Guide · Azelaic acid
Azelaic acid in Singapore what it does for acne, dark marks, melasma and rosacea
Azelaic acid is one of the few skincare ingredients with trial evidence across acne, pigment and rosacea. Here is what each strength is for, how it is supplied in Singapore, how to combine it with retinoids and niacinamide, and why it tingles.
Quick answer
- Azelaic acid is a gentle acid used on the skin for acne, post-acne dark marks, melasma and rosacea. In Singapore, the 20% cream is registered as a prescription-only medicine, while lower-strength azelaic acid skincare, often around 10%, is sold without a prescription.
- It calms inflammation, helps unblock pores, reduces acne bacteria and slows pigment production. Trials support it for mild to moderate acne, for melasma, where 20% cream performed similarly to 4% hydroquinone in 329 women, and for rosacea bumps, where a 15% gel reduced inflamed spots more than a plain gel.
- It pairs well with niacinamide and daily sunscreen, and can be used with a retinoid by splitting them between morning and night. Mild tingling or itching is common at first. A review from Singapore's National Skin Centre lists it among topical acne treatments suitable in pregnancy, but check with your doctor first.
- SkinRev Lab does not prescribe. Where a prescription strength is appropriate, Dr Sin Yong prescribes it at IN Eternity Clinic, Pacific Plaza, after a consultation priced by the clinic; melasma, rosacea and moderate to severe acne need a doctor's assessment.
The basics
What azelaic acid is and how it works
Azelaic acid is a naturally occurring acid that has been used in dermatology for decades. Unlike exfoliating acids such as glycolic or salicylic acid, it is not mainly a peel; its value comes from several actions at once.
Reviews describe it as active against the bacteria involved in acne, anti-inflammatory, able to normalise the build-up of skin cells that blocks pores, and able to slow melanin production in the skin. That combination is why one ingredient appears in plans for acne, dark marks, melasma and rosacea.
It works slowly. Acne usually starts to improve after about four weeks, and pigment is judged over two to three months or longer, with daily sunscreen throughout.
| Concern | What azelaic acid does | Strength of evidence |
|---|---|---|
| Mild to moderate acne | Fewer blackheads, whiteheads and inflamed spots | Conditional recommendation in the 2024 American acne guideline |
| Post-acne dark marks (PIH) | Fades brown marks gradually | Smaller studies; widely used, especially in darker skin |
| Melasma | Lightens patches, used with sunscreen | Randomised trials; similar to 4% hydroquinone |
| Rosacea bumps and pustules | Fewer inflamed spots, some reduction in redness | Two large randomised trials of the 15% gel |
| Visible thread veins | Little effect | Vascular laser is the usual option |
Acne
Azelaic acid for acne and clogged pores
For acne, azelaic acid works on both blocked pores and inflamed spots. The 2024 American Academy of Dermatology guideline, built on a systematic review, gives it a conditional recommendation, as it does salicylic acid; its strong recommendations go to benzoyl peroxide, topical retinoids such as tretinoin and adapalene, topical antibiotics and oral doxycycline.
In practice, azelaic acid suits people with mild to moderate acne who find retinoids too irritating, who are pregnant or planning a pregnancy, or who also have dark marks. It is often combined with other treatments rather than used alone.
Moderate to severe, cystic or scarring acne needs a doctor, because delay increases the risk of permanent scars. A cream is rarely enough on its own at that stage.
Dark marks
Post-acne dark marks (PIH) in Asian skin
Post-inflammatory hyperpigmentation (PIH) is the flat brown mark a spot leaves behind, and in Asian skin it is common and slow to fade. Because azelaic acid both calms the inflammation that sets off new marks and slows pigment production, it is a frequent choice when acne and marks appear together.
The evidence for PIH alone is thinner than for acne or melasma, and comes mostly from small studies. Sunscreen every morning and not picking matter at least as much; a mark a few shades darker than your skin often takes months to fade.
Red or pink marks are a different problem, post-inflammatory erythema, caused by small blood vessels rather than pigment. They respond to different treatments, so it helps to know which you have.
Melasma
Azelaic acid for melasma, compared with hydroquinone
In a 24-week double-blind trial of 329 women, 20% azelaic acid cream and 4% hydroquinone cream, each used with a broad-spectrum sunscreen, showed no significant difference in overall rating, patch size or depth of colour. About 65% of the azelaic acid group had good or excellent results, and no allergic sensitisation or ochronosis, a rare blue-black darkening, was seen with azelaic acid.
That makes it a useful option when hydroquinone is unsuitable or as a longer-term maintenance cream. It works gradually, and tingling is common in the first weeks.
