Tracking your azelaic acid journey

The short answer

Azelaic acid is a cream, gel or foam you put on your skin. It’s mostly used for mild to moderate acne, and some forms are used for rosacea. The American Academy of Dermatology notes it can also treat the dark spots that appear when acne clears.

For acne, DermNet lists a 20% cream. A 15% gel is approved in the US for rosacea, and MedlinePlus says the cream is the form used for acne, with the gel and foam used for rosacea. MedlinePlus covers it as a prescribed medicine. Whether you need a prescription, and which strengths you can get, varies by country, so ask a doctor or pharmacist which one, if any, suits you.

The American Academy of Dermatology’s 2024 acne guideline gives azelaic acid a conditional recommendation: an option worth considering, a step below first-line treatments like benzoyl peroxide and topical retinoids, which it recommends strongly.

It’s gentle and slow. DermNet says some improvement should show after about a month, with the best results after six months of continuous use.

A typical timeline

Your doctor or pharmacist will tell you what to expect for you. As a rough picture:

• First weeks: DermNet says it’s generally well tolerated. Itching, burning, stinging, tingling or dryness where you apply it can happen. People with very sensitive skin or eczema may find it irritating. It can lighten the skin, which is more noticeable on darker skin, and DermNet notes reports of asthma getting worse.
• Around 1 month: some improvement, for many people.
• Up to 6 months: results keep building, with the maximum around six months of continuous use.
• Dark marks: fade slowly too. They’re hard to judge by eye but easy to see in a photo timeline.

DermNet says severe redness, scaling, itching or burning is a reason to stop and get medical advice. Swelling of the face, lips or throat, or trouble breathing, needs emergency help. If you’re pregnant, planning a pregnancy or breastfeeding, tell your doctor before using it.

What’s worth tracking

• Progress photos at the same time and in the same light every day. Lighting matters even more if you’re watching dark marks fade.
• Pimple count and how your skin feels.
• Side effects you notice, like stinging or dryness, and when they eased.
• When you started, and any changes your prescriber makes.
• Your routine around it: moisturiser, sunscreen, and anything else you’re using.

A few things make daily photos comparable: the same spot and the same light (a window in the morning, or the same lamp at night), hair back, no makeup, and roughly the same distance from the camera. Take your first entry before you start using it, so day one really is day one. Skipping a day isn’t a disaster; the timeline still shows the trend.

How to track it in SkinTheory

1. Set a hypothesis, like “Azelaic acid fades my marks and calms my breakouts in 3 months”.
2. Take three photos a day: front, left and right in each entry.
3. Log skin feeling, mood and pimple count.
4. Add azelaic acid to your skincare routine so every entry shows what you were using.
5. Set routine reminders for morning and night with custom repeats.
6. Use the photo timeline as your before and after.

Was it the treatment, or something else?

Six months is a long stretch, and plenty will happen in it. If you break out in month two, was it the azelaic acid not doing enough, or the week of exams, takeaways and four hours of sleep?

Log the rest of your life alongside the treatment. SkinTheory’s Lab+ trackers cover Exercise, Dairy, Fast food, Sleep, Alcohol, Water, Protein and Period. Your own data is free forever, and any two Lab+ trackers can be used free at a time. The graphs line your pimple count up against them over the last 21 entries, so you can see whether a flare lines up with the treatment or with your life.

Worth reading:

• Dairy and sugar
• Your period
• Alcohol, sleep and stress
• The gym and your bedsheets
• New skincare products

SkinTheory’s experiments test one hypothesis over a set number of entries, such as 21. That’s useful alongside a long treatment: once your skin has settled, you can test one life change at a time, like cutting dairy for 21 entries, and see whether the graphs move, without touching the treatment itself.

Keep the record

Photos stay private in SkinTheory and never go to your camera roll. Keep the whole history on your phone for years, so if breakouts or marks come back, you can compare with the first time.

Take your log to your appointments. Months of photos in the same light say more about dark marks and breakouts than any description can.

Questions people ask

Sources and further reading

1. Azelaic acid: Uses, Application and More, DermNet
2. Azelaic Acid Topical: MedlinePlus Drug Information, MedlinePlus (U.S. National Library of Medicine)
3. Acne: Diagnosis and treatment, American Academy of Dermatology
4. Guidelines of care for the management of acne vulgaris, JAAD (2024), via PubMed

This guide is general information written by the SkinTheory team, not medical advice. SkinTheory isn’t a medical device. For diagnosis, prescriptions or side effects, talk to a dermatologist or doctor, and bring your SkinTheory log along.