Azelaic acid is a widely used topical treatment for rosacea, a common skin condition characterized by persistent facial redness, visible blood vessels, and often small, pus-filled bumps. Individuals with rosacea may experience flushing, where their face flushes easily and the redness can become long-lasting. While azelaic acid is generally effective, some people find that their symptoms seem to worsen when they begin using it, leading to concerns about its suitability.
How Azelaic Acid Works for Rosacea
Azelaic acid manages rosacea symptoms through several actions. It has anti-inflammatory properties, which help calm redness and swelling. This anti-inflammatory effect is partly achieved by reducing reactive oxygen species and influencing inflammatory pathways within the skin.
It also has mild exfoliating abilities, assisting in the removal of dead skin cells and preventing pore blockages. This helps reduce the papules and pustules often seen in rosacea. Additionally, azelaic acid has antimicrobial effects, which help control bacteria on the skin that may contribute to rosacea flare-ups.
Why Symptoms Might Seem to Worsen
When first using azelaic acid, temporary side effects may occur that resemble a worsening of rosacea. Common sensations include stinging, burning, itching, dryness, peeling, or increased redness. These reactions are a normal part of the skin’s adjustment and typically subside with continued use.
Symptoms can also worsen due to incorrect application. Applying too much product, using it too frequently, or combining it with other irritating skincare ingredients can heighten skin sensitivity and irritation. If the skin’s protective barrier is compromised, such as from harsh cleansers or over-exfoliation, azelaic acid may cause more irritation.
Beyond product application, rosacea flares can stem from various unrelated triggers. Factors like sun exposure, emotional stress, spicy foods, hot beverages, alcohol, and extreme weather are known to exacerbate rosacea symptoms. A perceived worsening might be coincidental, caused by external triggers rather than the azelaic acid itself. In rare instances, symptoms could worsen due to an underlying skin condition being misdiagnosed as rosacea, or a genuine allergic reaction to azelaic acid, which could manifest as severe redness, swelling, or blistering.
Managing Side Effects and Seeking Guidance
Initial irritation can often be managed by adjusting usage. Start with a lower frequency, such as every other day, and use a smaller amount of product to help the skin gradually build tolerance. Applying azelaic acid after a moisturizer may also help buffer its effects and reduce stinging or burning.
Maintaining a gentle skincare routine is important, including a mild cleanser and a non-comedogenic moisturizer. Daily broad-spectrum sunscreen use is crucial to protect the skin, as sun exposure is a common rosacea trigger.
Patience is necessary, as it can take several weeks to months to see azelaic acid’s full benefits and for the skin to fully adjust. If irritation is severe or persistent, new or unusual symptoms develop, there is no improvement after several weeks of consistent use, or you have concerns about the original diagnosis, consult a dermatologist.