Azelaic Acid & Acne

Azelaic acid the hot new skin topical? But does it help?

Many of us who have struggled with acne have experienced trying various new products to our skin care regimen to see if it can make a difference.

Lately Azelaic acid has been touted as a product that might be helpful for acne (as well as other skin concerns!) But does it really work?

Acne and other inflammatory skin concerns (such as roseacea and peri oral dermatitis) have similar mechanism features in how they cause symptoms on the skin.

How does acne form at the level of the skin?

Skim Microbiome

Our skin has its own microbiome - that is microbes that live on its surface in harmony with our skin system. When the microbiome reflects “healthy” bacteria profile, the “good guys” out compete the “bad guys” or more harmful strains of bacteria, causing less symptoms. This is a similar concept in our digestive system (and other areas that have a microbiome, like our vaginas!).

We know specific bacteria strains cause skin lesions. P. acnes, is a type of bacteria is known to cause acne by infecting hair follicles (pores) on our face.

Supporting the skin microbiome, and using anti-microbial products can help control these strains of bacteria that contribute and cause acne or other skin concerns.

Skin Immune System

Our skin is tied to our immune system in a number of ways. Firstly, because our skin acts a barrier to the outside world, it has immune function and cells that work to protect us against these external threats.

An example would be against bacteria that is trying to infect our skin (like p.acnes causing acne in that hair follicle) or when our wounds are healing. 

Secondly, our skin relies on many different cells to promote wound healing when we have an injury or infection, and part of this immune response involves inflammation. Inflammation, when we have a wound or infection is necessary for the healing of the wound.

In later stages of p.acnes infections, inflammation is what drives the creation of “white head” pimples. Inflammation causes the bigger pimple to be sore, tender, and full of pus. 

We are starting to understand that inflammation before a hair follicle is infection also plays a role in the creation of acne. Increased p.acnes bacteria on the skin triggers various immune cells in our skin, which also may increase sebum, or oil production.

You can start to see how so many different contributors to acne overlap in influencing one another at the level of the skin!

Sebum (oil production)

When we have increased sebum production, our skin is oily or shiny. An excess of sebum combines with dead skin cells on the surface of our skin to block hair follicles. When the follicle is clogged, it causes a pimple and it can trap the p.acnes bacteria.

Sebum can be overproduced for a variety of reasons, including increased testosterone (which is part of the reason we see increased acne in some hormonal concerns like poly cystic ovarian syndrome, or in adolescent boys), and as previously discussed, due to the increased presence of inflammation.

Keratin

Keratin is a substance that helps protect our skin from damage, but is overproduced in the follicle cells of people with acne. When the keratin is not properly expelled from the hair follicle (during normal growth) with oil (sebum), it can cause a blockage of cells in the hair follicle leading to an acne lesion (and infection with p. acnes bacteria). 

How does azelaic acid work?

Why would a product like azelaic acid work for acne? Well it happens to have an anti-microbial, anti-keratinizing, and anti-inflammatory effects. In this way it touches on many of the different areas by which acne lesions take hold. We are seeing this reflected in research, with azelaic acid showing improvement in acne, but also other skin concerns like roaseacea and perioral dermatitis. 

In research they typically use a 20% dose, which can cause irritation in some people. Commercially products like this from the ordinary are an affordable option with less side effects.

What else can we do?

This certainly isn’t the only topical product that can support acne - and certainly not the only support we can add in!

Acne has a multitude of different drivers, beyond just these at the level of the skin. This includes endocrine (hormone) impacts, diet, lifestyle factors, and genetics!

Working with a naturopathic doctor can be a great support for your skin. Book today to get started!