What Does Azelaic Acid Do for Mature Skin?

I originally started using azelaic acid for two pretty simple reasons: glowing skin and breakouts.

I kept seeing people using azelaic acid whose skin looked incredibly clear, bright and glowy. They were talking about smoother texture and more even-looking skin while, at the same time, using it to help manage breakouts.

As a woman over 60, that combination immediately got my attention.

I love anything that can wake up my skin and give it that smooth, polished, radiant appearance. And yes, I still get breakouts at 63.

Acne has actually been a lifelong issue for me. It can be daily or weekly—from small, raised bumps to those deeper, sometimes painful ones under the skin. I've been managing this for as long as I can remember.

Tretinoin has helped me tremendously. One of the ways retinoids treat acne vulgaris—the medical term for common acne—is by helping normalize the way skin cells shed inside the follicle, which helps prevent the plugging that can lead to clogged pores and inflammatory acne.

So when I kept seeing azelaic acid associated with clearer, brighter-looking skin AND breakout control, I thought: this might be an ingredient that makes sense for me.

I started with The Ordinary's 10% Azelaic Acid Suspension and tolerated it well. More recently, I decided to move up to prescription-strength Finacea 15% gel. But before I did, I wanted to understand this ingredient better.

1. Was azelaic acid really responsible for that brighter, smoother, more polished appearance I'd been seeing?

2. Could it help control the breakouts I'm still prone to?

3. And if it does make skin look brighter and smoother—why?

4. That last question became particularly interesting.

5. Because sometimes in skincare, the result everyone talks about isn't necessarily the actual job the ingredient is doing.

   
   

We say an ingredient makes skin “glow.” But perhaps the skin looks brighter because there's less inflammation, less congestion and more even pigmentation.

We say something “smooths” the skin. But perhaps it's improving some of the things that were making the surface look irregular in the first place.

The visible result can be real. I just want to understand what's creating it.

And that's when I really went down the azelaic acid rabbit hole.

Because once I started researching, my list of questions got longer.

1. Could it improve uneven pigmentation and overall clarity?

2. What about the mottling across my chest? The brown spots on my hands and arms? The keratosis pilaris I get on my body?

3. And because I've struggled with milia, I was especially curious about that one.

Does azelaic acid actually work on mature skin?

And perhaps more importantly: What can it realistically do for it?

The answer isn't simply yes or no. It's much more interesting than that.

First: What Exactly Is Azelaic Acid?

Despite the word acid, azelaic acid isn't simply another exfoliating acid like glycolic or lactic acid.

It's a naturally occurring dicarboxylic acid with several different actions in the skin. Research describes azelaic acid as having anti-inflammatory, antioxidant and anti-keratinizing properties, among others.

That's a surprisingly broad résumé for one ingredient. And it helps explain why azelaic acid has been studied for seemingly unrelated concerns including acne, papulopustular rosacea and melasma.

A 2023 systematic review looked at 43 randomized controlled trials involving azelaic acid. The researchers found evidence supporting its effectiveness for rosacea, acne and melasma.

Importantly for this series, however, the researchers found no eligible randomized controlled trials evaluating azelaic acid specifically for skin aging.

That's an important distinction.

Azelaic acid isn't a proven anti-aging powerhouse in the way we might think about a retinoid.

But that doesn't mean it can't make mature skin look better.

Research: King S, Campbell J, Rowe R, et al. A systematic review to evaluate the efficacy of azelaic acid in the management of acne, rosacea, melasma and skin aging. Journal of Cosmetic Dermatology. 2023;22(10):2650–2662. PMID: 37550898.

JOB #1: My Breakouts

This is one of the main reasons I've moved from an over-the-counter 10% azelaic acid product to prescription Finacea 15%.

And this is also one of the areas where the evidence is strongest.

Finacea 15% gel is FDA-approved for the inflammatory papules and pustules of mild-to-moderate rosacea. In simpler terms, we're talking about small, inflamed, acne-like bumps—some with a visible center.

