Azelaic Acid’s Harm to the Skin

Azelaic acid works by killing bacteria and dissolving dead, keratinized skin cells, thereby preventing follicular plugging and hyperkeratinization—in short, it helps treat acne and closed comedones. So, what are the potential adverse effects of azelaic acid on the skin?

What Are the Potential Adverse Effects of Azelaic Acid on the Skin?

Indeed, azelaic acid can cause adverse effects on the skin. Some individuals may develop rashes with prolonged use. Additionally, because azelaic acid exfoliates the stratum corneum, excessive or overzealous use may lead to skin peeling. It may also increase skin sensitivity, making the skin more prone to allergic reactions—even upon minimal exposure to allergens—resulting in erythematous rashes and pruritus (itching). Therefore, during treatment for folliculitis, strict adherence to prescribed dosing regimens is essential. Once clinical improvement begins, medication should be tapered or discontinued under medical guidance. Concurrent skin barrier repair measures are crucial during this period to prevent recurrent irritation.

Its mechanism of action involves antibacterial activity and dissolution of aged, keratinized corneocytes, thus preventing follicular plugging and abnormal keratinization—in other words, effectively treating acne and closed comedones. This ingredient is highly effective; many individuals with acne-prone skin experience noticeable improvement even after their first application. However, side effects do occur (as with most effective treatments)—notably, pruritus (itching).

The intensity of itching varies among individuals. Importantly, this sensation does not necessarily indicate an allergic reaction—it is simply pruritus. Those who find the itching intolerable are advised to begin with localized application. We hope this information is helpful to you!