Azelaic Acid UK: Uses, Strengths, Side Effects & Tretinoin Comparison
Azelaic acid is a topical ingredient used in acne and rosacea care and can also be considered by people concerned about post-acne marks and uneven tone. In the UK, licensed prescription products include Finacea 15% gel and Skinoren 20% cream.
This guide explains how azelaic acid works, the difference between 10%, 15% and 20% strengths, common side effects, how it compares with tretinoin and how to explore a personalised prescription pathway.
Azelaic Acid at a Glance
- Azelaic acid is used topically for acne and rosacea.
- Licensed UK prescription products include Finacea 15% gel and Skinoren 20% cream.
- NICE includes topical azelaic acid within acne treatment pathways.
- Root & Radiance currently offers 10%, 15% and 20% azelaic acid cream pathways.
- Common local effects include burning, itching, redness, dryness or irritation.
- Azelaic acid is not the same as tretinoin and does not work through the same mechanism.
What Is Azelaic Acid?
Azelaic acid is a naturally occurring dicarboxylic acid used as a topical treatment in dermatology. It has antimicrobial, anti-inflammatory and keratinisation-modulating effects that make it useful in several acne and rosacea pathways.
Finacea contains 15% azelaic acid as a gel. Skinoren contains 20% azelaic acid as a cream. Both are prescription-only medicines in the UK.
Azelaic acid is often considered when people want a non-retinoid topical option, including those who experience irritation with retinoids or who have acne alongside redness or rosacea-prone skin.
What Is Azelaic Acid Used For?
Acne
Azelaic acid can help reduce inflammatory acne lesions and influence abnormal keratinisation within follicles. NICE includes topical azelaic acid in acne treatment recommendations.
Rosacea
Finacea 15% gel is licensed for papulopustular rosacea as well as mild to moderate papulopustular acne of the face.
Post-acne marks
Azelaic acid is commonly considered for post-inflammatory pigmentation and uneven tone, particularly when acne and pigmentation occur together.
Redness-prone skin
Its anti-inflammatory properties make azelaic acid a useful ingredient to discuss when inflammatory lesions and redness are both part of the presentation.
Azelaic Acid 10%, 15% or 20%: What’s the Difference?
Concentration is only one part of the treatment. The formulation vehicle, clinical indication, skin sensitivity and previous treatment history also affect which route may be appropriate.
Azelaic Acid
10%A lower-strength compounded cream pathway that may be considered where a gentler starting route is preferred.
Explore 10%Azelaic Acid
15%A commonly used prescription strength. Finacea 15% gel is a licensed UK azelaic acid medicine for acne and papulopustular rosacea.
Explore 15%Azelaic Acid
20%A higher-strength route. Skinoren 20% cream is a licensed UK medicine for topical treatment of acne vulgaris.
Explore 20%How Does Azelaic Acid Work?
Helps normalise keratinisation
Azelaic acid influences abnormal keratinocyte proliferation and differentiation, which is relevant to blocked follicles and comedone formation in acne.
Antimicrobial activity
Azelaic acid reduces acne-associated microbial activity and contributes to the anti-acne effect seen with licensed topical products.
Anti-inflammatory action
This is particularly relevant when inflammatory acne lesions or rosacea-related papules and pustules are present.
Pigmentation pathway
Azelaic acid can influence tyrosinase activity and is commonly discussed when post-inflammatory pigmentation or uneven tone is a concern.
Azelaic Acid vs Tretinoin: What’s the Difference?
Azelaic acid and tretinoin are not interchangeable. Both may be used in acne-related skincare pathways, but they belong to different treatment classes and act through different mechanisms.
| Feature | Azelaic Acid | Tretinoin |
|---|---|---|
| Drug class | Dicarboxylic acid | Topical retinoid |
| Acne use | Yes | Yes, depending on prescribed pathway |
| Rosacea use | 15% gel is licensed for papulopustular rosacea | Not a standard licensed rosacea indication |
| Irritation potential | Can sting, burn, itch or dry the skin | Can cause dryness, peeling, erythema and irritation |
| Pregnancy considerations | Requires individual clinical advice | Topical retinoids are generally avoided during pregnancy |
| Prescription pathway | Some UK strengths/products are prescription only | Prescription medicine |
NICE specifically notes azelaic acid as an alternative topical option for some people who cannot tolerate topical retinoids.
How Long Does Azelaic Acid Take to Work?
Response varies with the indication, formulation and individual skin. For Skinoren 20% cream, the UK product information states that a distinct improvement in acne is generally apparent after about four weeks, with continued treatment over several months used to obtain the best results.
Rosacea studies with Finacea 15% gel have commonly assessed outcomes over approximately 12 weeks.
Explore an Azelaic Acid Treatment Pathway
Root & Radiance currently provides 10%, 15% and 20% azelaic acid cream pathways. The appropriate concentration depends on your skin concern, treatment history and clinical suitability.
Complete an online consultation to explore the treatment you would like assessed. Any prescription medicine is supplied only where clinically appropriate following prescriber review.