But azelaic acid has also been studied extensively for acne vulgaris, which is particularly relevant to me because acne has been a lifelong issue.

A large systematic review of randomized controlled trials found that azelaic acid improved acne compared with vehicle, including reductions in acne severity. Research has also demonstrated that azelaic acid can modify abnormal keratinization within acne-prone follicles.

That last part caught my attention.

I'm already using tretinoin, which is an important part of keeping my acne under control. So I'm not looking at azelaic acid as a replacement for tretinoin.

I'm asking:

Could azelaic acid complement what my tretinoin is already doing and give me another way to help control the inflamed bumps, clogged follicles and breakouts I'm still prone to?

For me, this isn't simply an experiment to see whether Finacea makes my mature skin look prettier.

Acne control is one of the primary jobs I'm hiring it to do.

And if clearer skin contributes to that brighter, smoother, more even-looking complexion I was originally after?

I'll happily take that too.

Research: King S, et al. Journal of Cosmetic Dermatology. 2023. PMID: 37550898.

Research: 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. 1989. PMID: 2475995.

JOB #2: The Marks Breakouts Leave Behind

This one has some particularly interesting evidence behind it.

A 2024 randomized, double-blind, placebo-controlled trial evaluated 15% azelaic acid gel twice daily for 12 weeks in people with mild-to-moderate acne.

Researchers weren't only looking at the acne.

They also evaluated post-inflammatory erythema—the red marks that can remain after inflammation—and post-inflammatory hyperpigmentation, or PIH, the darker discoloration that can linger after a breakout.

The study found improvements in acne-induced post-inflammatory erythema and hyperpigmentation measures with 15% azelaic acid gel.

In other words, azelaic acid potentially gives me a nice two-for-one:

Help address the acne AND help address some of the discoloration that inflammation can leave behind.

And here's where that “glow” people talk about starts to make more sense.

If I have fewer inflamed bumps and fewer lingering red or brown marks after those bumps heal, my complexion may naturally look clearer and more even.

That's something I care about even more now because an even, clear-looking complexion is a big part of what makes skin look healthy and radiant to me.

Research: 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. Dermatology and Therapy. 2024;14(5):1293–1314. PMID: 38734843.

JOB #3: Pigmentation and Uneven Skin Tone

This may be where azelaic acid becomes particularly interesting for mature skin—even though we shouldn't necessarily call it an anti-aging ingredient.

Pigment changes can become increasingly visible on chronically sun-exposed skin.

And azelaic acid has effects on abnormal pigment production and has been studied clinically for melasma, a condition that causes patches of hyperpigmentation.

A 2023 systematic review and meta-analysis included six randomized controlled trials involving 673 people comparing azelaic acid with hydroquinone for melasma.

Azelaic acid performed well. It produced a statistically greater improvement in one commonly used melasma severity measure, although there weren't significant differences in some other pigmentation outcomes, and the researchers concluded that larger studies with longer follow-up are needed.

So there's legitimate evidence that azelaic acid can influence certain kinds of excess pigmentation.

But here's where this investigation took a turn I wasn't expecting.

What About My Brown Sun Spots?

One of the reasons I became interested in using azelaic acid beyond my face is that I have brown spots on my arms and hands.

If azelaic acid helps pigmentation, it seems reasonable to think: Why wouldn't I put it on those?

Unfortunately, pigmentation isn't one single condition.

Those individual, flat brown spots that tend to accumulate on chronically sun-exposed areas such as the face, hands, arms and chest are often called solar lentigines.

You probably know them by their more familiar names: sun spots, age spots or liver spots—although they have nothing to do with the liver.

They develop largely as a result of cumulative ultraviolet exposure over time, which is why they're so common on skin that has received decades of sun exposure.

And here's where my azelaic acid investigation delivered some disappointing news.

