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Azelaic Acid Treatment for Acne

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

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.

Side Effects

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%.