Implications for practice

Azelaic acid has been shown to be an effective therapy in mild-to-moderate papulopustular acne and to be as effective as 0-05% isotretinoin in comedonal acne. The onset of action is slower than that seen with benzoyl peroxide. Azelaic acid can be used less sparingly than isotretinoin -2-5 cm of cream should be applied to the face. Patients should be counselled to expect a delayed response. Anecdotal reports have suggested that azelaic acid may reduce the incidence of post-inflammatory hyperpigmentation, which is possibly attributable to its activity on abnormal melanocytes.79 Darker skinned patients should be monitored for signs of hypopigmentation.

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