I found a study that specifically tested a 20% azelaic acid formulation on solar lentigines.

It wasn't effective.

Interestingly, that study found that fainter, mottled pigmentation detected under ultraviolet examination responded better to topical treatments than the established solar lentigines did.

That's an important distinction because it's very easy to hear: “Azelaic acid helps hyperpigmentation.” And translate that into: “Azelaic acid will fade my brown sun spots.”

Those aren't necessarily the same thing.

Azelaic acid has much better evidence for certain pigment disorders, including melasma and post-inflammatory hyperpigmentation, than it does for established solar lentigines.

MY VERDICT ON BROWN SPOTS:

DON'T COUNT ON IT.

I'm lowering my expectations here.

I wouldn't add azelaic acid specifically because I wanted to erase established sun spots on my hands and arms.

That's simply not where the evidence is strongest.

Research: Hermanns JF, Petit L, Piérard-Franchimont C, et al. Assessment of topical hypopigmenting agents on solar lentigines of Asian women. Dermatology. 2002;204(4):281–286. PMID: 12077522.

But What About the Mottling Across My Chest?

This one is less straightforward—and it's one I'm particularly interested in.

My chest isn't just dotted with individual brown spots. I have more diffuse mottling and uneven pigmentation from years of sun exposure.

That's why I'm not ready to completely dismiss azelaic acid here.

Remember that solar-lentigines study?

The fainter, mottled pigmentation detected under ultraviolet examination responded better to the topical treatments than the established solar lentigines did.

That absolutely does not prove that Finacea will improve the mottling on my chest.

“Mottling” is a description, not a diagnosis, and different pigment changes can have very different causes.

But because azelaic acid has legitimate evidence for some forms of hyperpigmentation, this is an area I'm interested in watching on my own skin.

So for now I'm putting this one in the:

POSSIBLY — BUT I'M TESTING IT

category.

And an important reminder: new, changing, irregular or otherwise concerning pigmented lesions need proper medical evaluation rather than simply being treated cosmetically.

But Wait—Why Does Everyone Say Azelaic Acid Makes Their Skin GLOW?

Now we're back to one of the things that made me want to try azelaic acid in the first place.

Search through people's experiences with azelaic acid and you'll repeatedly encounter some version of: “My skin just looks better.”

Brighter.

Clearer.

Smoother.

More even.

Glowy.

And after looking at the research, I think this is where an important distinction needs to be made.

Glow isn't a clinical endpoint.

I haven't found a randomized trial measuring whether people look more radiant after using Finacea.

But that doesn't necessarily mean the visible result people are describing isn't real.

Look at the individual things azelaic acid can potentially influence.

It can help inflammatory lesions.

It can improve redness associated with certain inflammatory conditions.

It has evidence for post-inflammatory red and brown marks.

It can improve certain forms of hyperpigmentation.

And it can influence abnormal keratinization.

So imagine skin with: less congestion + less visible inflammation + more even pigmentation + fewer post-breakout marks. That skin may very reasonably look clearer, brighter, smoother and more radiant. You look in the mirror and think: “Azelaic acid is giving me a glow.”

And you may not be wrong.

The “glow” just isn't necessarily the direct job azelaic acid is doing.

It's the visible payoff of several other things it may be doing underneath.

The same may be true for some of the smoother-looking texture people describe.

I don't think the evidence supports saying azelaic acid is resurfacing mature skin or remodeling it in the way we might talk about other ingredients.

But if you're reducing bumps, congestion, inflammation and uneven pigmentation, the skin's surface may simply appear smoother and more polished because you've improved some of the things that were making it look irregular.

That's a distinction I want to make throughout this series.

The visible result can be real. I just want to understand what's creating it.

JOB #4: Texture and Clogged Follicles

And this brings us to another interesting piece of the azelaic acid puzzle.

Azelaic acid isn't simply calming inflammation.

Research suggests that it also affects keratinization—the process through which skin cells mature and shed.

