Azelaic acid is a natural dietary constituent that is thought to have antimicrobial effects. It is used in the treatment of the following conditions:

• Azelaic acid Cream Formulation:

  • Treatment of mild to moderate acne vulgaris. 

  • Azelaic acid is recommended as an adjunctive treatment for acne and particularly for post-inflammatory pigmentation by the American Association of Dermatology).

• Foam and Gel formulation):

  • Treatment of mild to moderate rosacea with papules and pustules. (Use for erythema in the absence of papules or pustules has not been evaluated).

Azelaic acid Dose in Adults

Dose in the treatment of Acne vulgaris:

• Cream 20%:
  • Apply a thin film topically to the affected areas two times a day in the morning and evening.
  • Improvement may be seen after 4 weeks of therapy.
  • The dose may be reduced if persistent skin irritation occurs.

Dose in the treatment of Rosacea:

• Gel 15% and foam 15%:
  • Apply a thin layer topically to the affected areas of the face two times a day in the morning and evening.
  • Reassess the patient if no improvement occurs after 12 weeks of therapy.

Azelaic acid Dose in Childrens

Dose in the treatment of Acne vulgaris:

• Children older than 12 years and Adolescents:
  • Cream (Azelex 20%):
    • Apply a thin film to the affected areas two times a day in the morning and evening.
    • Patients with persistent symptoms should be advised a once daily application.

Pregnancy Risk Factor B

• You may use topical administration during pregnancy.
• Negative fetal outcomes have been linked to oral administration.

Azelaic acid use during breastfeeding:​​​​​​​

• It is unknown if the drug can be absorbed into breastmilk.
• You should use the cream formulation with caution.
• According to the manufacturers, nursing mothers should avoid gel and foam formulations.

Azelaic acid Dose in Renal Disease:

• Adjustment in the dose has not been provided in the manufacturer's labeling.
• However, because of the negligible systemic absorption, dose adjustment is not required.

Azelaic acid Dose in Liver Disease:

• Adjustment in the dose has not been provided in the manufacturer's labeling.
• However, because of the negligible systemic absorption, dose adjustment is not required.

Common Side Effects of Azelaic acid Include:

• Dermatologic:
  • Burning sensation of skin
  • Stinging of skin
  • Tingling of skin

Less Common Side Effects of Azelaic acid Include:

• Dermatologic:
  • Pruritus
  • Erythema
  • Skin Irritation
  • Acne
  • Contact Dermatitis
  • Desquamation
  • Xeroderma
  • Xerosis
• Local:
  • Application Site Pain
  • Application Site Pruritus

Contraindication to Azelaic acid Include:

• Allergy reactions to any component of the drug or the drug itself

Warnings and Precautions​​​​​​​

• Hypersensitivity
  • It can cause allergic reactions such as angioedema and shortness of breath.
  • Patients with persistent symptoms should stop taking medication.
• Hypopigmentation
  • It is possible to develop hypopigmentation. Patients with darker skin tones should be closely monitored for any skin changes.
• Skin irritation:
  • It can cause skin irritation such as stinging, burning, and pruritus within the first few weeks.
  • If severe skin irritation is observed, treatment should be stopped immediately.
• Asthma
  • It can cause asthma exacerbations.

Monitoring Parameters:

None required.

How to administer Azelaic acid?

• Apply a thin film into a thin clean and dry skin and gently massage it. Wash the hands following application.
• The use of occlusive dressings and wrappings should be avoided. Cosmetics may be applied after the gel or foam formulation has dried.
• For facial cleansing, use only mild soaps or soapless lotions. It is not indicated for oral, intravaginal, and ophthalmic use.

Mechanism of action of Azelaic acid:

• It is a dietary constituent that is normally found in whole-grain cereals and can be formed endogenously as well.
• It is unknown what azelaic acids does. 
• It reduces the formation microcomedones through its antimicrobial activity against Cutibacterium epidermidis and staphylococcus aureus.

The Beginning of ActionThe time frame for applying topical cream is four weeks. 

The cream should be 3% to 5% in concentration.absorbedIt penetrates the skin's stratum corneum.

Very little of the drug is availableMetabolizedby the process of oxidation into shorter chain dicarboxylic acids.

Eliminating half-lifeAfter topical application in healthy subjects, it takes approximately 12 hours.excretedPrimarily via urine as an unchanged drug

International Brands of Azelaic acid:

• Acne Foundation
• Acnean
• Acnederm
• Acnederm Medicated Lotion
• Acnestop
• Acnezac
• Ami
• Anzela
• Av F Aza Acne Foundation
• Aza 20
• Azaderm
• Azalea
• Azclear
• Azeclear
• Azel
• Azelan
• Azelderm
• Azelec
• Azelin
• Aziderm
• Azogel
• Cutacelan
• Ezalic
• Finacea
• Scene
• Skinorem
• ZA
• Zelface
• Zeliris

Azelaic acid Brands in Pakistan: