Azelaic (nonandic) acid

Azelaic acid is a dicarboxylic acid. It is known less than the same glycolic or salicylic. But dermatologists love her - for her antibacterial and anti-inflammatory properties.

Initially, azelaic acid is a natural acid found in cereals such as barley, wheat and rye. These grains have long been known for their beneficial properties. Previously, azelaic acid was extracted from these grains in limited quantities, making it relatively rare in the beauty industry. However, it was possible to create synthetic azelaic acid, and now everyone can turn on its daily skin care.

Most often, this ingredient can be found in the composition of remedies for problematic skin, as well as skin prone to cuperose. She gently exfoliates her skin, struggling with pigmentation, comedones and acne. And also relieves redness.

Concentrations and application

In 2022, it is recommended to choose products with an azelaic acid content of 10%. A higher concentration (20%) is also quite common, but in this case a consultation with a beautician is needed. Especially if you have sensitive skin.

When using a product with azelaic acid (however, as with any acids), it is recommended not to forget about sunscreen. SPF from 30, not less than. This will avoid the consequences of increased sensitivity of the skin to ultraviolet light.

It is recommended not to use azelaic acid in combination with other acids - glycolic, salicylic, lactic, retinol.

Azelaic acid is good because it suits even sensitive skin. But it is still recommended to start small, first use once a week, then gradually increase the frequency of use to three.

In the treatment of rosacea

Main article: Rosacea treatment

One of the most successful therapies for rosacea is based on the use of azelaic acid in various cosmetic forms, which has a keratolytic, antibacterial, vasoconstrictive, anti-inflammatory and antioxidant effect, which completely "covers" the pathogenetic links of this disease^[1].

Azelaic acid is a saturated dibasic acid, its therapeutic effect in rosacea is mainly based on the inhibition of the production of reactive oxygen species by neutrophils. In some studies, the clinical outcome for the papulopustular form of rosacea of 15% azelaic acid gel is comparable to 1% metronidazole gel, with the only adverse side effect of azelaic acid being moderate local burning and sensitivity^[2].

An important feature of azelaic acid is its high "penetrating" ability when used topically. Small lipophilic azelaic acid easily passes through the intercellular spaces of the stratum corneum, exerting a keratolytic effect (loosens the stratum corneum and accelerates the desquamation process). Having reached the living layers of the epidermis, azelaic acid inhibits the processes leading to the release of a number of free fatty acids with proinflammatory effects - the anti-inflammatory properties of azelaic acid are associated with this.

In addition, azelaic acid inhibits DNA transcription in melanocytes, reducing melanin production. This property is important for the treatment of rosacea, especially in persistent pustulization of elements, when hyperpigmentation appears due to chronic inflammation. Penetrating the excretory ducts of the sebaceous glands, azelaic acid normalizes the disturbed processes of keratinization in the follicles of the glands, eliminates follicle hyperplasia, and contributes to the self-purification of the ducts.

By inhibiting the growth of Propionibacterium acnes and Staphylococcus epidermidis, azelaic acid thereby reduces the intensity of cleavage by the action of bacterial enzymes of sebum triglycerides. This means that the amount of free fatty acids released by this breakdown - "provocateurs" of inflammation - decreases. The encapsulation of azelaic acid into the liposomal nanosize transport system allows for increased penetration through the barrier structures of the skin and the delivery of azelaic acid to deeper layers of the skin, up to the dermis. Here, azelaic acid realizes its anti-inflammatory effect due to antioxidant properties and seboregulatory effect due to 5a-reductase inhibition.

Azelaic acid (AHA) peels

Azelac azelain peels: compositions and properties

Dr. Serrano and colleagues have been studying the possibilities of using drugs with azelaic acid for treatment for a long time. As rosacea a result, according to the data for 2018, drugs and methods of their use were developed, consisting in a long course of procedures for complex chemical peels AZELAC and special home care.

The AZELAC system includes three peels that can be used alone or in combination with each other, providing a synergistic effect on the skin to solve the following problems:

• rosacea (all stages);
• hyperpigmentation (melasma, solar lentigo, postinflammatory hyperpigmentation);
• acne, postacne;
• hyperplasia;
• fine wrinkles.

Azelac peels:

• have anti-inflammatory, anti-radical and vasoconstrictive effects;
• inhibiting 5a reductase by reducing sebum release and improving skin with increased sebosecretion, controlling hyperkeratosis;
• exhibit antibacterial properties with respect to S. epidermidis, S. aureus, P. acnes, Proteus mirabilis, Candida albicans;
• inhibiting tyrosinase by aligning skin color.

Azelaine peels can be carried out throughout the year (with adequate protection in the summer) and with any phototype. They cause different degrees of exfoliation depending on the composition of the peeling preparation and the number of layers applied. Various combinations of peels are used to treat rosacea, which is explained by the variety of etiological and pathogenetic factors of dermatosis, its stage and clinical form of the disease. Method of application of peels, sequence of their application and duration of exposure simulate clinical response in accordance with disease stage.

Azelaic acid is used in concentrations of 30%, but mainly in cases of increased seborulation, that is, on oily skin. Almond acid is a softer variant used for light surface peels, which can also be combined with azelaic for deeper penetration.

Before applying the peeling composition, the skin should be thoroughly degreased. Actually, the composition itself can be applied using a brush, a gauze roller or a cotton swab. The exposure time of peeling in rosacea depends on many factors: active substances and their concentration in the composition, the course of the disease, skin type, etc. In any case, to achieve results, wait for the frost effect (frost effect, freeze period - protein denaturation in the epidermis). This time varies, for example, when azelaic and almond acids are used, the peeling residence time will be longer than when salicylic^[2] is used^[2].