An in-vivo and in-vitro study of 47 people found that 20% azelaic acid significantly improved acne lesions and modified epidermal keratinization. Within the acne-prone follicle, researchers observed changes including a reduction in the thickness of the horny layer and normalization of filaggrin distribution.

The researchers described azelaic acid as an anti-keratinizing agent.

That's particularly interesting to someone like me who has always been prone to those clogged, under-the-skin bumps.

But I wouldn't describe azelaic acid as simply another exfoliating acid.

It isn't doing exactly the same job as the glycolic acid I might use to exfoliate my skin.

And that's important because I'm already using other actives.

I don't need five ingredients doing exactly the same thing.

Research: Mayer-da-Silva A, et al. PMID: 2475995.

Could Azelaic Acid Help Milia?

I REALLY wanted an answer to this one.

Unfortunately, I haven't found good clinical evidence demonstrating that topical azelaic acid treats or prevents ordinary milia.

And that's important because it would be very easy to build a plausible-sounding argument:

Milia contain keratin.

Azelaic acid affects keratinization.

Therefore azelaic acid treats milia.

That's not evidence.

Its anti-keratinizing action makes the question biologically interesting, but until we have clinical evidence demonstrating a benefit for milia, I'm putting this in the:

INTERESTING THEORY — NOT PROVEN

category.

I'm going to pay attention to my own skin, but I wouldn't recommend azelaic acid to someone specifically as a proven milia treatment based on the evidence I've found.

What About Keratosis Pilaris?

This one surprised me.

Keratosis pilaris—or KP—involves keratin plugging the openings of hair follicles, creating those familiar little rough bumps that commonly appear on areas like the upper arms and thighs.

So once again, azelaic acid's effects on keratinization make it interesting.

And unlike milia, I did find keratosis pilaris discussed in a peer-reviewed review of azelaic acid's dermatological uses.

But there's an important caveat.

The authors characterized the evidence supporting azelaic acid for KP as weaker than the evidence supporting its better-established uses.

So I wouldn't replace better-established KP approaches based on this evidence.

But because I already have azelaic acid and I have KP on my body?

I'm intrigued enough to experiment and document what happens.

MY KP VERDICT:

POSSIBLE — BUT THE EVIDENCE IS WEAK.

That's very different from saying “azelaic acid treats KP.”

Research: Sieber MA, Hegel JKE. The versatility of azelaic acid in dermatology. 2020. PMID: 32730109.

So Is Azelaic Acid an Anti-Aging Ingredient?

Here's where I landed after doing all this research.

Not in the way I normally use that term.

When I'm talking about something like tretinoin, I'm interested in evidence involving collagen, wrinkles, photoaging and structural changes in skin.

That's not where the strongest evidence for azelaic acid lies.

In fact, the large 2023 systematic review I mentioned earlier specifically looked for randomized controlled trials examining azelaic acid and skin aging and found none that met its criteria.

But here's the fascinating part:

A skincare ingredient doesn't necessarily have to reverse a structural mechanism of aging to make mature skin look significantly better.

If my skin becomes:

clearer + calmer + more evenly pigmented + smoother-looking

I'm probably going to think it looks healthier, fresher and more radiant.

And that's really what attracted me to azelaic acid in the first place.

I wanted skin that looked awake.

Clear.

Smooth.

Polished.

Glowy.

The research has simply given me a much better understanding of why azelaic acid might help create that appearance.

That's why azelaic acid might ultimately earn a place in my mature-skin routine—but for very specific jobs.

So…does azelaic acid actually work on mature skin?

YES — BUT . . .

Not because mature skin requires azelaic acid.

And not because I've found compelling evidence that azelaic acid reverses wrinkles, sagging or collagen loss.

It works because some of the things azelaic acid is genuinely good at treating can still matter tremendously to how mature skin looks.

Here's where I've landed:

• My inflammatory breakouts and acne-prone skin — YES.

