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topical · for rosacea & facial redness

Azelaic Acid (Topical)

Reviewed by the Nimbera editorial team · Last updated May 2026

A 2015 Cochrane review by van Zuuren et al. (106 RCTs, n=13,631) found high-quality evidence that azelaic acid was more effective than placebo (RR 1.46, 95% CI 1.30-1.63) for rosacea, with significant reductions in inflammatory lesion counts and erythema severity.$10-$15 for OTC 10%; $50-$100+ for prescription 15% gel depending on insurance

How to use

Apply a thin layer of azelaic acid (10% OTC formulations such as The Ordinary Azelaic Acid Suspension 10%) to the affected face area twice daily after cleansing and before moisturiser. Start with once-daily application and increase to twice daily after 1-2 weeks to minimise initial tingling. Prescription 15% gel (Finacea) requires a doctor's prescription and is more evidence-backed for rosacea.

How it works

Azelaic acid inhibits the enzyme tyrosinase (reducing hyperpigmentation), suppresses reactive oxygen species produced by neutrophils (anti-inflammatory), normalises abnormal follicular keratinisation, and has direct antimicrobial activity against Cutibacterium acnes and Demodex-associated bacteria implicated in rosacea pathogenesis.

Where to buy

OTC: The Ordinary Azelaic Acid Suspension 10% (widely available), Paula's Choice 10% Azelaic Acid Booster - at Sephora, ULTA, and Amazon. Prescription 15% gel (Finacea, Skinoren) via dermatologist or telehealth platforms like Curology or Apostrophe.

Typical cost: $10-$15 for OTC 10%; $50-$100+ for prescription 15% gel depending on insurance

Safety notes

Initial tingling, burning, or mild peeling is common and usually subsides after 2-4 weeks. Avoid contact with eyes, mouth, and nostrils. Use SPF 30+ sunscreen daily as azelaic acid can increase photosensitivity. Not recommended in the first trimester of pregnancy without medical advice. OTC 10% products have less clinical evidence for rosacea than prescription 15% formulations.

Drug & supplement interactions

  • Always tell your doctor or pharmacist about any supplements you take.
  • Interactions can occur with prescription medications, blood thinners, and immunosuppressants.
  • Herbal remedies can affect how the body absorbs or metabolises drugs.
  • Check drugs.com interactions checker before starting.

Clinical source

van Zuuren et al., Interventions for rosacea, Cochrane Database Syst Rev, 2015

This information is compiled from primary clinical literature and is for informational purposes only. It is not a substitute for professional medical advice. Read our full disclaimer.