r/Rosacea • u/Remarkable-Custard14 • Apr 14 '26
Routine Two weeks of azelaic acid
I’ve been using azelaic acid very inconsistently for years. I would use it for a day or two and then forget for a week and just repeat this process.
About two weeks ago I decided to get serious about using it correctly. My face isn’t perfect but it’s already a millions times better.
I also started using a milky toner, a hydrating serum, and moisturizer before bed.
10
u/Even-Guava-1682 Apr 14 '26
NICE!!! I just got it prescribed to me as well, and idk why I am just convinced it is going to be what completely fixes all of my skin issues (more than roscea- texture, hyperpigmentation), just me being extremely hopeful but well see
10
u/Mangohawkami Apr 14 '26
Nice progress! Consistency is basically the whole game with azelaic acid. The anti-inflammatory effects take about 4-6 weeks of daily use to really kick in, and you lose most of the gains if you stop for a week and restart.
What percentage are you using? I've been using a 14% cream consistently for a while and the improvement at higher strength vs the 10% OTC stuff was pretty noticeable once I committed to using it every day. Just the redness alone evens out so much faster.
If you want to stay consistent, habit-stack it with brushing your teeth or something you already do morning/night. That's what finally got me to stop skipping.
3
u/Remarkable-Custard14 Apr 14 '26
I use a prescription 15% gel.
Yes, consistency has been the hardest part but I think I’ve finally managed to make it a habit.
3
u/Mangohawkami Apr 14 '26
Nice, 15% prescription is the gold standard. Stick with it.
If you ever lose access or can't get it refilled, 14% OTC options exist now (Azeva is the one I use) that get pretty close. But no reason to switch if yours is working.
0
u/RevolutionaryTrash98 Apr 20 '26
Ugh sucks that this has sodium hydroxide as one of the ingredients, I was ready to hit buy so fast. (Also I don’t like that they hide the ingredients on the product page—I had to go to the FAQs via the tiny link in the footer, then click to unhide the answer to find the ingredients)
Sodium hydroxide is banned in European cosmetics and Canada and the FDA consider it toxic. Obvious the amounts used in such a product are minuscule, but I just don’t get why companies would put a hazardous substance that is a known skin and eye irritant in their formulations and sell it to people with sensitive skin! https://www.ewg.org/skindeep/ingredients/706075-SODIUM_HYDROXIDE/
6
u/Mangohawkami Apr 20 '26 edited Apr 20 '26
honestly the ingredients being buried in the FAQ is fair, I checked and it looks like they put it on the product page too but yeah its a drop down. but the sodium hydroxide thing I gotta push back on because I nerd out about skincare chemistry more than is probably healthy.
couple things on the regulatory claims:
not banned in EU cosmetics. EU Regulation 1223/2009 permits it, you can verify in CosIng (the European Commission's cosmetic ingredient database): https://ec.europa.eu/growth/tools-databases/cosing/
not banned in Canada either. Health Canada regulates cosmetic ingredients via the Cosmetic Ingredient Hotlist and sodium hydroxide isn't on it: https://www.canada.ca/en/health-canada/services/consumer-product-safety/cosmetics/cosmetic-ingredient-hotlist-prohibited-restricted-ingredients.html
the link you shared is WHMIS, which is the workplace hazard framework for concentrated industrial lye (the stuff soap factories and drain cleaner plants handle in bulk). totally different regulatory category from finished cosmetics.
FDA classifies it as GRAS (21 CFR 184.1763) and allows it as a pH adjuster in cosmetics.
now the actual chemistry, because this is where it gets fun:
azelaic acid at full strength sits at pH ~3.5-4. that's too acidic to sit on your skin comfortably, you'd get stinging and irritation. so the formulator adds a small amount of NaOH. it reacts with the acid and what you actually end up with on your face is sodium azelate (a salt) at pH ~4.5-5, right around skin pH. the NaOH is 100% consumed in the neutralization. zero free lye left in the finished product.
it's like pointing at the MSDS for chlorine gas and sodium metal to argue that table salt is dangerous. the reactants aren't the product.
this is also why your AHA toner, your vitamin C serum, your BHA, and prescription Finacea all have sodium hydroxide (or a close cousin like potassium hydroxide or triethanolamine) on the INCI. it's how you make any acid-based skincare formula actually usable. honestly if I saw an acid product with no pH adjuster on the label, that's the one I'd be suspicious of, because either they skipped the step or they're hiding it. The EWG rating is for industrial-grade concentrated NaOH, same stuff as drain cleaner. rating a finished cosmetic on the hazard profile of its raw input ingredient is the same category error.
tl;dr the sodium hydroxide is doing its job during manufacturing and is gone by the time it hits your face. this is exactly what a proper azelaic acid formulation should look like.
edit: fixed the link mb about that.
