Azaelic acid is one of the most underrated active skin care ingredient which is found naturally in our skin, and is helpful in the treatment acne,rosacea and as part for your skin care routine for a blemish free skin.
Azaelic acid (AA) is a dicarboxylic acid that is naturally found in wheat, rye and barley. Azaelic acid is also produced by a yeast that lives in our skin called Malassezia furfur. This explains why over colonisation by this yeast results in pale patches in the skin which is medically termed as Pityriasis versicolor. Owing to this acid’s potential to cause reduce pigmentation, azaelic acid has been widely used to treat hyperpigmentation.
AA is found in grains such as wheat, rye,barley 
M. furfur as seen by an electron miscorscope
How does it work?
- Azaelic acid has been shown to have a bacteriostatic (inhibits the growth of microbacteria) and bactericidal (kills the microbacteria) action against micro organisms in our skin particularly Priopionibacterium sp (bacteria responsible for acne).
- Azaelic acid also displays anti keratinising effect i.e it inhibits the proliferation of keratinocytes (cells of our skin) which would otherwise build up and clog our pores thus leading to formation of comedone (white or black head)- precursors for acne. If you recall from my previous posts, retinoids (vitamin A derivative) also has this action. AA does not however reduce sebum production (oil secretion) in your skin unlike oral isotretinoin (vitamin A derivative used in the treatment of acne).
- Azaelic acid demonstrated cytotoxic effect (toxic to cell) towards active melanocytes (pigment producing cells of our skin), which means it does not affect the inactive melanocytes in the normal skin, thus it particularly targets just the abnormally pigmented area. It also inhibits the action of the enzyme tyrosinase, which is required for melanin (skin pigment) synthesis. Therefore it is effective as a skin lightening agents and is used to treat pigmentation disorders.
- Azaelic acid (AA) has been found to act as a scavenger of reactive oxygen species (ROS) therefore reduces inflammation and redness of the skin.
- Source :https://www.ncbi.nlm.nih.gov/pubmed/1712709
Dermatological conditions in which Azaelic acid is proven to be beneficial
Acne:
Azaelic acid in the strength of 20% have been shown to be effective in the treatment of mild to moderate acne. Studies have shown that twice daily application of 20% AA cream is effective than a vehicle (cream without any active ingredient) in the management of acne. Significant results were only well appreciated after 12 weeks i.e 3 months of continuous use. A study has also shown that 20% AA is as effective as 0.05% tretinoin (retinoid) in the treatment of comedonal acne.
Another study comparing the effectiveness of 15% AA with 5% benzoyl peroxide and 1% clindamycin gel (other active ingredients for the treatment of acne) showed equal efficacy of AA at the end of 4 months.
All these studies as well as reports from dermatologists have noted that the average time of achieving improvement with AA for acne was ~73 days equivalent to over 2 months of continuous use.
Azaelic acid is a great option for acne prone skin especially if someone is not tolerating other active ingredients used for acne such as adapalene, tretinoin or benzoyl peroxide.
Rosacea:
AA is FDA approved in the US for the management of rosacea (particularly papupopustular rosacea). Rosacea is a condition which can present like acne with multiple red bumps with red inflamed cheeks. Patients with rosacea have extremely sensitive skin and the redness can be triggered by various stimuli such as hot drinks, smoking etc.
A case of rosacea- red inflamed skin with papules (red bumps) and dilated blood vessels
15-20% AA used topically twice a day was shown to be effective for reducing the number of papules and pustules and to a little extent the redness in patients with rosacea. These improvement were achieved over a 15 week course of treatment.
Pigmentation:
Azaelic acid either alone or in combination with various other active ingredients is used to fight pigmentation. A study on the effectiveness of topical 20% AA in patients with FST IV -VI i.e brown or Indian skin type to black African type, concluded that twice daily application of AA lighten the pigmentation after 24 weeks (6 months) and also improved the smoothness and texture of the skin (which is great if you’re trying to even out your skin tone and skin texture)
Combination of 20% AA and 0.05% tretinoin is also available for the treatment of melasma. The study to support this combination compared AA as monotheray vs the combination therapy. Patient showed faster improvement in the form of decrease pigmentation and decrease in the size of the pigmented area in the combination group than AA monotherapy. However at the end of the study, i.e 6 months both treatment form achieved similar overall results.
How to use azaelic acid ?
Studies on azaelic acid either use 15% or 20% AA applied to the entire face twice a day. The side effects are mild stinging sensation or itching for the initial few days which subsides with subsequent continuous use.
- First cleanse your face using a gentle cleanser
- Let your face dry for like 30 mins and then apply a small amount of AA to your entire face.
- If you are new to active ingredients for your skin care, I suggest starting with a low strength such as 10% AA twice a day to a clean face which can then be increased to 15% or even to a maximum of 20% AA.
- This can then be layer with a moisturiser on top.
- Do not forget your sunscreen in the morning after the above routine.
- AA can be used as spot treatment for the inflamed acne or rosacea as well in addition to the twice daily application.
What to expect with Azaelic acid?
AA is a good option to treat mild to moderate acne and rosacea and its safe during pregnancy and can be used safely in nursing mothers as well.
For those of you who are planning pregnancy, or are pregnant, AA is a great option to use especially for someone who was using a retinoid (which is contraindicated in pregnancy) and needs some other active ingredient for their skin care.
Azaelic acid will definitely test your patience. Acne and rosacea usually show improvement in 2-6 months while it can take upto 6 months to achieve significant results with AA for pigmentation disorders such as Melasma.
Azaelic acid available in the market
AA is available as 10%,15% and 20% cream and gel particularly used for the treatment of acne and rosacea.
Finacea 15% is available as a foam and is particularly useful for rosacea who cannot tolerate other ingredients present in the cream base.
AA is also available as a combination of 20% AA + 0.05% tretinoin cream and as a combination with trenexamic acid in a serum form.
Dr Naphisabet Wanniang 