cream containing 0.2 g/g in 30 g tubes
The precise mechanism of action of azelaic acid in patients with acne is unclear. There is an antibacterial action on Propioni bacterium acnes and a possible effect on follicular plugging.
Azelaic acid cream is applied twice a day. Part of the dose is absorbed through the skin and azelaic acid can be detected in breast milk. The drug is not approved for patients under 17 years old.
In comparative studies, azelaic acid has been more effective than placebo, but has no significant advantage over other treatments e.g. benzoyl peroxide, oral tetracycline.
Most adverse effects are due to irritation of the skin and often occur in the first few weeks of treatment. Some patients will stop using the cream before a clinical improvement in their acne becomes apparent after approximately one month of treatment. While burning, itching, erythema and scaling are the common adverse reactions, photosensitivity can occur.
The maximum improvement may require 4 months of treatment. However, a 30 g tube will only last about two weeks if used on the face alone. Treatment should not exceed 6 months' duration.