Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Azelaic acid is primarily used as a topical treatment for conditions such as acne vulgaris and rosacea, both of which are often treated with antibiotics. The rationale for using azelaic acid as an alternative to antibiotics is supported by scientific evidence. Azelaic acid possesses antimicrobial properties, particularly against Cutibacterium acnes (formerly Propionibacterium acnes) and Staphylococcus epidermidis, which are implicated in acne pathogenesis. In addition to its antimicrobial activity, azelaic acid exhibits anti-inflammatory effects, further contributing to its efficacy in acne and rosacea treatment.

Several randomized controlled trials and meta-analyses have shown that topical azelaic acid (usually in 15-20% formulations) is comparable in efficacy to topical antibiotics such as clindamycin and erythromycin for mild to moderate acne. Azelaic acid is also effective in rosacea, where it reduces papules, pustules, and erythema. Importantly, azelaic acid does not appear to induce bacterial resistance, making it a valuable alternative to antibiotics, especially amid growing concerns about antibiotic resistance. For these reasons, dermatological guidelines often recommend azelaic acid as either a first-line or adjunctive therapy for acne and rosacea, particularly in cases where antibiotic stewardship is a concern.

Overall, the use of azelaic acid as an alternative to antibiotics in dermatology is justified by moderate scientific evidence (rated 3 out of 5), with support from clinical trials, mechanistic studies, and clinical practice guidelines.

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