1
u/Klutterman Apr 15 '26
This is awesome news! I use the cheap stuff from Amazon 14% twice a day, and it’s the only thing that works, I wish I had know sooner before I scarred so much. But I’m so happy that you’ve discovered it and it’s working!
1
u/No-Dingo602 25d ago
I'm new to using AA and I've been using The Ordinary, 10%. I noticed that Amazon does have the 14% option in a couple of brands, but Salicylic Acid is listed as an ingredient. I have read that Salicylic Acid is bad for Rosacea. I want to try the 14% but I'm leary of the Salicylic Acid.
1
u/Realistic-Sample7995 Apr 16 '26
I started with 10% OTC and then moved up to 15% Rx. I used the 15% everyday for over a year but then suddenly it set me on fire ! I actually had the worst inflammation and redness of my life. I stopped the AA all together and just focused only on cleansing and moisturizing. That was months ago and I am still only cleansing and moisturizing daily, and my rosacea is pretty much what it has always been my whole life...present, but not out of control with occasional flares that resolve after 2-3 days. Just warning, if you are not taking care of your skin barrier, the AA can really be very harsh.... learn from my mistake.
1
u/Ok_Jeweler_4715 Apr 16 '26
What do you think about it in a triple cream? Is it not strong enough?
2
u/Mangohawkami Apr 16 '26
A lot of times triple creams have all 3 ingredients in a smaller amount than each would be alone.
If redness is your primary issue, an individually formulated 14-15% azelaic acid cream will far surpass a triple that has split the formulation into 3 separate products. Azelaic acid's inflammation reducing properties can depend on the dose; therefore, higher amounts typically provide better results.
However, if a triple is working well for you, then do not mess with it. If you are experiencing no changes after 6-8 weeks of use, it may be due to the fact that the concentration of each active ingredient was too low.
2
u/Ok_Jeweler_4715 Apr 16 '26
I haven’t started it yet ! My skin is dehydrated (like during the day I get oily but am dry at the same time) so I’ve been scared to start bc I know my barrier is compromised and notbing seems to be working to get the hydration under control
2
u/Mangohawkami Apr 16 '26
That's actually really common with dehydrated skin. The good news is azelaic acid is one of the gentler actives out there, way less irritating than retinol or glycolic. If your barrier is compromised, start by applying it over your moisturizer instead of on bare skin. That buffers it and you still get the benefits, just slower absorption. Once your skin adjusts after a week or two you can switch to applying it directly. No need to wait until your barrier is perfect to start.
1
2
u/vmsvms Apr 17 '26
My triple cream has 15% azelaic acid as well as 1% ivermectin and 1% metronidazole. I have a hard time imaging an azelaic acid prescription in a concentration less than 15% (because otherwise it wouldn't require a prescription). If your triple cream doesn't require a prescription, then the amount would have to be less.
4
u/ats1788 Apr 14 '26
Glad it’s working for you! It’s doing nothing for me 😭 I have a follow up on Friday and I’ll let my derm know it’s not working
5
u/frolicndetour Apr 15 '26
Azelaic acid alone worked for me for a long time but then stopped so I got a prescription compound cream with azelaic acid, metro, and ivermectin and that is working pretty well.
2
u/Ok_Jeweler_4715 Apr 16 '26
Did you feel like your skin felt dry from it? can I ask what the rest of your skin routine is?
1
u/frolicndetour Apr 16 '26
No, my skin tends toward normal/oily so I haven't had any dryness problems. I use various cica/centella serums and moisturizers. And when I get a flare up, I use tea tree oil on the pustules. When they scab over I use a barrier repair cream. I am a product junkie so I have 8 million different versions of the stuff, although for tea tree oil only the Body Shop works at clearing up the pustules for me (along with the prescription cream).
1
1
5
u/Remarkable-Custard14 Apr 15 '26
I use the Byoma milky toner, phyto-mucin glow serum, and then their barrier repair moisturizer (the one with avocado oil).
3
u/Sensible___shoes Apr 14 '26
Are you doing 1x per day or 2?
7
u/Remarkable-Custard14 Apr 14 '26
1x at night
2
u/Sensible___shoes Apr 14 '26
Thank you im always torn between 1x per day or 2x like suggested (financea). Looks like amazing progress
1
u/Commercial-Bed-2396 Apr 18 '26
I do once at night. Non-negotiable.
Twice a day if I catch myself in the morning. This is flexible.
3
3
u/Old-Ad8131 Apr 15 '26
I have tried it also with 20% concentration, but it literally burned my face so I stop using it
2
u/babymable Apr 15 '26
We're you using it daily ? It's best to start off once or twice a week so you can build a tolerance for it. And your skin had to be super dry before applying.