How to Use Azelaic Acid
Use azelaic acid according to the instructions for the specific formulation supplied. Licensed 15% gel and 20% cream products have their own dosing directions, so one formulation should not automatically be assumed to have the same instructions as another.
Clean and dry the skin
Apply to clean, dry skin unless your prescriber or product instructions advise otherwise.
Use a thin layer
Use the amount directed for the area being treated rather than applying extra product.
Introduce gradually if needed
Stinging, dryness or irritation can occur, particularly when treatment is started. Your clinician may advise reducing frequency if irritation develops.
Keep the routine simple
Moisturiser and an appropriate sunscreen can support tolerability, particularly if other active skincare products are also being used.
Azelaic Acid Side Effects
Topical azelaic acid is generally used locally on the skin, but irritation and other adverse effects can occur.
Burning or stinging
Burning, stinging or tingling can occur at the application site, particularly early in treatment.
Itching
Pruritus or itching is a recognised local reaction with licensed azelaic acid products.
Dryness or scaling
Some people experience dry skin, scaling or general irritation around treated areas.
Redness
Erythema can occur. Persistent or severe reactions should be discussed with a healthcare professional.
Severe irritation, swelling, allergy-like symptoms or worsening asthma symptoms should be clinically assessed.
Can You Use Azelaic Acid During Pregnancy?
Pregnancy should always be discussed with the prescriber or pharmacist before starting or continuing prescription skincare.
UK product information for licensed topical azelaic acid products states that adequate and well-controlled studies in pregnant women are limited. This differs from topical retinoids such as tretinoin, which are generally avoided during pregnancy.
Can You Use Azelaic Acid with Tretinoin?
Azelaic acid and tretinoin may appear within the same broader skincare plan, but combining active ingredients can increase irritation in some people.
If both are prescribed or recommended, they may be introduced gradually or separated within the routine according to individual tolerability and prescriber advice.
More active ingredients do not automatically produce better results. The treatment plan should reflect the skin condition, previous response and ability to tolerate the formulation.
Can You Get Azelaic Acid Online in the UK?
Azelaic acid is available in different cosmetic and medicinal strengths. Licensed UK medicines such as Finacea 15% gel and Skinoren 20% cream are prescription-only medicines.
Root & Radiance provides an online assessment pathway for prescription azelaic acid formulations. A treatment request is reviewed by a prescriber before any prescription-only medicine is supplied.
Azelaic Acid Alternatives and Personalised Skin Options
Azelaic acid is only one topical skincare pathway. The most appropriate treatment depends on whether the main concern is acne, rosacea, post-inflammatory pigmentation, irritation or a combination of concerns.
Azelaic Acid FAQs
What is azelaic acid?
Azelaic acid is a topical dicarboxylic acid used in dermatology. Licensed UK prescription products include Finacea 15% gel and Skinoren 20% cream.
What does azelaic acid do?
Azelaic acid has antimicrobial, anti-inflammatory and keratinisation-modulating effects. It is used in acne and rosacea pathways and is also commonly considered when post-inflammatory marks or uneven tone are a concern.
Is azelaic acid good for acne?
Yes. Azelaic acid is an established topical acne treatment. NICE includes topical azelaic acid within acne management pathways.
Can azelaic acid help rosacea?
Finacea 15% gel is licensed in the UK for papulopustular rosacea as well as mild to moderate papulopustular facial acne.
Is 20% azelaic acid stronger than 15%?
20% contains a higher concentration, but concentration alone does not determine which treatment is better or more suitable. The vehicle, indication, tolerability and clinical assessment also matter.
How long does azelaic acid take to work?
Response varies. UK product information for Skinoren 20% cream states that distinct improvement in acne is generally apparent after about four weeks, with continued treatment used for best results.
What are the side effects of azelaic acid?
Common local effects can include burning, stinging, itching, redness, dryness or scaling. Significant or persistent reactions should be discussed with a healthcare professional.
Can I use azelaic acid with tretinoin?
The two ingredients may be used within the same broader treatment plan where appropriate, but combination use can increase irritation. Follow the directions given for your individual regimen.
Can I buy azelaic acid online in the UK?
Different strengths and formulations are available. Licensed prescription medicines such as Finacea 15% gel and Skinoren 20% cream require an appropriate prescription pathway.
What azelaic acid strengths does Root & Radiance offer?
Root & Radiance currently offers 10%, 15% and 20% azelaic acid cream pathways in 30 g sizes, subject to clinical assessment and prescriber approval where prescription treatment is requested.
Explore More Azelaic Acid & Skin Guides
Clinical information: This page is general information and does not replace individual medical advice. Information has been informed by the UK Finacea 15% Gel and Skinoren 20% Cream product information and NICE guidance on acne vulgaris.
Sources: Finacea 15% Gel Summary of Product Characteristics , Skinoren 20% Cream Summary of Product Characteristics and NICE NG198: Acne vulgaris management .