in the treatment of mild to moderate rosacea. Recently, a 15% gel formulation was developed that vastly improved the delivery of AzA and has been proven by multiple studies to be effective in the treatment of rosacea. We present studies that examine both of these formulations, first in comparison with their vehicles and then in contrast with other well-accepted topical treatments of rosacea, such as metronidazole cream and gel.” [278]

--------------end quote from Rosacea 101

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End Notes

[1] Azeliac Acid, Wikipedia

"Azelaic acid is a saturated dicarboxylic acid found naturally in wheat, rye, and barley. It is also produced by Malassezia furfur, also known as Pityrosporum ovale, which is a species of fungus that is normally found on human skin." DrugBank

[2] Generic Azelaic Acid Gel 15%

[3] Azelaic Acid Topical, MedlinePlus

[4] 

May want to look into the Bayer Savings Card (US patients only)

[5] Azelaic Acid (Topical Route) Mayo Clinic

[6] Treating Acne with Azelaic Acid, healthline

[7] Azelaic Acid, Brenner's Encyclopedia of Genetics (Second Edition), 2013, Acne Vulgaris and Acne Rosacea, Hana Grobel MD, Sarah A. Murphy MD, in Integrative Medicine (Fourth Edition), 2018, ScienceDirect 

[8] Int J Pharm. 2019 Apr 06;:
Preparation of in situ hydrogels loaded with azelaic acid nanocrystals and their dermal application performance study.
Tomić I, Juretić M, Jug M, Pepić I, Čižmek BC, Filipović-Grčić J

[9] Avicenna J Phytomed. 2020 Sep-Oct;10(5):460-471
Azelaic acid stimulates catalase activation and promotes hair growth through upregulation of Gli1 and Gli2 mRNA and Shh protein.
Amirfakhryan E, Davarnia B, Jeddi F, Najafzadeh N

[10] Can Fam Physician. 2019 Nov; 65(11): 803.
Topical treatments for rosacea
Paul Fritsch, MD

[11] Finacea Foam 15% (for folliculitis)

[12] Skin Appendage Disord. 2016 Sep; 2(1-2): 26–34.
Rosacea Management
Manal Abokwidir and Steven R. Feldman

[13] Dovepress, 18 March 2016 Volume 2016:9 Pages 71—77
New developments in the treatment of rosacea – role of once-daily ivermectin cream
Cardwell L, Alinia H, Moradi Tuchayi S, Feldman SR

[14] Rosacea: A New Crop of Treatments
2016-05-13 08:52:38, Pharmacy Times
Jeannette Y. Wick, RPh, MBA, FASCP

[15] Cosmeceutical Aptitudes of Azelaic Acid

[16] PubMed RSS Feed - -The multiple uses of azelaic acid in dermatology: mechanism of action, preparations, and potential therapeutic applications

Rosacea 101 endnotes_______

[275] Cumulative irritation potential among metronidazole gel 1%, metronidazole gel 0.75%, and azelaic acid gel 15%.
Colón LE, Johnson LA, Gottschalk RW; Cutis. 2007 Apr;79(4):317-21.

[276] Azelaic acid in the treatment of papulopustular rosacea: a systematic review of randomized controlled trials.
Liu RH, Smith MK, Basta SA, Farmer ER; Arch Dermatol. 2006 Aug;142(8):1047-52.

[277] Interventions for rosacea. van Zuuren EJ, Graber MA, Hollis S, Chaudhry M, Gupta AK, Gover M.
Cochrane Database Syst Rev. 2005 Jul 20;(3):CD003262.

[278] A clinical overview of azelaic acid.
Elewski B, Thiboutot D; Cutis. 2006 Feb;77(2 Suppl):12-6.

[eacarrington2]

finacea caused my mild case to be quite severe after one weeks use.

why are there no current members nor posts?

bizi

[szimanski3]

It has been a few years since I had health insurance to cover Finacea, but I did use it for several months. For me it helped mildly and caused no irritation, which I find odd because my skin is quite sensitive to most things. I also do not have any negative effects with the Metrogel that I am kind of stuck with until I am covered by insurance. I think my results were better overall with the Finacea, however there was no dramatic results.

I am completely unable to use any moisturizers or cosmetics from regular store shelves, so I wonder why my skin tolerates Finacea so well when others have issues? I know every body is a little different in its sensitivities, like taking the antibiotics makes my nail beds lift, however for a prescription preparation designed for people with highly sensitive skin, it is distressing that it could make some cases worse.

[Guide]

On 6/21/2011 at 9:37 PM, eacarrington2 said:

finacea caused my mild case to be quite severe after one weeks use.

why are there no current members nor posts?

bizi

That is the question. Over 1300 members and hardly anyone posts. Maybe if we offered a RRDi tee shirt for each post there would be motivation to post?  You would think that these members would at least post once out of a volunteer spirit? I just got a Rx for the azeliac gel and foam versions and they should arrive next week in the mail. I will be posting my findings using these two on my face and scalp in my rosacea blog. 

[Guide]

On 6/21/2011 at 9:37 PM, eacarrington2 said:

finacea caused my mild case to be quite severe after one weeks use.

why are there no current members nor posts?

bizi

Good question. The answer is social media. Learn more.