Azelaic Acid Gel: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Azelaic Acid Gel is a topical medicine made from a naturally occurring acid, used mainly to treat rosacea and also used for acne. It works by calming skin inflammation, fighting bacteria, and reducing oxygen-related compounds that damage skin. Common side effects include burning, stinging, itching, and dryness at the application site, while rare serious reactions can include allergic responses. It is typically applied as a thin layer to clean, dry skin, usually twice daily.

What is Azelaic Acid Gel

Azelaic acid gel is a topical medicine made from a naturally occurring acid. It is applied to the skin to treat rosacea and is also used for acne.

Azelaic Acid Gel uses

• Topical treatment of inflammatory papules and pustules and redness (erythema) of mild to moderate rosacea
• Used to treat rosacea
• Treats acne vulgaris
• Helps reduce inflammatory pimples
• Helps unclog pores
• Treats inflammatory lesions of rosacea with certain formulations

Benefits of Azelaic Acid Gel

• Has anti-inflammatory and antimicrobial effects
• Helps reduce the number of inflammatory bumps and pustules linked to rosacea
• May improve overall facial redness
• Reduces acne-causing follicular blockage
• Has anti-inflammatory activity
• May help improve uneven pigmentation after acne
• Does not contain a topical steroid

How Azelaic Acid Gel works

The medicine seems to calm inflammation in the skin by lowering certain substances that cause irritation and redness, and it also fights bacteria and reduces the oxygen-related compounds that damage skin.

Azelaic Acid Gel dosage

Wash and pat the skin dry with a soft towel before applying. Use only very mild soaps or soap-free cleansing lotions on the face. Apply a thin layer to the entire affected area and gently massage it in. Do not use bandages or dressings over the treated skin unless your doctor tells you to. Wash your hands before and after applying. Keep away from the eyes, mouth, nose, and other mucous membranes; if it gets in these areas, rinse with plenty of water.

Makeup or non-medicated cosmetics can be applied once the gel has dried on the skin. Keep using it as directed even if your symptoms improve, as it may take several weeks to see the full effect. Avoid alcohol, hot foods and drinks, and spicy foods while using this medicine, as they may worsen rosacea.

If you miss an application, apply it as soon as you remember, but if it is almost time for your next dose, skip the missed one and go back to your normal schedule. Do not apply two doses at once.

Available forms and strengths

• Gel, 15% w/w

Side effects of Azelaic Acid Gel

Common

• Skin burning, stinging, or tingling
• Itching
• Dry skin, scaling, or flaking
• Redness or irritation at the application site
• Mild swelling (edema)

Serious

• Signs of an allergic reaction, such as rash, hives, itching, swollen or blistered skin, wheezing, chest or throat tightness, trouble breathing or swallowing, or swelling of the mouth, face, lips, or tongue
• Change in skin color
• Shortness of breath or worsening asthma

Warnings and precautions

• There isn't enough well-controlled research in pregnant women, so this medicine should only be used during pregnancy if the possible benefit is thought to outweigh the possible risk to the baby. 
• Talk to your doctor before use. A small amount of the medicine may pass into breast milk, so caution is advised if you are breastfeeding while using this gel.
• Topical absorption is low, so no routine renal dose adjustment is generally required. No routine hepatic dose adjustment is generally required. Avoid alcohol while using this medicine, since it may make rosacea symptoms worse. 
• This medicine is not expected to affect your ability to drive or use machinery.
• This medicine is for use on the skin only - do not swallow it, and keep it away from your eyes, mouth, and nose, as it may cause burning.
• If you have asthma, use this medicine carefully, since some people have had their asthma get worse while using it. Contact your doctor right away if this happens.
• Using other skin products at the same time as this gel may cause more irritation. Check with your doctor before using other products on your skin.
• There have been rare reports of lighter patches of skin (hypopigmentation) after using azelaic acid. People with darker skin should watch for early signs of this.
• If the skin becomes very irritated, use the medicine less often or stop for a few days until the irritation settles.

Storage

• Store at room temperature. Do not freeze.
• Store in a dry place. Do not store in a bathroom.
• If using the pump product, throw away any part not used 8 weeks after opening.
• Keep all drugs out of the reach of children and pets.
• Throw away unused or expired drugs; do not flush down a toilet or pour down a drain unless told to do so. Check with your pharmacist about take-back programs.
• Store at room temperature (between 15ºC and 30ºC).

When to see a doctor

• Get medical help right away if you notice signs of a serious allergic reaction, such as rash, hives, itching, swollen or blistered skin with or without fever, wheezing, tight chest or throat, or trouble breathing, swallowing, or talking.
• Seek medical attention if you notice a change in your skin color after using this medicine.
• Get help right away if you experience shortness of breath while using this medicine.
• If you think you or someone else may have taken too much of this medicine, contact your local poison control center or get medical help right away.

Alternatives

• Adapalene
• Benzoyl peroxide
• Topical clindamycin
• Metronidazole gel