Melasma is a long-term condition driven by sun, visible light, heat and hormones, so no cream clears it for good. A doctor usually combines a lightening cream with strict sun protection and sometimes oral tranexamic acid or gentle laser, and keeps a maintenance plan going.
Rosacea
Azelaic acid for rosacea bumps and redness
Rosacea is a medical skin condition, and azelaic acid is one of the prescription treatments used for its acne-like bumps and pustules. In two randomised trials of a 15% gel used twice daily in 664 people with moderate papulopustular rosacea, inflamed spots fell by 58% and 51%, compared with 40% and 39% with a plain gel, and more people had less redness (44% and 46%, against 29% and 28%).
It does little for visible thread veins or flushing, which usually need vascular laser or other treatment. Because rosacea-prone skin stings easily, a doctor may start with once-daily use.
Redness that is new, scaly, around the mouth or eyes, or not responding to treatment needs a diagnosis first. It may be perioral dermatitis, seborrhoeic dermatitis, Demodex-related inflammation or a reaction to products, each treated differently.
Strengths
Azelaic acid strengths in Singapore: 10%, 15% and 20%
Strength and formulation matter, and so does who supplies it. In Singapore, the 20% cream is registered as a prescription-only medicine. Its entry on the National Drug Formulary includes an exemption that allows supply without a prescription, up to 30 g, for mild to moderate acne in people aged 12 and over, which in practice means from a pharmacist. For melasma or rosacea, it is used on a doctor's advice.
The 15% gel is the strength studied most for rosacea and is a prescription product in many countries; ask your doctor what is currently available locally. Lower-strength azelaic acid, often around 10%, is sold as skincare. These products are less studied and vary in formula, so they suit mild unevenness or maintenance better than acne or melasma treatment.
| Strength | Usual form | How it is supplied in Singapore | Main use |
|---|---|---|---|
| Around 10% or less | Serums, creams, suspensions | Sold as skincare without a prescription | Mild unevenness, maintenance; limited trial data |
| 15% | Gel or foam | A prescription product in many countries; check local availability with your doctor | Rosacea bumps and pustules |
| 20% | Cream | Prescription-only medicine; a pharmacist may supply up to 30 g for mild to moderate acne, age 12 and over | Acne; melasma and PIH on a doctor's advice |
How to use
Using azelaic acid with retinoids, niacinamide and sunscreen
Apply a thin layer to clean, dry skin over the whole affected area, not only on individual spots. The 20% cream is used twice daily; if your skin is sensitive, start once a day in the evening for the first week. Keep it away from the eyes, mouth and inside the nose.
Add one new product at a time and give it two to four weeks before adding the next. The 20% cream's product information advises against using it continuously for more than 12 months at a time, so follow your doctor's plan for how long to continue.
| Pair with | Works together? | How |
|---|---|---|
| Niacinamide | Yes, usually well tolerated | Same routine, or niacinamide in the morning and azelaic acid at night |
| Tretinoin, adapalene or retinol | Yes, with care | Azelaic acid in the morning and the retinoid at night, or alternate nights |
| Benzoyl peroxide | Yes, within a doctor's plan | Often split between morning and night to limit dryness |
| Glycolic or salicylic acid | Sometimes | Avoid layering in one routine at first; irritation adds up |
| Vitamin C | Yes | Vitamin C in the morning and azelaic acid at night if the pair stings |
| Sunscreen | Essential | Every morning and reapplied outdoors; Singapore's UV is high all year |
Side effects
Tingling, itching and other side effects
The commonest side effects are burning, tingling, itching or redness where it is applied, with some dryness or scaling. These are usually mild and tend to settle as the skin adjusts. Applying it to fully dry skin, using a plain moisturiser and dropping to once a day for a week or two usually helps.
Less often, people notice greasy skin, a temporary flare of spots, or lightening of the skin, which is worth watching for in darker skin. Rarely, it causes blisters, an allergic rash or worsening asthma. Stop and seek medical help for swelling of the face or eyes or difficulty breathing. Anyone allergic to azelaic acid, or to propylene glycol in the 20% cream, should not use it.
Pregnancy
Is azelaic acid safe in pregnancy and breastfeeding?
Azelaic acid is one of the topical acne treatments most often considered during pregnancy. A review from Singapore's National Skin Centre recommended topical treatments as first-line for acne in pregnant and breastfeeding women, listing azelaic acid among them, and advised avoiding oral and topical retinoids, hormonal treatment and tetracycline antibiotics.
