Azelaic Acid for Rosacea

By Dr Magnus Lynch
MA(Cantab) DPhil(Oxon) MRCS FRCP
Consultant Dermatologist & Dermatological Surgeon

Azelaic acid is a an effective topical treatment for rosacea and can reduce redness, inflammation, and bumps. Unlike many other treatments it is considered safe during pregnancy.

Is azelaic acid worth trying for rosacea?

Yes. Azelaic acid is effective for many patients with mild to moderate rosacea. It works by calming inflammation and helping normalise skin cell turnover. Many patients notice improvement in redness and pustules after 6–8 weeks of consistent use.

What strength of azelaic acid should I use?

Azelaic acid comes in two main strengths for rosacea:

• 15% gel – generally well tolerated and often the starting choice.
• 20% cream – slightly stronger, good for resistant areas.

Start with once-daily application on a small area to check that it does not irritate your skin. You can apply to a wider area after this.

How can I stop azelaic acid from burning or itching?

Burning or itching is common initially but usually improves with consistent use. Tips to reduce irritation:

• Moisturise first: Apply a gentle, water-based moisturiser such as Cetaphil or Cerave 5–10 minutes before azelaic acid.
• Use a small quantity: A pea-sized amount for the entire face is usually enough at first then build up.
• Avoid broken skin: Do not apply to areas of active inflammation or open wounds.

How long until I see results?

Improvement is usually seen after 6–8 weeks, but some patients notice gradual benefits earlier.

Products

I do not have financial ties to any brands, but patients often find these helpful:

• Finacea 15% gel
• Skinoren 20% cream

Both are suitable for rosacea and generally well tolerated when introduced gradually.

What alternative topical treatments are available?

Another good option is topical ivermectin (e.g. Soolantra). I generally find this to be the most effective treatment for inflammatory rosacea. It can also be combined with azelaic acid.

Related articles

• Ivermectin (Soolantra) for rosacea
• Prescription Creams for Rosacea
• Rosacea in Pregnancy and Breastfeeding

About Dr Magnus Lynch

I am a London-based Consultant Dermatologist and Dermatological Surgeon. I am highly experienced in skin cancer diagnosis and treatment, Mohs micrographic surgery, facial reconstructive surgery, laser treatments, regenerative dermatology, acne, rosacea and acne scarring. Since 2019, I have been passionate about sharing information online about dermatology and skin care. I studied at the Universities of Cambridge and Oxford, and completed my dermatology training and Mohs fellowship at the prestigious St John’s Institute of Dermatology. I graduated from medical school in 2003 and have worked exclusively in Dermatology since 2012.

I lead a research team at King’s College London investigating the molecular biology of skin cancer and skin cancer diagnostics, and I constantly aim to translate the latest findings into better patient care. You can learn more about my Research.

In recent years I have been involved in Media Appearances, including the Channel 5 series 'Skin A&E', where I perform skin surgeries and treat various skin conditions. Filming for the next series has recently completed and the series will be released later in 2025.

How I can help

My NHS practice is at Guy's Hospital. I consult with private patients at several well-appointed and conveniently located sites across central London:

• London Bridge Hospital: Conveniently situated within The Shard, next to London Bridge station.
• Skin55 Ltd: Located at 55 Harley Street, this beautiful Edwardian building houses one of the largest private dermatology facilities in the UK with a comprehensive laser suite.
• OneWelbeck: Located close to Bond Street underground station. Mohs surgery, lasers, and other skin surgeries are performed in the state-of-the-art surgical suite here.

A new consultation is £250, a follow up consultation is £220. For more information on fees, please visit Prices.