After the peel time, the acids are neutralized with basic pH buffer, as a rule, 10% aqueous sodium bicarbonate solution is applied.

Rehabilitation period

In the following weeks, regular use of reliable sunscreens and moisturizing products is mandatory. In the papulopustular form of rosacea, after each peeling procedure, topical antibiotic therapy is indicated (2-3 applications of antimicrobial cream or gel per day for 7-10 days): this significantly reduces the risk of bacterial complications. For rehabilitation after peels and treatment of rosacea, various topical drugs are used in a wide variety of regimens and regimens.

With rosacea complicated by pustules and papules, azelaic acid is used both independently and in combinations - with almond acid or, in case of risk of bacterial infection, with antibiotics (clindamycin or erythromycin). Side effects in such cases are usually rare (manifested in a third of patients) and are limited to redness and dry skin, burning and active peeling.

Effective in treating pustular-papular rosacea, another antibiotic, tetracycline, which acts more like an anti-inflammatory agent - in addition to these and antimicrobial properties, it is useful in other respects. Tetracycline antibiotics inhibit the activity of metalloproteinase (MMP2, MMP9) enzymes that degrade collagen, as well as phospholipases-2 and chemotaxis. On top of that, tetracyclines also inhibit the synthesis of some other inflammatory factors - interleukins (IL-1 b, IL-6) and tumor necrosis factor (TNF a). It is assumed that in the future, therapy for severe forms of rosacea will be based on the use of chemically modified tetracyclines (CMT)^[2]

Metronidazole has proven effective as an inflammation-reducing agent: its anti-inflammatory properties are associated with inhibition of reactive oxygen species production by xanthine oxidases and neutrophils. According to a Cochrane review of 33 clinical studies, only metronidazole and tetracyclines (in some cases also azelaic acid) have unequivocally demonstrated efficacy in the external treatment of rosacea.

In case of developing tolerance or allergy to the above antimicrobial drugs, macrolides can be prescribed: erythromycin, clarithromycin and azithromycin. They inhibit neutrophil hamotaxis and also reduce the synthesis of pro-inflammatory cytokines.

Retinoids are also prescribed in the treatment of rosacea after peels. Thus, it can be used in various concentrations (from 0.01% to 0.05%) of trentinoin, although, as a rule, it is prescribed at a concentration of 0.025% - this is perhaps the most commonly used titer for rosacea. Its efficacy in this case is comparable to oral administration of isotretinoin in a daily dose of 10 mg. But it should be borne in mind that side effects when using retinoids on the skin with rosacea occur more often and they are more severe than with other topical drugs. The most common of them are burning, xerosis (excessive dry skin), redness, active peeling of the skin. It is because of the risk of developing side effects that trentinoin is recommended for rosacea as a second-choice drug. Although, on the other hand, retinoids can also be administered orally (isotretinoin) in extremely severe forms of papulopustolic rosacea. For example, this is a yield for patients with severe rosacea varieties who achieved only partial remission after taking oral tetracyclines and metronidazole.

In the test mode, local remedies based on tacrolimus and pimecrolimus are used in rosacea - a new class of anti-inflammatory drugs that are usually used in the treatment of skin manifestations of allergies. Data on the use of these drugs in rosacea are limited, although cases of their successful use have been described. The most famous side effects - local burning and redness - are quite common and sometimes quite severe.

Brimonidine (patented name Mirvaso) is the most recent development for 2018 in the medical treatment of rosacea, which is prescribed in the form of a gel at any stages of the disease and not only after peels. Brimonidine normalizes the condition of blood vessels in the skin and thereby has a therapeutic effect. Since this is a relatively new drug, its effectiveness in reducing the symptoms of rosacea has not yet been established. As for the risk of adverse reactions, these are:

• local hyperaemia (10%) and redness (8%),
• hypersensitivity of the skin at the application site (4%),
• increased intraocular pressure (4%) and
• headaches (4%)^[2].

Agents with azelaic acid

Enzyme powder for washing Aravia

Enzyme powder for washing with papain and azelaic acid Aravia. It is intended for deep cleansing of oily and problematic skin, prone to the appearance of acne elements. Delicately cleans the skin of dirt, excess sebum and leftover makeup. After washing, tissue "breathing" improves, the feeling of purity and freshness remains, with regular use, the manifestation of imperfections on the skin decreases. When water is added, the powder turns into a light foam, activating the action of a soft cleansing complex and azelaic acid. Choosing Zdrav.Expert for 2023.

don’t touch my skin

Serum with azelaic acid. It is declared that the serum is good because it gently exfoliates the skin, while not drying it out. The main component is azelaic acid: it has antibacterial and anti-inflammatory effects. Plus - squalane (just protects against dehydration), antioxidants and phospholipids. It is suitable for oily skin prone to inflammation, and skin with rosacea and pigmentation.

anna sharova

Azelaic acid tonic. Anhydrous tonic based on mint hydrolate and with azelaic acid in the composition. It soothes the skin, reduces inflammation and traces of acne and rosacea. Plus it evens out the tone and gently exfoliates.

g. love

Azelic Active Azelaic Acid Anti-Rash Cream Corrector. The cream contains azelaic acid and extract of the leaves of the tree with it. They gently exfoliate the skin, brighten pigmentation and reduce inflammation. The cream also soothes and restores skin and regulates sebaceous glands. An important plus - it quickly absorbs without leaving a bold film.

art&fact

Anti-inflammatory face cream. The concentration of azelaic acid in this cream is 15%. Oily problem skin is suitable - the cream gently exfoliates it, cleans the pores, reduces inflammation. And it also strengthens antioxidant protection.

See also

• Rosacea