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Topical dicarboxylic acid (anti-acne / anti-rosacea) Pregnancy: Generally considered safe in pregnancy for topical use — one of preferred options for acne management during pregnancy.

Azelaic Acid 15–20%

Brand names: Finacea (15% gel — rosacea), Skinoren (20% cream — acne), Azaduo (20% gel)

Adult dose

Dose: Apply twice daily to affected areas
Route: Topical
Frequency: Twice daily (morning and evening)
Max: Apply to entire acne-prone or rosacea-affected area
Acne vulgaris: Skinoren 20% cream — apply twice daily to entire face and affected areas. Rosacea: Finacea 15% gel — apply twice daily to affected facial areas. Mechanism: bacteriostatic against C. acnes and P. acnes, anti-inflammatory, normalises follicular hyperkeratinisation, and reduces post-inflammatory hyperpigmentation.

Paediatric dose

Route: Topical
Frequency: Twice daily
Max: Apply to affected areas
Concentration: 15% gel or 20% cream Application/ml
Licensed from 12 years for acne. Adolescents: same as adult dosing.

Dose adjustments

Renal

N/A — topical use, negligible systemic absorption.

Hepatic

N/A — topical use.

Clinical pearls

  • NICE recommended for both acne and rosacea — versatile agent with anti-inflammatory and antibacterial properties
  • No antibiotic resistance: useful alternative or adjunct when antibiotic resistance is a concern
  • Post-inflammatory hyperpigmentation (PIH): azelaic acid actively reduces PIH — valuable in darker skin types (Fitzpatrick IV–VI)
  • Rosacea (Finacea 15%): well-evidenced for papulopustular rosacea — comparable to metronidazole gel
  • Pregnancy-safe: one of few anti-acne agents considered compatible in pregnancy

Contraindications

  • Hypersensitivity to azelaic acid or any excipient

Side effects

  • Local irritation, burning, and tingling (first 2–4 weeks — usually resolves)
  • Skin dryness and peeling
  • Hypopigmentation (with prolonged use on darker skin — monitor)
  • Rare contact dermatitis

Interactions

  • No clinically significant systemic drug interactions

Monitoring

  • Acne/rosacea response at 6–8 weeks
  • Skin tolerance
  • Hypopigmentation in darker skin types (prolonged use)

Reference: BNFc; BNF; BAD Acne Guidelines 2021; BAD Rosacea Guidelines; NICE CG184. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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