A systematic review to evaluate the efficacy of azelaic acid in the management of acne, rosacea, melasma and skin aging

King, Sarah; Campbell, J R; Rowe, Renarta; Daly, Marie-Louise; Moncrieff, George; Maybury, Catriona

doi:10.1111/jocd.15923

Cited by 9 publications

(3 citation statements)

References 42 publications

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“…Also, it inhibits KLK5 and cathelicidin, and increases serine protease activity [114,115]. A recent meta-analysis demonstrated that erythema intensity and inflammatory lesion counts significantly improved in rosacea patients treated with AA compared with a vehicle after 12 weeks [116]. Moreover, a randomized trial showed that the use of 15% azelaic acid gel twice daily for 15 weeks has higher efficacy compared to 0.75% metronidazole gel, particularly regarding the inflammatory features of rosacea [117].…”

Section: Papulopustular Rosaceamentioning

confidence: 99%

Advances in the Pathogenesis and Treatment of Rosacea: A Phenotype-Based Therapeutic Approach

Galluccio,

D’Onghia,

Malvaso

et al. 2024

Cosmetics

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Rosacea is a common chronic inflammatory skin disorder that mainly affects the central face. It is primarily characterized by recurrent episodes of flushing, persistent erythema, inflammatory papules, telangiectasias, phymatous changes, and ocular symptoms. Its pathogenesis is complex and still not completely understood. It encompasses innate and adaptive immune system dysregulation, neurovascular dysfunction, and genetic and environmental factors. To date, four subtypes of rosacea have been identified, based on the predominant clinical features: erythemato-teleangiectatic, papulopustular, pyhomatous, and ocular rosacea. New insights into this condition have led to several pharmacological treatments, including topical medications, spanning from the conventional azelaic acid, metronidazole, benzoyl peroxide, clindamycin, and erythromycin to new ones including not only brimonidine, oxymetazoline, ivermectine, and minocycline but also systemic drugs such as oral antibiotics, isotretinoin, non-selective β-blockers or α2-adrenergic agonists, and laser- or light-based therapies, together with new therapeutic approaches. The aim of this study was to review the current literature on the pathophysiology of rosacea and to provide an overview of therapeutic approaches that specifically address each clinical subtype.

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Section: Papulopustular Rosaceamentioning

confidence: 99%

Advances in the Pathogenesis and Treatment of Rosacea: A Phenotype-Based Therapeutic Approach

Galluccio,

D’Onghia,

Malvaso

et al. 2024

Cosmetics

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“…Its anti-inflammatory properties stem from the inhibition of cytokines and induction of peroxisome proliferator-activated receptor γ (PPAR γ) [ 26 ]. It is not known to confer antibiotic resistance, but common side effects reported are itching and burning [ 27 ].…”

Section: Reviewmentioning

confidence: 99%

Updates on Topical Dyad and Triple Combination Therapies Approved for Acne Vulgaris

Podwojniak,

Tan,

Sauer

et al. 2024

Cureus

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Acne vulgaris is a multifaceted disease characterized by inflammatory and noninflammatory lesions. Topical combination therapies offer a multifaceted approach to acne treatment, with synergistic effects and a broad spectrum of action against multiple factors in acne pathogenesis in one single formulation. Clindamycin phosphate/benzoyl peroxide/adapalene, a combination therapy consisting of clindamycin phosphate 1.2%, benzoyl peroxide (BPO) 3.1%, and adapalene 0.15%, is a novel treatment, the only FDA-approved triple combination drug that offers effective treatment of acne vulgaris. This review aims to provide information on clindamycin phosphate/benzoyl peroxide/adapalene and review the literature on combination topical acne medications approved in the United States. This search was conducted on topical combination therapies for acne, their efficacy, adverse effects, and impacts on quality of life with a specific focus on the newly approved clindamycin phosphate/benzoyl peroxide/adapalene and its sub-component dyads, along with other combinations. PubMed, SCOPUS, Embase, Cochrane, and Web of Science databases were searched for publications in 2018-2023. Primary sources were given priority, and secondary sources such as other reviews were considered to supplement any missing information. It was found that various topical dyad and triad combinations exist for acne vulgaris, including adapalene/BPO, tazarotene/clindamycin, clindamycin/BPO, adapalene/clindamycin, topical tretinoin/azelaic acid, topical tretinoin/BPO, and clindamycin phosphate/benzoyl peroxide/adapalene. Dyad and triple combinations represent a promising, convenient solution for acne management, potentially improving patient adherence due to its single formulation. Clindamycin phosphate/benzoyl peroxide/adapalene exhibited significantly high efficacy in treating both inflammatory and noninflammatory lesions, a minimal side effect profile, although no significant changes in quality-of-life measures. Further research is indicated to assess its long-term efficacy and impact on other acne metrics such as cost, scarring, psychosocial implications, and impact on diverse patient populations.

