Overview
What is it?
Topical antibiotics are antimicrobial agents used to reduce the bacteria *Cutibacterium acnes* (formerly *Propionibacterium acnes*) on the skin, which is a key contributor to acne. Azelaic acid is a naturally occurring dicarboxylic acid found in grains like wheat, rye, and barley. It has antioxidant, anti-inflammatory, and comedolytic (pore-clearing) properties, making it effective for treating acne .
How does it work?
Topical antibiotics work by killing or inhibiting the growth of *C. acnes* bacteria on the skin, reducing inflammation and preventing new acne lesions. Azelaic acid works by reducing inflammation, preventing the formation of comedones (clogged pores), and treating post-inflammatory hyperpigmentation (dark spots left after acne heals). Together, they target multiple causes of acne, including bacterial growth, inflammation, and clogged pores .
What are the benefits?
Topical antibiotics are effective against inflammatory acne, while azelaic acid is effective for both mild non-inflammatory and inflammatory acne, as well as post-inflammatory hyperpigmentation. Both treatments are considered safe during pregnancy and lactation, making them suitable for a wide range of patients . Azelaic acid is also well-tolerated and has minimal side effects, making it a good option for sensitive skin .
Effectiveness
What does the research say?
Research shows that azelaic acid is effective for treating acne, though it may be slightly less effective than benzoyl peroxide in some cases. It has been found to be comparable to tretinoin and clindamycin in reducing acne lesions. Topical antibiotics like clindamycin and erythromycin are effective for inflammatory acne, especially when combined with benzoyl peroxide to reduce the risk of antibiotic resistance .
Side Effects
Mild skin irritation
Mild skin irritation, such as itching or stinging, may occur with both topical antibiotics and azelaic acid, especially during the first few weeks of use .
Dryness or peeling
Dryness or peeling can occur, particularly with azelaic acid, as it exfoliates the skin and unclogs pores .
Redness or burning sensation
A redness or burning sensation may be experienced, especially if the skin is sensitive or if the product is applied too frequently .
Antibiotic resistance (with topical antibiotics)
Topical antibiotics like erythromycin and clindamycin can contribute to antibiotic resistance if used alone for long periods. Combining them with benzoyl peroxide can help reduce this risk .
Pseudomembranous colitis (rare, with clindamycin)
Pseudomembranous colitis, a rare but serious side effect, has been reported with clindamycin use. This is more common with oral antibiotics but can occur with topical use as well .
Evidence
Clinical Studies & Trials
[1] Guidelines of care for the management of acne vulgaris
This paper provides guidelines for managing acne vulgaris, a common skin condition affecting adolescents and adults.
View study[2] Management of Acne Vulgaris: A Review
This review discusses the global prevalence of acne vulgaris and its impact on quality of life, along with treatment options.
View study[3] Acne treatment review and future perspectives
This paper reviews current acne treatments, including topical and oral options, and discusses future advancements in acne therapy.
View study[4] Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha-hydroxy acid) for acne
This meta-analysis compares the effectiveness of azelaic acid with other acne treatments, such as benzoyl peroxide and tretinoin.
View study[5] The versatility of azelaic acid in dermatology
This review highlights the anti-inflammatory and antioxidant properties of azelaic acid and its efficacy in treating acne and other skin conditions.
View study[6] Treatment of Acne Vulgaris During Pregnancy and Lactation: A Narrative Review
This review discusses the safety and efficacy of topical antibiotics and azelaic acid for treating acne during pregnancy and lactation.
View study[7] Treatment of Acne in Pregnancy
This paper outlines safe and effective treatments for acne during pregnancy, including topical azelaic acid and antibiotics.
View study[8] Azelaic acid: Properties and mode of action
This review explores the mechanisms of action of azelaic acid, including its anti-inflammatory, antibacterial, and comedolytic effects.
View study