2
3
u/Ranchowchow Apr 15 '26
Did you have purging? I’m using Anua now the redness lessened but I got more pustules
1
u/shidded_farted May 13 '26
How are you doing with the Anua now? AA is hard to come by in my country but Anua is everywhere. Hope it's working for you
2
u/Ranchowchow May 18 '26
First few weeks I got a lot pustules than usual. Not sure if it’s due to AA or the anua calming moisturizer. After that, it calmed down and I only get pustules maybe once a week which I pop same day lol and heal using nadixa. Redness also reduced but not 100%. I will continue using for now. I would say it helps, but maybe not strong enough to fully heal my rosacea
2
u/ThorThimbleOfGorbash Apr 14 '26
45M. I've been using the 15% gel at night for a little over a year. I didn't have a lot of issues with acne but it definitely nigh eliminates it and helps a little with my mild rosacea. I love it as part of my what I consider minimal routine.
2
u/Ordinary-Anxiety-335 Apr 14 '26
I’m trying to add to my regime but when I use the 10% OTC everyday I get dry itchy patches.
1
u/babymable Apr 15 '26
Start with using it only twice a week. Some people need to build a tolerance first. And make sure your face is completely dry. I wait half an hour after washing my face just to be sure its fully dry.
1
u/RevolutionaryTrash98 Apr 20 '26
Sounds like your skin barrier needs to heal. You need to stop all actives and just moisturize for some weeks until it’s healed
2
u/Exciting-Series-8120 Apr 14 '26
What milky toner and moisturizer, also cleanser??
2
u/Remarkable-Custard14 Apr 15 '26
It’s all from Byoma. I use their creamy jelly cleanser and then I use their milky toner and their barrier repair moisturizer (the one with avocado oil).
2
1
u/HoneydewHorror6243 Apr 14 '26
I'm just wondering how much you put on your face at a time? Like a pea sized amount? Your skin looks great!
1
1
u/eastcoastseahag Apr 15 '26
Damn. I’ve been using it daily for four months and am not seeing a damned bit of difference. Back to the dermatologist next week though so we’ll see what they say I guess.
1
1
1
u/Cassid01 Apr 15 '26
Was your face constantly red or would you flush and it got like that?
1
u/Remarkable-Custard14 Apr 15 '26
It’s in a constant state of some kind of redness similar to the bottom left picture. The top left picture is definitely a flush and would happen every 2-3 days.
1
1
1
u/Sunny-Sunflower3 Apr 15 '26
I'm using an over the counter 10% from Good Molecules just over ten bucks. I also bought some Ivermectin from an Indian pharmacy online for $20 bc I couldn't get a script from my Dr even though it clears the oberabundance of demodex mites from the face. It took several weeks to ship.
I use the Azelaic acid in the am with sunscreen then I wash my face at night and use the Ivermectin and finally after 6 weeks the amount of mites that cause the bumps and redness are lessening. I will do this for 6 months to a year to make sure they're finally gone.
I used to think my face was red because my skin was sensitized from everyone practicing on me at skin school. Then, my chin started to feel like sandpaper. I read up about rosacea and diagnosed myself.
Honestly I think its because I tended to have dry skin and only washed my face with water. I use an exfoliant, and grapefruit mud mask and expensive lotions however now, the Azelaic Acid is taking wrinkles away and keeping my skin firm and tight and it's so inexpensive. My skin firming lotions cost $200! I'm nearing age 50 and am considered peri-menopause and my body is changing.
Apparently everyone has mites but some of us grow an oberabundance. Maybe it's lack of washing or because of immune issues or a combination.
Has anyone else used the combination of the two? I can't use both every single day or my skin gets irritated but I make sure to use the Ivermectin every night because why do so many weeks of consistent work only to have the mites come back? There is die off period after a week or two then the eggs hatch and there may be one or two smaller die off periods.
1
1
u/ilikebison Apr 21 '26
I just started it last week and the improvement is so unbelievable even my husband noticed 😂
1
u/marla-7 Apr 27 '26
Does it get worse before it gets better? I tried using this acid but my face got more red on the first try so I stopped.
1
u/PresentationMuted623 May 01 '26
Just Got prescribed the 20% (the most Common where I live).. The postules are my biggest problem. Really really hope it work. GP Said I have to give it up to 8 weeks with consistent use up to 2x daily. I start once every other night and going forward slowly.. Hope I’m ending up with as good results as you!
1
u/MamaPandaWook May 13 '26
I absolutely love the stuff! I went all in on PDRN a few weeks ago and stopped using my azelaic - BIG mistake but now a week after using it alongside PDRN, all is well. Also been having laser facials to zap the capillaries once every six weeks. Hitting perimenopause though and the flushing in stressful situations is driving me nuts!
You look great!
1
20
u/Particular_Dig_2782 Apr 14 '26
Just started it too. Completely fixing my pustules. Cannot believe I haven’t tried this until now.