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“…Azelaic acid, another key agent in melasma management, is valued for its ability to target melanin synthesis effectively. The objective of this study is to compare the efficacy of topical 5% tranexamic acid versus 20% azelaic acid in patients with melasma, aiming to provide valuable insights into the comparative effectiveness of these treatments (15,16). This comparison is crucial for advancing the understanding of treatment options for melasma, guiding clinicians in optimizing therapeutic strategies for this challenging and multifaceted skin condition.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Efficacy of 5% Tranexamic Acid vs 20% Azelaic Acid in Patients of Melasma

Mushtaq,

Marwat,

Saleem

et al. 2024

JHRR

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Background: Melasma is a significant cosmetic concern globally, affecting individuals across various ethnic backgrounds, particularly in South Asian populations. The condition's etiology is complex, involving genetic, hormonal, and environmental factors such as sun exposure. Despite numerous treatment options, melasma remains challenging to manage effectively. Recent studies have explored the efficacy of tranexamic acid and azelaic acid, both of which target the melanin synthesis pathway but through different mechanisms. Objective: The aim of this study was to compare the effectiveness of topical 5% tranexamic acid versus 20% azelaic acid in the treatment of melasma, with a focus on changes in the Melasma Area and Severity Index (MASI) scores. Methods: This prospective comparative study was conducted at the Dermatology department of PIMS Hospital, Pakistan, over six months from August 2023 to January 2024. A total of 200 patients with melasma were enrolled and randomly assigned to two groups: Group A received 5% tranexamic acid cream, and Group B received 20% azelaic acid cream, both applied twice daily. Inclusion criteria included men and women aged 18 to 50 years with a diagnosis of melasma for at least six months. Pregnant women, patients with a history of Systemic Lupus Erythematosus (SLE) or Discoid Lupus Erythematosus (DLE), and those on hormonal therapy were excluded. The primary outcome measure was the change in MASI scores from baseline to the end of the study period. Data were analyzed using SPSS Version 25. Results: The study found significant differences in treatment efficacy between the two groups. Group A (tranexamic acid) showed a reduction in MASI scores from 7.94 ± 1.88 at baseline to 5.50 ± 1.61 post-treatment. Group B (azelaic acid) demonstrated a decrease from 8.21 ± 1.96 to 5.89 ± 1.49. The proportion of patients experiencing excellent response was higher in Group A (36.0%) compared to Group B (19.0%), with a statistically significant difference in overall treatment efficacy (P<0.0001). Conclusion: Topical 5% tranexamic acid was more effective than 20% azelaic acid in improving MASI scores in patients with melasma. This study supports the inclusion of tranexamic acid as a preferable treatment option for melasma, offering a promising alternative for those not responding to conventional therapies.

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A systematic review to evaluate the efficacy of azelaic acid in the management of acne, rosacea, melasma and skin aging

Cited by 9 publications

References 42 publications

Advances in the Pathogenesis and Treatment of Rosacea: A Phenotype-Based Therapeutic Approach

Advances in the Pathogenesis and Treatment of Rosacea: A Phenotype-Based Therapeutic Approach

Updates on Topical Dyad and Triple Combination Therapies Approved for Acne Vulgaris

Comparison of Efficacy of 5% Tranexamic Acid vs 20% Azelaic Acid in Patients of Melasma

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