Topical azelaic acid

When topical azelaic acid applications are used, the face should be gently cleansed and then the topical application applied to the dried skin. As a general guide, one finger tip unit (FTU) per two palms worth of area affected is a good guideline, but it is advisable to follow manufacturer’s recommendations as different brands will vary slightly. For example Finacea recommends 1 FTU for the face and Skinoren 2 FTU. (Further details about specific products can be found from the Electronic Medicines Compendium – www.emc.medicines.org.uk). The treatment should be applied twice daily and gently massaged into the face. After use the individual should be instructed to wash their hands. The patient should expect to see significant improvement in 4–8 weeks, although it can be used over a prolonged period of many months if necessary.

The most common side effect is skin soreness and irritation and this can be minimised by reducing the amount of treatment used each day (to just once daily), before gradually building up to the recommended dosages. Because the products are irritating, care should be taken to avoid contact with the eyes and other mucous membranes. Should contact occur the areas should be washed with large amounts of water. There is little evidence for any ill effects that would mean the products needed to be stopped during pregnancy or breast feeding; however, this should be discussed for each individual case.