How Azelaic Acid Works

The effect in acne and rosacea may be explained by PPAR activation.

Azelaic acid (AzA) is a naturally occurring nine-carbon dicarboxylic acid. Topical applications of AzA successfully treat the papules and pustules of acne and rosacea — but how?

Investigators assessed the anti-inflammatory abilities of AzA by irradiating keratinocytes in culture with 20 mJ/cm² of ultraviolet B (UVB) spectrum light (~minimal erythema dose in type I skin). The keratinocytes produced the inflammatory cytokines interleukin (IL)-1, IL-6, and tumor necrosis factor α. This effect was inhibited by AzA. AzA itself caused no cytotoxicity, cytokine release, or cell death at doses currently available in creams and gels.

AzA also prevented translocation to the nucleus of the nuclear factor κ-light-chain–enhancer of activated B cells NF-κB…

Reviewing Author

Mark V. Dahl, MD

Disclosures

Consultant / Advisory board Ulthera, Inc.; AuBio LifeSciences, LLC; Paris Therapeutics

Equity Elorac, Inc.; Makucell, Inc.; Paris Therapeutics

Editorial boards UpToDate

Leadership positions in professional societiesNational Rosacea Society (Chairman, Medical Board)

Mark V. Dahl, MD

Disclosures

Consultant / Advisory board Ulthera, Inc.; AuBio LifeSciences, LLC; Paris Therapeutics

Equity Elorac, Inc.; Makucell, Inc.; Paris Therapeutics

Editorial boards UpToDate

Leadership positions in professional societiesNational Rosacea Society (Chairman, Medical Board)