Usage
- Azelaic acid and salicylic acid are prescribed for the topical treatment of mild to moderate acne vulgaris and the inflammatory papules and pustules of mild to moderate rosacea. Azelaic acid can also be used to treat hyperpigmentation, such as melasma. Salicylic acid also has keratolytic activity, meaning it helps to break down the outer layer of skin which can help with skin conditions such as psoriasis and warts.
- Pharmacological Classification: Both are classified as keratolytic agents. Azelaic acid is a dicarboxylic acid, and salicylic acid is a beta-hydroxy acid (BHA).
- Mechanism of Action: Azelaic acid works through multiple mechanisms, including antibacterial, anti-inflammatory, and anti-keratinizing properties. It inhibits the growth of Propionibacterium acnes, a bacteria implicated in acne, and reduces inflammation. It also normalizes the process of keratinization, preventing clogged pores. Salicylic acid is a keratolytic agent, meaning it breaks down the bonds between skin cells. It helps to exfoliate dead skin cells and unclog pores, which can help to prevent and treat acne. It also has anti-inflammatory properties.
Alternate Names
- Azelaic Acid: Nonanedioic acid
- Salicylic Acid: 2-Hydroxybenzoic acid
- Brand Names: There are many brand names for products containing azelaic acid and salicylic acid, and their availability can vary by region. It is best to consult with a pharmacist or dermatologist for available brands in India.
How It Works
- Pharmacodynamics: Azelaic acid reduces inflammation and inhibits the growth of P. acnes bacteria, while also normalizing keratinization. Salicylic acid works by breaking down the bonds between skin cells and promoting exfoliation, it also has anti-inflammatory properties.
- Pharmacokinetics: Azelaic acid, when applied topically, is minimally absorbed into the systemic circulation. Salicylic acid also has low systemic absorption when applied topically.
- Mode of Action: Azelaic acid inhibits the thioredoxin reductase enzyme in the mitochondria of keratinocytes and melanocytes, and it also has antimicrobial effects and inhibits neutrophil and mast cell activity. Salicylic acid keratolytic activity is the result of the breakdown of hydrogen bonds between corneocytes and intercellular lipids.
- Elimination Pathways: Most azelaic acid is eliminated from the body unchanged in the urine. Salicylic acid is metabolized by the liver and eliminated in the urine.
Dosage
Standard Dosage
Adults:
- Azelaic Acid: Apply a thin layer of 15% gel or foam, or 20% cream to the affected area twice daily.
- Salicylic Acid: Concentrations in over-the-counter products typically range from 0.5% to 2%. Follow product instructions.
Children:
- Azelaic Acid: For children 12 years and older, the dosage is the same as for adults. For children under 12 years, consult a doctor.
- Salicylic Acid: Consult a doctor for pediatric dosing.
Special Cases:
- Elderly Patients: No specific dosage adjustments are typically needed.
- Patients with Renal Impairment: No specific dosage adjustments are typically needed.
- Patients with Hepatic Dysfunction: No specific dosage adjustments are typically needed.
- Patients with Comorbid Conditions: No specific adjustments outside of standard medical practices.
Clinical Use Cases
Azelaic acid and salicylic acid are primarily intended for topical use and not indicated for clinical cases such as intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Dosage adjustments might be needed in case of skin irritation where the frequency of application might be decreased or stopped.
Side Effects
Common Side Effects:
- Dryness, itching, burning, or stinging at the application site.
- Redness or irritation of the skin.
- Changes in skin color (hypopigmentation).
Rare but Serious Side Effects:
- Allergic reactions (skin rash, itching, hives, swelling).
- Worsening of asthma (for azelaic acid).
Long-Term Effects:
- Long-term use is generally safe, but some patients may experience persistent dryness or irritation.
Adverse Drug Reactions (ADR):
- Severe skin irritation or allergic reaction.
Contraindications
- Hypersensitivity to azelaic acid or salicylic acid.
Drug Interactions
- No significant drug interactions have been documented for topical azelaic acid or salicylic acid. However, avoid using with other topical acne medications, especially retinoids, unless directed by a physician, as this can increase the risk of irritation.
Pregnancy and Breastfeeding
- Azelaic Acid: Generally considered safe for use during pregnancy and breastfeeding.
- Salicylic Acid: Topical application is generally considered safe during pregnancy and breastfeeding due to limited systemic absorption. However, avoid high concentrations or prolonged use.
Drug Profile Summary
- Mechanism of Action: See above.
- Side Effects: See above.
- Contraindications: See above.
- Drug Interactions: See above.
- Pregnancy & Breastfeeding: See above.
- Dosage: See above.
- Monitoring Parameters: Monitor for skin irritation and allergic reactions.
Popular Combinations
Combination therapy is not recommended for azelaic and salicylic acid as it does not have additional clinical benefits and may increase the risk of irritation.
Precautions
- General Precautions: Perform a patch test before applying to a large area. Avoid contact with eyes and mucous membranes.
- Specific Populations: See “Pregnancy and Breastfeeding”.
- Lifestyle Considerations: No specific lifestyle considerations.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Azelaic Acid + Salicylic Acid?
A: These are typically not combined in one product. Refer to the dosage section above for guidance on individual products containing these ingredients.
Q2: Can azelaic acid and salicylic acid be used together?
A: While it’s possible to use both, it’s generally recommended to alternate application or use them in separate skincare routines (morning and evening) to avoid potential irritation.
Q3: What skin conditions can azelaic acid and salicylic acid treat?
A: Azelaic acid is effective for acne, rosacea, and hyperpigmentation. Salicylic acid is primarily used for acne.
Q4: Are there any side effects associated with using these acids?
A: Common side effects include dryness, itching, burning, redness, and irritation at the application site. Rarely, allergic reactions can occur.
Q5: Are azelaic acid and salicylic acid safe to use during pregnancy?
A: Topical application of both azelaic acid and salicylic acid are generally considered safe during pregnancy, although it’s always best to consult with a doctor.
Q6: How long does it take to see results when using these acids?
A: It can take several weeks to months of consistent use to see noticeable improvement.
Q7: Can I use makeup while using these acids?
A: Yes, you can generally apply makeup after the medication has dried.
Q8: What should I do if I experience skin irritation?
A: Reduce the frequency of application or discontinue use temporarily. Consult a doctor if irritation persists or is severe.
Q9: What are the differences between azelaic acid and salicylic acid?
A: Azelaic acid has anti-inflammatory, antibacterial, and anti-keratinizing properties and is effective for acne, rosacea, and hyperpigmentation. Salicylic acid primarily works as a keratolytic agent, exfoliating dead skin cells and unclogging pores to treat acne.
