Topical anti-acne / anti-rosacea Pregnancy: Considered safe — minimal systemic absorption; no teratogenic signal. First-line topical for acne and rosacea in pregnancy.

Azelaic acid

Brand names: Skinoren (cream 20%), Finacea (gel 15%)

Adult dose

Dose: Apply a thin layer to affected area BD (after washing and drying skin). Continue at least 4 weeks for visible improvement; up to 6 months for full effect.

Route: Topical

Frequency: Twice daily

Cream 20% for acne; gel 15% for rosacea. Avoid eyes, lips, mucous membranes.

Clinical pearls

Effective for mild–moderate inflammatory acne and papulopustular rosacea (NICE NG198, BAD Rosacea Guideline).
Reduces post-inflammatory hyperpigmentation — particularly useful in skin of colour where retinoids/BPO may worsen pigmentation.
Pregnancy-safe alternative to topical retinoids and oral tetracyclines — first-line topical for acne in pregnancy and breastfeeding.
Antibacterial (against P. acnes) and anti-keratinising (mild comedolytic).
Onset of improvement at 4 weeks; full effect at 12 weeks. Counsel patient to persist through initial irritation.

Contraindications

Hypersensitivity to azelaic acid or excipients
Children under 12 years (not studied)

Side effects

Burning, stinging, tingling on application (common — usually subsides in 1–2 weeks)
Erythema, dryness, scaling
Pruritus
Hypopigmentation (may be desirable for post-inflammatory hyperpigmentation; rarely concerning otherwise)
Worsening of asthma (rare — gel formulation reports)

Interactions

Other topical irritants (retinoids, BPO, salicylic acid): apply at different times to reduce irritation

Monitoring

Treatment response at 4 and 12 weeks

Reference: BNF 90; SmPC Skinoren / Finacea; NICE NG198 (Acne 2021); BAD Rosacea Guideline 2021. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways