Yes. Azelaic acid can help treat acne and gradually fade the flat brown or gray marks that pimples leave behind. Some evidence suggests that it may also help red or pink marks. Prescription-strength 15% and 20% products have the strongest direct evidence for acne-related discoloration. A specially made 10% formula has also worked in a trial, but ordinary 10% cosmetic products are less well studied. Acne may start improving within several weeks. Dark marks often need several months.[1, 3, 5, 6, 7, 8, 11]
PIH means post-inflammatory hyperpigmentation. These marks are usually brown, gray or darker than your skin. PIE means post-inflammatory erythema. These marks are usually red, pink or purple. A mark can contain both.
Azelaic acid is not a scar eraser. It may fade flat color over or around a scar, but it cannot lift a pitted scar or remove raised scar tissue. First check whether your main concern is color, texture or both. Our PIH vs PIE vs acne scars guide explains the difference.
The research is promising, but it is not perfect. Several studies included only a small number of people, lasted a few months or did not use the strongest possible study design. This means azelaic acid may help, but the research cannot guarantee the same result for everyone.
In this guide
- Does azelaic acid actually work?
- How it may fade brown and red marks
- Why it can also help acne
- What 10%, 15% and 20% mean
- How to use it and when results may appear
- Using it with salicylic acid or glycolic acid
- Irritation and important safety warnings
- Why sunscreen matters for dark spots
- Simple routine examples
- Frequently asked questions
Does azelaic acid for dark spots actually work?
Yes, especially when acne and flat brown or gray marks are happening together. Azelaic acid can treat active breakouts while also helping some of the discoloration left behind. The 2024 American Academy of Dermatology acne guideline conditionally recommends topical azelaic acid. In plain English, dermatologists consider it a reasonable option, but the evidence is not strong enough to say it will work for everyone.[1, 2]
In the United States, Azelex 20% cream is approved for mild-to-moderate inflammatory acne. Current 15% gel labeling is for the bumps and pimples of rosacea, not acne. A clinician may still use a product outside its approved purpose when evidence and experience support it. This is called off-label use.[3, 4]
In a 12-week study, people applied either 15% azelaic acid gel or an inactive comparison gel twice daily. Red marks showed clearer improvement by weeks 8 and 12. Some brown-mark measurements also improved, although the results were not equally convincing across every measurement. The study was small, so it is encouraging rather than definitive.[5]
Science note: how the 12-week study was designed
The study enrolled 72 people and 60 completed it. It was randomized and double-blind, which reduces some bias. The inactive comparison gel is called the vehicle. The study was registered after it began, and not every brown-mark measurement clearly performed better than the vehicle. Those limits are why the result should be described as promising, not conclusive.
Two smaller studies point in the same general direction. A 16-week pilot study of about 20 people reported improvement in acne and brown marks with 15% gel, but it had no randomized comparison group. Another small trial found that both 20% azelaic acid and 5% topical tranexamic acid improved acne-related brown marks. The study did not prove that the two treatments were exactly equal.[6, 7]
Azelaic acid has credible evidence, but the realistic result is steady improvement, not a seven-day transformation.
Evidence over hypeFor a wider comparison with retinoids, niacinamide, tranexamic acid and exfoliating acids, read How to Fade Post-Acne Dark Spots Without Damaging Your Skin.
How azelaic acid may fade brown and red marks
Brown or gray marks
When a pimple becomes inflamed, the skin may produce extra pigment while healing. This can leave a flat brown, gray or darker mark called PIH. If some pigment sits deeper in the skin, the mark may look more gray-brown and take longer to fade.
Azelaic acid may interfere with part of the pigment-making process. That can help excess pigment fade gradually. It is not household bleach, and it should not be described as stripping all pigment from the skin.
Science note: the pigment mechanism
Laboratory research suggests that azelaic acid can affect tyrosinase, an enzyme involved in making melanin. It may also have a stronger effect on unusually active pigment-producing cells than on normal surrounding cells. These findings help explain how it may work, but the exact mechanism in living human skin is not fully settled.[13, 17]
Results also depend on how deep the pigment is, whether new pimples keep appearing, how irritated the skin becomes and how well it is protected from light. Official labels contain rare reports of lighter patches, called hypopigmentation, so an unexpected loss of color should not be ignored.[3, 4, 11]
Red or pink marks
Red or pink post-acne marks are usually linked more closely to lingering inflammation and visible blood vessels than to extra pigment. These marks are often called PIE. Active acne, rosacea and small visible blood vessels can look similar, so every red spot is not automatically PIE.
Azelaic acid may help some acne-related redness. Its anti-inflammatory activity is one possible reason, but the clinical study did not prove exactly why the redness improved. The evidence for red marks is newer and less established than the evidence for acne and brown marks.[5, 14]
Mixed marks are common. A pitted or raised scar can also have brown pigment or redness over it. Check texture first, then look at color. A dermatologist may be needed when the mark is difficult to identify.
Why azelaic acid can also help acne
Treating active acne matters because every new inflamed pimple can leave another mark. Azelaic acid is useful here because it may work on breakouts and discoloration in the same routine.
In simple terms, azelaic acid may affect acne-associated bacteria, reduce some inflammatory activity and help prevent dead skin cells from building up inside pores. Scientists are still studying exactly how much each action contributes to real-world results.
Science note: what laboratory studies found
Laboratory and prescribing information describe antimicrobial activity, anti-inflammatory effects in skin cells called keratinocytes, and changes in keratinization, the process that controls how skin cells mature and shed. Older papers use the name Propionibacterium acnes; the acne-associated organism is now generally called Cutibacterium acnes. The Azelex label also says that the exact acne mechanism is unknown and that the real-life importance of some test-tube findings is uncertain.[3, 14, 15, 16]
The practical point is simpler than the cell biology: one well-tolerated active may be easier to use consistently than several aggressive products.
A painful blemish that keeps returning in the exact same place may involve repeated blockage, friction, picking, a cyst or another condition. Read Why Acne Keeps Returning in the Same Spot if that pattern sounds familiar.
10% vs 15% vs 20% azelaic acid
A higher number does not automatically mean a better result. The formula, texture, amount used and how well your skin tolerates it all matter. Research has not established a simple rule that 20% always works faster or irritates more than 15% or 10%.
| Strength | What we know | What it means for you |
|---|---|---|
| 10% | One clinical trial found that a specially engineered 10% hydrogel improved acne.[8] | Some 10% products may help, but the trial cannot be applied to every cosmetic serum or suspension. Evidence for ordinary 10% products on acne-related dark marks is limited. |
| 15% | Small studies support 15% gel for acne-related red and brown marks. In the United States, the current 15% gel label is for inflammatory rosacea, not acne.[4, 5, 6] | This is one of the best-studied strengths for acne marks, but the studies are still small. Acne use of the U.S. prescription gel is off-label. |
| 20% | Azelex 20% cream is FDA-approved for mild-to-moderate inflammatory acne. Small studies also support 20% cream for some pigmentation concerns.[3, 7] | It has strong regulatory support for acne, but concentration alone does not guarantee faster fading or more irritation. |
Choose a product you can use consistently without repeatedly irritating your skin. A stronger product that makes you stop is not automatically more useful than a lower-strength product you can tolerate.
Science note: cosmetic vs prescription
The FDA classifies a product by what it is intended and marketed to do, not only by its ingredient list. A cosmetic and a prescription drug may both contain azelaic acid while having different formulas, evidence, approved uses and regulatory review.[12]
How often to use azelaic acid
Start with the directions for your specific product or prescription. Azelex 20% cream and the current 15% gel label direct a thin layer twice daily for their approved uses. Azelex says that many people with inflammatory acne begin seeing improvement within about four weeks. That refers to pimples, not complete fading of dark marks.[3, 4]
Sensitive skin may need a slower start. If irritation continues, Azelex labeling supports reducing use to once daily or pausing until the skin settles. Starting once daily or less often is a cautious approach, not a proven perfect schedule.[3]
- Cleanse gently. Use a mild cleanser and pat the skin dry. Broken or very inflamed skin may sting more.
- Apply a thin layer. More product has not been shown to work faster and may increase irritation. Avoid the eyes, mouth and other sensitive areas.
- Add moisturizer if needed. Moisturizer can help with dryness. Applying it before azelaic acid is a personal tolerance test, not a proven better method.
- Use sunscreen every morning. When treating brown marks, sun protection is part of the treatment.
When should you expect results?
Acne and dark marks usually move at different speeds. Pimples may begin improving around the first month. In small studies, some red and brown mark measurements changed after about 8 to 16 weeks. This does not mean every mark will disappear by week 16.[3, 5, 6]
Complete fading often takes much longer. The AAD notes that some dark spots can take 6 to 12 months to fade, while deeper pigment may remain longer. New breakouts, irritation and unprotected light exposure can also slow progress.[11]
Science note: where the 8-to-16-week estimate comes from
The 2024 trial measured changes at weeks 8 and 12 using 15% gel. A smaller open-label study followed 15% gel for 16 weeks. These were specific products and small groups, so the timeline should be treated as an early improvement window, not a universal clearing deadline.
Take progress photos in the same lighting about once a month. This makes slow changes easier to notice than daily mirror checking.
Can you use azelaic acid with salicylic acid?
Yes, they can be part of the same routine, but that does not mean you should layer strong versions every night. Both can cause dryness, burning and peeling, especially when the skin is already irritated.
One cautious option is to use a salicylic acid cleanser with leave-on azelaic acid. Another is to use a 2% salicylic acid leave-on product on a different night while you learn what your skin tolerates. These are practical ways to reduce irritation, not schedules proven to be best in a clinical trial. Learn more in The Truth About Salicylic Acid 2%.
Can you use azelaic acid with glycolic acid?
They can also appear in the same plan, but glycolic acid adds another source of exfoliation. Starting both at once may make it difficult to tell which product is causing burning, tightness or peeling. Separate nights and a lower frequency are cautious options.
Science note: what the combination studies actually tested
A 34-person professional peel study used 20% salicylic acid and 20% azelaic acid together for four supervised sessions. It showed that the mixture was used successfully in that specific protocol. It did not test the stability of every home formula.[10]
A separate 24-week study used 20% azelaic acid with 15% or 20% glycolic acid in darker-skinned patients with facial hyperpigmentation. That structured regimen performed similarly to 4% hydroquinone by week 24, but it was not the same as combining azelaic acid with a consumer 7% toner.[9]
Irritation can create more redness and may worsen PIH. If the routine causes persistent burning, tightness, peeling or darker marks, simplify it. Our The Ordinary Glycolic Acid 7% review explains who should be careful with frequent glycolic acid use.
Irritation and important safety warnings
Azelaic acid is often chosen when tolerability matters, but it can still irritate the skin. Burning, stinging, tingling, itching, dryness, scaling and redness are listed side effects. Mild tingling can happen early in treatment.[3, 4]
Stop using the product and seek medical advice for persistent or severe burning, facial or eye swelling, hives, breathing difficulty, blistering or a significant itchy rash.
Official labels also contain rare reports of lighter skin patches, called hypopigmentation. Azelaic acid has not been well studied in people with dark complexions, so watch for unexpected loss of color. This warning does not prove that it is broadly unsafe for deeper skin tones, but it should not be ignored.[3, 4]
Current 15% gel labeling also includes reports of worsening asthma. If you have asthma and notice it getting worse during use, stop and contact a clinician.[4]
If oily skin is also tight, flaky or persistently stingy, another exfoliating acid may make things worse. Stabilize the routine first. See our guide to oily but dehydrated skin.
Why sunscreen changes whether dark spots improve
Dark-spot treatment starts with sunscreen. Ultraviolet light and visible light can make pigmentation worse and slow fading.[11]
Use a broad-spectrum SPF 30 or higher every morning. For stubborn dark marks, especially in medium and deep skin tones, a tinted sunscreen with iron oxides can add protection from visible light. When outdoors, reapply about every two hours and after swimming or sweating, following the product directions.[11]
Beauty of Joseon Relief Sun is untinted according to its current official ingredient list. It may feel comfortable for many people, but comfort is personal and it does not contain an iron-oxide tint. Choose a sunscreen that fits your pigmentation needs and that you can apply generously.[20]
Simple azelaic acid routine examples
Keep the layers basic
Gentle cleanse or rinse, azelaic acid, moisturizer if needed, broad-spectrum sunscreen.
Protect the skin barrier
Gentle cleanser, azelaic acid, moisturizer. Sensitive skin may need once-daily or less frequent use at first.
Separate strong leave-ons
Try a salicylic cleanser, or use a 2% leave-on product on a different night while tolerance is unclear.
Use it less often
Keep glycolic acid on separate nights and reduce the frequency if dryness, burning or peeling appears.
These are conservative examples, not personal medical plans. Prescription directions take priority. A dermatologist can help with painful nodules, new scars, widespread acne, uncertainty about the diagnosis or acne that is not improving with correctly used treatment.[19]
Frequently asked questions
Does 10% azelaic acid work?
It can. One specially formulated 10% azelaic acid hydrogel improved acne in a clinical trial. That does not mean every 10% cosmetic serum or suspension will work the same way, especially for dark marks.[8]
How long does azelaic acid take to fade acne marks?
Acne may start improving within about four weeks. In small studies, some red and brown mark measurements changed after about 8 to 16 weeks. Complete fading often takes several months and deeper marks can take longer.[3, 5, 6, 11]
Is azelaic acid better for PIH or PIE?
The evidence is stronger for brown or gray post-inflammatory hyperpigmentation, called PIH. One newer study also found improvement in some red post-acne marks, called PIE, but that evidence is less established.[5, 13]
Can azelaic acid remove pitted or raised scars?
No. It may fade flat discoloration over a scar, but it cannot lift an indentation or remove raised scar tissue. Textural scars need scar-specific assessment and treatment.[18]
Can I use azelaic acid every day?
Many azelaic acid products are made for daily use, and some prescription labels direct twice-daily use. Sensitive skin may need a slower start. Follow the directions for your product or prescription.[3, 4]
Should azelaic acid be used in the morning or at night?
Either can work. Twice-daily prescription directions use morning and evening. For once-daily use, choose the time that fits your routine and causes the least irritation.
Can it be combined with salicylic acid or glycolic acid?
Yes, but using several strong leave-on products together can increase burning, dryness and peeling. Introduce them slowly, consider separate nights and reduce use if irritation develops.[9, 10]
Is tingling normal?
Brief mild tingling can happen. Stop using the product and seek medical advice for persistent burning, severe redness, swelling, hives, breathing difficulty, blistering or a significant itchy rash.[3, 4]
When should I see a dermatologist?
Seek professional care for painful nodules, new scars, severe or widespread acne, unexpected light patches, a major reaction, worsening asthma, uncertainty about the diagnosis or treatment that is not working despite correct use.
Sources
- 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. AAD guideline page. doi:10.1016/j.jaad.2023.12.017.
- Reynolds RV, Yeung H, Cheng CE, et al. Correction to Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2026;95(1):347. doi:10.1016/j.jaad.2026.04.009.
- U.S. Food and Drug Administration. Azelex (azelaic acid cream) 20% prescribing information. Revised February 2024. FDA label.
- DailyMed. Azelaic Acid Gel, 15% prescribing information. Revised May 2026. Current label.
- Shucheng H, Zhou X, Du D, et al. Effects of 15% Azelaic Acid Gel in the Management of Post-Inflammatory Erythema and Post-Inflammatory Hyperpigmentation in Acne Vulgaris. Dermatol Ther (Heidelb). 2024;14:1293-1314. Full text. DOI.
- Kircik LH. Efficacy and safety of azelaic acid gel 15% in the treatment of post-inflammatory hyperpigmentation and acne: a 16-week, baseline-controlled study. J Drugs Dermatol. 2011;10(6):586-590. PubMed.
- Sobhan M, Talebi-Ghane E, Poostiyan E. A comparative study of 20% azelaic acid cream versus 5% tranexamic acid solution for postinflammatory hyperpigmentation in acne vulgaris. J Res Med Sci. 2023;28:18. Full text. DOI.
- Tomic I, Miocic S, Pepic I, Simic D, Filipovic-Grcic J. Efficacy and Safety of Azelaic Acid Nanocrystal-Loaded In Situ Hydrogel in the Treatment of Acne Vulgaris. Pharmaceutics. 2021;13(4):567. PubMed. DOI.
- Kakita LS, Lowe NJ. Azelaic acid and glycolic acid combination therapy for facial hyperpigmentation in darker-skinned patients: a clinical comparison with hydroquinone. Clin Ther. 1998;20(5):960-970. PubMed.
- Abdel Hay R, Hegazy R, Abdel Hady M, Saleh N. Clinical and dermoscopic evaluation of combined salicylic acid 20% and azelaic acid 20% versus trichloroacetic acid 25% chemical peel in acne: an RCT. J Dermatolog Treat. 2019;30(6):572-577. PubMed. DOI.
- American Academy of Dermatology. How to fade dark spots in darker skin tones. Updated March 10, 2025. AAD guidance.
- U.S. Food and Drug Administration. Is It a Cosmetic, a Drug, or Both? FDA guidance. Accessed July 28, 2026.
- Feng X, Shang J, Gu Z, et al. Azelaic Acid: Mechanisms of Action and Clinical Applications. Clin Cosmet Investig Dermatol. 2024;17:2359-2371. Full text. DOI.
- Mastrofrancesco A, Ottaviani M, Aspite N, et al. Azelaic acid modulates the inflammatory response in normal human keratinocytes through PPAR-gamma activation. Exp Dermatol. 2010;19(9):813-820. PubMed. DOI.
- Bojar RA, Holland KT, Cunliffe WJ. The in-vitro antimicrobial effects of azelaic acid upon Propionibacterium acnes strain P37. J Antimicrob Chemother. 1991;28(6):843-853. PubMed.
- Mayer-da-Silva A, Gollnick H, Detmar M, et al. Effects of azelaic acid on sebaceous gland, sebum excretion rate and keratinization pattern in human skin. An in vivo and in vitro study. Acta Derm Venereol Suppl (Stockh). 1989;143:20-30. PubMed.
- Schallreuter KU, Wood JW. A possible mechanism of action for azelaic acid in the human epidermis. Arch Dermatol Res. 1990;282(3):168-171. PubMed. DOI.
- American Academy of Dermatology. Acne scars: treatment. AAD guidance. Accessed July 28, 2026.
- American Academy of Dermatology. Acne: overview and when to seek care. AAD guidance. Accessed July 28, 2026.
- Beauty of Joseon. Relief Sun: Rice + Probiotics SPF50+ PA++++ product page and ingredient list. Official product page. Accessed July 28, 2026.
Medical disclaimer: This article is for general education and does not replace diagnosis or treatment from a qualified clinician. Seek medical advice for painful or severe acne, scarring, unexpected pigment loss, a significant reaction, breathing symptoms or worsening asthma.
Stay curious, stay evidence-based.