Experience in pregnancy is still limited, and the Singapore patient leaflet for the 20% cream says a doctor should decide whether it is appropriate. If you are pregnant, trying to conceive or breastfeeding, tell your doctor before starting any acne or pigment treatment.
In our network
Where azelaic acid fits at IN Eternity Clinic and SkinRev Lab
Prescription-strength azelaic acid is a medicine, and SkinRev Lab does not prescribe or inject. Where it is appropriate, Dr Sin Yong prescribes it at IN Eternity Clinic, 9 Scotts Road, #12-01 Pacific Plaza, beside Orchard MRT, after a consultation, as part of a plan for acne, dark marks, melasma or rosacea that may also include other creams, oral treatment or laser. Consultation and treatment are priced by the clinic; WhatsApp +65 8815 3008.
SkinRev Lab, at CityLink Mall #B1-28 by City Hall MRT, offers non-medical care alongside a doctor's plan. HydraFacial Syndeo clears congested pores in 45 minutes (Signature S$288 before GST; first-visit rate at the counter), and SKINLDM uses ultrasound micro-massage to calm reactive, redness-prone skin (S$288 before GST; first visit S$68). Neither replaces medical treatment for melasma, rosacea or moderate acne.
Sources
References & sources
- National Drug Formulary, Singapore. Product information: azelaic acid 20% w/w cream, registration SIN07138P. Last updated 9 October 2026.
- Pharmaceutical Society of Singapore. Azelaic acid 20% w/w cream or lotion: patient information leaflet (HSA-reviewed); 2016.
- Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1-1006.e30.
- Schulte BC, Wu W, Rosen T. Azelaic acid: evidence-based update on mechanism of action and clinical application. J Drugs Dermatol. 2015;14(9):964-968.
- Baliña LM, Graupe K. The treatment of melasma. 20% azelaic acid versus 4% hydroquinone cream. Int J Dermatol. 1991;30(12):893-895.
- Thiboutot D, Thieroff-Ekerdt R, Graupe K. Efficacy and safety of azelaic acid (15%) gel as a new treatment for papulopustular rosacea: results from two vehicle-controlled, randomized phase III studies. J Am Acad Dermatol. 2003;48(6):836-845.
- Kong YL, Tey HL. Treatment of acne vulgaris during pregnancy and lactation. Drugs. 2013;73(8):779-787.
Common questions
Your questions,
answered
What does azelaic acid do for skin?
It reduces acne bacteria and inflammation, helps unblock pores and slows pigment production. That makes it useful for mild to moderate acne, post-acne dark marks, melasma and the bumps of rosacea. Results build over weeks to months.
Can I buy azelaic acid over the counter in Singapore?
Lower-strength azelaic acid skincare, often around 10%, is sold without a prescription. The 20% cream is a prescription-only medicine, although a pharmacist may supply up to 30 g for mild to moderate acne in people aged 12 and over. For melasma or rosacea, see a doctor.
Is azelaic acid better than niacinamide?
They do different jobs and work well together. Azelaic acid has stronger trial evidence for acne, melasma and rosacea bumps; niacinamide is gentler and supports the skin barrier, oil control and even tone. Many routines use both.
Can I use azelaic acid with tretinoin or retinol?
Yes, with care. A common approach is azelaic acid in the morning and the retinoid at night, or using them on alternate nights. Start one product at a time, and use a moisturiser and daily sunscreen.
How long does azelaic acid take to work?
For acne, improvement usually starts after about four weeks and continues over several months. Dark marks and melasma take longer, often two to three months or more, and need daily sunscreen to hold the result.
Why does azelaic acid tingle or burn?
Tingling, itching or mild burning is the commonest side effect, especially in the first weeks or on sensitive skin. Apply it to fully dry skin, buffer with moisturiser and reduce to once daily. Stop and see a doctor if you get swelling, blisters or a spreading rash.
Is azelaic acid safe during pregnancy?
A review from Singapore's National Skin Centre lists topical azelaic acid among first-line acne options in pregnancy and breastfeeding, unlike retinoids. Experience is still limited, so check with your doctor before starting.
Does azelaic acid help melasma?
It can. In a trial of 329 women, 20% azelaic acid with sunscreen performed similarly to 4% hydroquinone. Melasma tends to return, so it is most useful within a doctor-led plan with strict sun protection.
Is azelaic acid good for rosacea?
For the acne-like bumps and pustules of rosacea, it helps: a 15% gel reduced inflamed spots more than a plain gel in two large trials. It does little for visible thread veins, and rosacea should be diagnosed by a doctor.