Azelaic acid or benzoyl peroxide for inflammatory acne?

Benzoyl peroxide is one of the most common and well-researched acne treatments known in the skincare industry. But in the past decade, azelaic acid has gained popularity and more brands are using this compound as a star ingredient for anti-acne and hyperpigmentation treatments. With so many ingredients it can be hard to decide which to use for your skin.

Azelaic acid vs benzoyl peroxide – which is better for acne? This article will help you understand which ingredient you should use for your type of acne.

Azelaic acid vs benzoyl peroxide

A key to choosing between both ingredients is by understanding their mechanisms in treating acne.

Azelaic acid

Azelaic acid is a naturally occurring acid derived from plants like wheat, barley, and rye. It is used in the treatment of acne and hyperpigmentation.

It works to treat acne by killing acne-causing bacteria present in clogged pores.

It also effectively prevents the production of keratin in follicles. This is a good thing as an accumulation of keratin in pores or follicles creates a breeding ground for acne bacteria.

Azelaic acid can be found in the form of gels, creams and foams applied topically on the skin.

Benzoyl peroxide

Benzoyl peroxide is a potent antibacterial agent used in the treatment of acne. This ingredient helps treat acne by destroying bacteria present on the skin by releasing oxygen in clogged pores.

It is considered one of the most effective antimicrobial treatments for inflammatory acne but it’s not natural. It is commonly found in over-the-counter skincare products but also exists in prescription strength medicines paired with antibiotics for severe forms of acne.

Similarities between azelaic acid and benzoyl peroxide

A scientific review of the diagnosis and treatment of acne outlines that both azelaic acid and benzoyl peroxide have antibacterial, anti-inflammatory, exfoliating, and comedolytic (can prevent the formation of comedones) properties.  

Which is better for acne: Azelaic acid or benzoyl peroxide? 

For acne management, the choice between these two active ingredients is determined by the severity of your acne.

This scientific article on topical acne treatments, reveals that benzoyl peroxide is the most effective topical treatment against acne. It is even more effective than most topical antibiotics. It is very effective against moderate to severe inflammatory acne disorders such as pustular, nodular, papular, and especially cystic acne.

Azelaic acid, on the other hand, is most effective for mild to moderate forms of acne. This includes comedonal, papular, and pustular acne.

However, because the mechanism of azelaic acid is not yet fully understood, data on the efficacy of this molecule on severe forms of acne is still a little bit controversial. This study, for example, states that 20% azelaic acid is effective in treating nodulocystic acne.  

The bottom line is because benzoyl peroxide has been around for a longer period of time and its effects are more known, it is the most recommended for cystic acne. However, if you are after more natural ingredients this will not be your first choice of treatment.

Can I mix benzoyl peroxide and azelaic acid?

It is considered safe to use both benzoyl peroxide and azelaic acid combined for the treatment of inflammatory acne. If you are suffering from moderate inflammatory acne, combining both comedogenic and antibacterial agents is a great way to get rid of your breakouts.

How to use azelaic acid and benzoyl peroxide together

These two active ingredients can be used in the same routine preferably at night because both can cause hypersensitivity to the sun. How you layer them will depend on the form of the product. Always remember water/gel-based or light textures before oil or creams. However, if both have the same texture, azelaic acid comes before benzoyl peroxide

Because both products have some side effects, especially benzoyl peroxide, it is advisable to start with small amounts of each product and then build up to measure your skin’s tolerability to the actives.

Both can be applied twice a day. When using a benzoyl peroxide apply only to affected areas as a spot treatment. Wait until the product dries up before following with a moisturizer.

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