When bacteria are exposed
to antibiotics, they produce chemical reactions to resist these drugs. Once
antibiotics are introduced in the body, the bacteria that the antibiotics
targets gradually develops resistance on the drug and that poses both a problem
on the treatment and therapy of acne. The development of drugs used in acne
treatment has to take bacterial resistance into consideration; thus, the
combination of retinoids and antimicrobials such as benzoyl peroxide and
azelaic acid is recommended together with doses of antibiotics over short
periods of time.
Azelaic acid, a naturally occurring saturated decarboxylic acid,
was first sampled in the 1970s in Europe as a treatment for skin
hyperpigmentation. It was only by sheer coincidence that it was
discovered to treat acne. Since then, studies have been made and
were able to confirm the validity of the chance discovery. These
studies also found a number of acne problems azelaic acid was
able to cure, which included comedonal and inflammatory acne lesions,
and its effects were established to parallel that of other topical
medications. There are few studies also that were able to show
Azelaic acid is capable of being as effective as oral tetracycline
without the side-effects. Today, azelaic acid is considered antimicrobial
and highly recommended as a secondary option in treating mild
to moderate acne.
What makes Azelaic acid work well with acne treatment remains
unknown, although researches has advanced to the point of establishing
the fact that azelaic acid has antibacterial and anti-keratinizing
properties. Because azelaic has antibacterial properties, it significantly
reduces the production of bacteria on the skin, keeping the skin
pores clear. It also reduces the bacteria found in the follicle.
As an anti-keratinizing agent, it reduces the production of keratin,
a natural substance that is believed to lead the development of
acne and returns to normal the disordered growth of skin cells
lining the follicle. A limitation though of the Azelaic acid is
it can only work well on acne caused by bacteria and has no effect
on the other case.
Unlike antibiotics, azelaic acid does not foster resistance of
bacteria, and unlike benzoyl peroxide, it does not stain the skin
or the clothing. It is not photosensitive, for which reason it
is particularly useful in summer time. It is also useful for patients
who cannot tolerate topical retinoids. Azelaic acid helps reduce
pigmentation, so it is particularly useful for dark skinned patients
whose acne leaves persistent brown marks or who have cancerous
melasma. However, patients with dark skin should be monitored
for hypopigmentation (too little skin color). Caution is advised
when it is used by lactating or pregnant women though.
Azelaic acid could be used as a cream or as a gel preparation
(the newest innovation in the market) and thus, it is well absorbed
by the skin when applied topically. Normal procedure of application
is application of the cream or gel on the area surrounding the
acne once a day after thorough cleansing is done. If the patient
has sensitive skin, gradual application should be observed, increasing
in frequency only when patient’s skin can adjust and can
tolerate further medication. As a word of caution, direct contact
with the eyes should be avoided.
It has been noted that the response of azelaic treatment with
acne takes considerable amount of time. Typical visible results
would appear after one month of continuous treatment and even
apparent results can be noted after six months. If acne remains
active, treatment is safe to pursue for a longer period.
There are no recorded serious side effects for the use of azelaic
acid since it is non-toxic and early side effects are reported
tolerable on a small fraction of patients. Side effect that do
occur are limited to a burning sensation on the skin that sometimes
includes irritation. Compared to Benzoyl peroxide and tretinoin,
Azelaic acid has lower complaint rate at 5%.