Topical azelaic acid is effective for managing rosacea, acne and melasma, says Dr Sarah King in his study published in the Journal of Cosmetic Dermatology.
The co-author of this study "A systematic review to evaluate the efficacy of azelaic acid in managing acne, rosacea, melasma and skin ageing" is Dr Jo Campbell. AA is indicated for treating acne and rosacea, but there needs to be more research on its effectiveness in other dermatological conditions.

In this study, researchers aimed to determine the effectiveness and safety of topical AA for acne vulgaris, rosacea, hyperpigmentation/melasma, and skin ageing by reviewing RCTs of at least six weeks' treatment from Databases like MEDLINE, Embase, CINAHL, and ClinicalTrials.gov (up to December 2022).
Forty-three RCTs met the inclusion criteria.
Considering Meta-analyses within 20 rosacea studies, it was found that on treatment with AA, there was a significant improvement in manifestations like erythema severity, inflammatory lesion counts, overall improvement, and success in attaining skin clarity after 12 weeks compared to vehicle.
Regarding effectiveness, metronidazole 0.75 % was less effective compared to AA, considering the improvement in disease manifestations.
From Sixteen studies, researchers suggested that AA is more effective than a vehicle for acne, improves global assessments, and reduces acne severity better than a vehicle.
In comparison, erythromycin gel, AA 20% reduced more lesion.
Seven melasma studies suggested that AA 20% is better than a vehicle for both severity and global improvement.
AA 20% is better than hydroquinone 2% for global improvement, they noted
No eligible RCTs were found evaluating skin ageing.
Concluding further, they said, compared to vehicles, the effectiveness of AA is more for rosacea, acne and melasma.
The study suggested that AA may be a good option for dermatologic conditions. More studies are warranted to evaluate the effectiveness of AA on skin ageing.
Further reading:
King S, Campbell J, Rowe R, Daly ML, Moncrieff G, Maybury C. A systematic review to evaluate the efficacy of azelaic acid in the management of acne, rosacea, melasma and skin ageing. J Cosmet Dermatol. 2023 Aug 7. doi: 10.1111/jocd.15923.