Azelaic Acid for Rosacea

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

Azelaic acid is one of the most effective topical treatments for rosacea. It can reduce redness, inflammation, and acne-like bumps, and is often used as a first-line treatment for mild to moderate disease. Unlike many rosacea medications, it is also considered safe during pregnancy and breastfeeding.

Is azelaic acid worth trying?

For many patients, the answer is yes. Azelaic acid works by calming inflammation and helping to normalise skin cell turnover. It is particularly useful for papules and pustules, and some patients also notice an improvement in background redness. Most people begin to see results after 6–8 weeks of regular use.

What strength should I use?

The two most commonly prescribed formulations are:

Finacea 15% gel
Skinoren 20% cream

I usually recommend starting with once-daily application to a small area of skin. If it is well tolerated, you can gradually increase to treating the entire affected area.

Why does azelaic acid burn or itch?

A mild burning, stinging, or itching sensation is common when treatment is first started. This usually settles as the skin adapts.

You can reduce irritation by applying a gentle moisturiser 5–10 minutes before treatment, using only a pea-sized amount for the whole face, and avoiding application to broken or very inflamed skin. Introducing treatment gradually is often the best way to improve tolerance.

How long does azelaic acid take to work?

Rosacea treatments require patience. Most patients notice improvement after 6–8 weeks, although some begin to see benefits sooner. Continued use is often needed to maintain control of symptoms.

What if azelaic acid doesn't work?

If azelaic acid is ineffective or causes irritation, other prescription options are available. My preferred topical treatment for inflammatory rosacea is ivermectin (Soolantra), which is often more effective for papules and pustules. In some cases, azelaic acid and ivermectin can be used together.

Dr. Magnus Lynch, Consultant Dermatologist

About Dr Magnus Lynch

I am a London-based Consultant Dermatologist and Dermatological Surgeon. I am highly experienced in skin cancer diagnosis, Mohs micrographic surgery, acne, rosacea, acne scarring and laser treatments. 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. 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.

My NHS practice is at Guy's Hospital. I consult with private patients at the London Bridge Hospital, OneWelbeck (near to Bond Street station) and on Harley Street. A new consultation is £250. Book A Consultation.