• Post-breakout redness and pigmentation — YES.

• Certain kinds of uneven pigmentation — YES, with important qualifications.

• Overall clarity/evenness and that possible “glow” — YES, PLAUSIBLY—but likely because of the individual improvements happening in the skin rather than “glow” being an action of azelaic acid itself.

• Established brown sun spots/solar lentigines — DON'T COUNT ON IT.

• Chest mottling — POSSIBLY, depending on what's causing it. I'm testing this one.

• Keratosis pilaris — POSSIBLE, but the evidence is weak.

• Milia — THEORETICALLY INTERESTING, but not clinically proven.

• Wrinkles, collagen loss and sagging — NOT THE JOB I'M HIRING IT TO DO.

And perhaps that's the biggest takeaway from my first Does It Actually Work on Mature Skin? investigation.

It's easy to hear that an ingredient “brightens,” “fights aging,” “improves texture” or “treats pigmentation.”

Those descriptions can be so broad they're almost meaningless.

I want to know what job I'm actually hiring an ingredient to do.

With azelaic acid, I'm starting with a very specific job.

I'm acne-prone, and I always have been. Tretinoin has become an important part of keeping that under control, particularly because I know what happens when I'm not diligent: I can still develop clogged follicles and those deeper bumps underneath my skin.

So my first question with Finacea is whether adding azelaic acid helps me maintain clearer skin—with fewer inflamed bumps and breakouts.

Then come the potential bonuses I'm especially interested in at this stage of life:

• Could it make my complexion more even?

• Could it help prevent the red and brown marks that sometimes follow inflammation?

• Could my skin look brighter, smoother and clearer overall?

• Could it help any of the diffuse mottling on my chest?

• Could I see any improvement in my KP?

• And yes, I'm keeping an eye on those pesky milia too—even though the evidence tells me not to expect much there.

The research can tell me what should happen.

But I also have my own experience to go on.

I've enjoyed the results I've seen while using The Ordinary's 10% Azelaic Acid Suspension. My skin does appear brighter, smoother and clearer to me—and that's my personal observation, not a clinical measurement.

It's also been incredibly easy to add azelaic acid into my existing routine, which matters to me. I don't want a complicated routine filled with products I won't use consistently.

So I'm not starting Finacea 15% wondering whether I like azelaic acid. I already do.

Now I'm curious whether moving to the prescription strength will give me even more improvement—particularly with my breakouts, overall clarity, uneven pigmentation and that smooth, polished appearance I was hoping for when I started using azelaic acid in the first place.

That's my experience with it so far, and because it's simple and it's working on the breakouts and more refined-looking skin (which makes my skin appear 'glowy') I'm keeping it as a part of my mature skincare routine.

Research Referenced

King S, Campbell J, Rowe R, et al. A systematic review to evaluate the efficacy of azelaic acid in the management of acne, rosacea, melasma and skin aging. Journal of Cosmetic Dermatology. 2023;22(10):2650–2662. PMID: 37550898.

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. Dermatology and Therapy. 2024;14(5):1293–1314. PMID: 38734843.

Albzea W, et al. Azelaic Acid Versus Hydroquinone for Managing Patients With Melasma: Systematic Review and Meta-Analysis of Randomized Controlled Trials. 2023. PMID: 37457606.

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. 1989. PMID: 2475995.

Hermanns JF, Petit L, Piérard-Franchimont C, et al. Assessment of topical hypopigmenting agents on solar lentigines of Asian women. Dermatology. 2002;204(4):281–286. PMID: 12077522.

Sieber MA, Hegel JKE. The versatility of azelaic acid in dermatology. 2020. PMID: 32730109.

This blog post shares my personal experience and my layperson's interpretation of published research for general informational and educational purposes. My experience is individual and your experience may be different. This content is not medical advice. Prescription products, including Finacea and tretinoin, should be used with professional guidance and according to the instructions provided by your healthcare professional.