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Unleashing the Marvels of Azelaic Acid on Acne and Rosacea breakouts

Ruth Casaletto, pharmacist and founder of Chemist & Co Skin Clinic, writes about Acne and Rosacea breakouts with skincare routines and links at the end of this article to readily available products that help alleviate these conditions.

Are those breakouts on your skin, Acne or Rosacea?

Both Acne and Rosacea can cause breakouts on the face. Confusion between the two is common, as one is often mistaken for the other. This can lead to ineffective treatment. Here's how to know which one you have.


Acne usually starts with the tiny hair follicles on your skin becoming clogged with dead skin and natural face oils, leading to blackheads (open clogged pores) or whiteheads (closed clogged pores). These can then develop into spots. These spots can be papules (small red bumps) or pustules (papules with pus at the tips). Acne can be present on the face, chest, shoulders and back.

If you experience painful lumps and cysts under your skin, it is important that you speak to your doctor, as antibiotics might be necessary to clear up the infection.

Example of Acne


Rosacea can flare up from sun exposure, heat, alcohol, stress, caffeine, and spicy foods. It usually involves intense skin reddening due to more prominent blood vessels and does not typically present with black or whiteheads. Sometimes, antibiotics are required to treat a persistent infection.

Example of Rosacea

How does Azelaic Acid work?

Azelaic acid is beneficial for its anti-inflammatory properties in rosacea. Skin in rosacea patients tends to be very sensitive and can sting, so prescribing guidelines recommend 15% strength. Research has shown that 15% is effective in patients with mild-to-moderate rosacea breakouts without being too harsh. Some preparations have added ingredients like antioxidants, calming aloe vera and colloidal oats that help reduce irritation.

In Acne patients, 20% Azelaic acid within products is most effective. It penetrates the skin and breaks up blackheads and whiteheads. Azelaic acid also kills the bacteria known as P. acne, which helps cause inflammation and pus formation in acne. Ingredients like squalene and glycerine are sometimes added to preparations to make it less drying.

How to Use Azelaic Acid

It is very important to prepare the skin before applying azelaic acid. This allows the treatment to penetrate the skin much better for more effective results.

Although they look similar, acne and rosacea skin require different skincare routines.

In acne, the main aim is to reduce the amount of black and whiteheads and stop the more inflamed spots from developing.

In rosacea, the main aim is to calm and soothe the skin and make the skin barrier as efficient as possible.

We have prepared a simple Skincare Routine with readily available products, containing the right ingredients for both Acne and rosacea skin. If you would like your very own skincare plan, get in touch!

Skincare Routine Steps

Acne Skincare

Rosacea Skincare

​1. Cleanse the skin using a mild cleanser. Use morning & night.

​2. Apply your moisturiser. Use morning & night.

​3. Apply a thin layer of Azelaic Acid only on the areas of breakouts. Use morning & night.

​4. ALWAYS wear a 50+ SPF in the morning (even if your moisturiser contains an SPF). Use every morning.

Starting Tips:

  • Use regularly for a minimum of 12 weeks to see benefits.

  • If you have sensitive skin, test a patch first.

  • Start gently using it once at night every other day, then gradually increase to using it twice daily.


  • Avoid contact of topical azelaic acid with the eyes, mouth, and mucous membranes.

  • Do not use it in pregnancy or breastfeeding.

Not quite sure?

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If you feel your skin condition is affecting your mental health, speak to your doctor or click on this link, where help is available.


About the Author:

Ruth is an experienced pharmacist working within GP practices on the Wirral in the UK.

Ruth developed an interest in dermatology in her teenage years after struggling with acne herself. Ruth uses her pharmaceutical knowledge to source ingredients within products and technologies that are clinically evidenced to work.

Unfortunately, mainstream medical care does not routinely offer a holistic approach to skin management. At Chemist & Co Clinic, we discuss nutrition, skincare, lifestyle, and technology with our clients while working alongside any medical treatment your doctor or dermatologist prescribes.



This post contains affiliate links, which means we may earn a commission if you click on one of the product links and make a purchase. We only recommend products that we have researched based on our professional experience and scientific knowledge.


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