For years, benzoyl peroxide has been the go to in the acne world. Throwback to the Pro-Active era when everyone was destroying their barrier. Benzoyl peroxide, we still love you, but you can be drying as hell, especially for my sensitive, eczema-prone, acne-prone queens. 

Dear Benzoyl Peroxide, 

Azelaic Acid is coming for you. 

Although it wasn’t FDA approved until 2002 and was originally prescribed for rosacea, newer studies have highlighted azelaic acid’s powerful effects on acne. In fact some recent studies (2023) have proven it to be just as effective as traditional treatments while being significantly better tolerated.

So what does azelaic acid actually do if you have acne? It’s anti-inflammatory, meaning it helps calm redness and irritation in inflamed papules (pimps with no white head) and pustules (white heads). It has antibacterial properties, helping reduce acne-causing bacteria without being toxic or overly harsh, which makes it safe for long-term use. It has gentle exfoliating effects by reducing epidermal hyperkeratinization (basically helping your pores shed dead skin cells at a normal rate so they don’t clog). On top of that, it inhibits the pigment-producing enzyme tyrosinase, which helps prevent and fade post-inflammatory hyperpigmentation (those stubborn dark marks left behind after breakouts).

Now let’s translate the science for a second. Azelaic acid inhibits the overactivity of TLR-2, a receptor involved in skin inflammation and follicular hyperkeratinization. In normal human language? It helps calm inflammation at the cellular level and supports healthy shedding inside the pore, reducing the likelihood of clogged, inflamed lesions forming in the first place. It regulates the chaos instead of attacking your skin barrier.

This is why I especially love azelaic acid for my queens who are higher on the Fitzpatrick scale, more sensitive to dryness, or prone to post-inflammatory hyperpigmentation. Dermatologists often prescribe higher concentrations to treat papules, pustules, and rosacea, and in many cases will choose it over a retinoid because it’s significantly more tolerable. If benzoyl peroxide wrecks your barrier or retinoids make you peel like a snake, azelaic acid can be a beautiful middle ground.

What makes it even more impressive is that it works before, during, and after the life of a pimple. Before a breakout, it helps follicles shed normally to prevent clogged pores. During a breakout, it reduces inflammation in papules and pustules. After a breakout, it inhibits tyrosinase to help reduce dark marks and uneven pigmentation. Not many ingredients can claim that kind of full-cycle support.

And here’s the tea from the study. In a 6-month double-blind study, 20% azelaic acid was compared to 0.05% Tretinoin cream. Both significantly reduced the number of acne lesions, but azelaic acid was better tolerated and caused fewer side effects than the retinoid. Similar results, less irritation. For acne-prone skin that is already inflamed or barrier-compromised, that difference matters.

So when would I recommend azelaic acid? If you’re more melanin-rich and struggle with dark marks, if you’re sensitive and reactive, if you deal with both acne and rosacea, or if you want something effective but gentle enough for long-term use, azelaic acid deserves a spot in your routine. She’s not loud or dramatic. She’s steady, regulating, and barrier-friendly. And sometimes, that’s exactly what acne-prone skin needs.

Blemish Babe Tip: Azelaic was found to be the most effective in its 20% form…that means you may need a prescription if you want to swap out your classic tret, or you can visit your favorite esthi to get a peel with this A-list acid.