Azelaic Acid vs Salicylic Acid

By Calum Torrington

20 September 2022

In today’s day and age, you would think that something that appears to be as simple as acne could be cured for good. However, like the common cold, it is an issue far more complicated than it appears.

The fact is that treatments for acne haven’t changed much in the last several decades!

What you pick up off the shelf at your local pharmacy nowadays will likely contain the same active ingredients as a product from 1990.

While not an issue that impacts one's health, acne-prone skin can certainly reduce a person’s well-being. Many report feeling embarrassed or having lower self-esteem due to the presence of acne.

Even though the condition is most associated with teens, many continue to struggle with acne later in life.

Treatments for acne are numerous, including antibiotics, combination birth control, and a variety of topical treatments. In cases of moderate to severe acne, the best course of action is to see a dermatologist find the best course of treatment.

In this post, we are going to cover two similar types of skin care ingredients: Azelaic acid and Salicylic acid. As it can be difficult to decide which treatment is the best choice, get ready for a deep dive!

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Similarities between Azelaic Acid and Salicylic Acid

While “acid” may sound like a scary word to use when talking about something to put on your face, both of these actives are a common treatment for acne.

Azelaic acid and salicylic acid are similar as both work on the epidermis- the layer of the skin we can see.

Both are antibacterial, anti-inflammatory, and keratolytic agents (they dissolve dead skin cells). Both are used in the treatment of mild-to-moderate inflammatory acne.

Either ingredient can be prescribed by your doctor at higher concentrations, but are also available over-the-counter at lower strengths in a variety of forms.

In both cases, it does take quite a long time for salicylic acid and azelaic acid to get to work- usually between two to three months.

Doctors will often prescribe these acids in combination with another form of treatment that is faster-acting.

What is Azelaic Acid?

Azelaic acid is a naturally occurring dicarboxylic acid found in grains such as rye, wheat, and barley, along with being produced from a fungus that lives on our skin.

Topical azelaic acid treats acne by inhabiting the pores and killing the bacteria within. It also decreases the production of a natural substance that can lead to acne, called keratin.

Along with mild to moderate acne, azelaic acid has also been used to treat rosacea and melasma, as well as for correcting uneven skin tone.

It tends to be milder than salicylic acid, and therefore more appropriate for individuals with sensitive skin types.

Azelaic acid is safe to use up to twice daily. It should be applied after washing the face with a mild cleanser and then patting dry.

Sunscreen should also be used as the acid will increase the chances of sunburn, and irritation to the skin is a common side effect that should be reported to a doctor.

What is Salicylic Acid?

Salicylic acid is a plant hormone (beta hydroxy acid, or BHA) derived from willow bark which works as a chemical exfoliant.

This ingredient helps the skin to shed dead skin cells which, in turn, unblocks pores.

Overall, it decreases redness and inflammation, reduces the number and appearance of pimples, and helps with the healing process.

Besides being a treatment for acne, salicylic acid is also used to control oil production, soothe skin, stop bacteria growth, and increase collagen growth to help with fine lines and wrinkles.

Salicylic acid can be harsh due to its exfoliating properties and can damage the skin, causing irritation. It can also make acne worse in certain situations, such as when it is used too frequently.

Azelaic Acid vs Salicylic Acid: which should you choose?

If you have sensitive skin, azelaic acid will likely be the better option.

If you are of the oily skin type, then salicylic acid may be the better option as it can decrease oil production.

For that same reason, it would be best to avoid salicylic acid if your skin is dry as it may further dehydrate your skin.

Either can help to even out skin tone and reduce redness, but if reduction of fine lines and wrinkles is a factor for you, then there is more evidence that salicylic acid is the better option.

Combining Azelaic Acid and Salicylic Acid

You are certainly able to use both ingredients together if you can’t decide between the two, and the combination has been shown to be an effective treatment for inflammatory acne.

However, caution should be exercised as both acids can be irritating to the skin (especially for people with sensitive skin), and your risk of irritation will increase if you choose to use both.

Ideally, you should start with the one active you think will be most effective, and see if you have any adverse reactions before trying the second.

How to use them together

Firstly, you do not want to apply both ingredients at the same time.

Salicylic acid serum is only meant to be used 1 to 3 times per week, while Azelaic acid can be used once to twice daily:

If you are using Azelaic acid once daily, then you can simply add the Salicylic acid treatments at a different time of day one to three times per week.
If you are on a twice-a-day schedule, simply replace your Azelaic acid treatment one to three times a week. For example, if you apply in the morning and at night, then Monday and Thursday nights you would skip the azelaic acid and use salicylic acid in its place.

Our Product Recommendations

If you have sensitive or dry skin and think azelaic acid is the right choice for you, The Ordinary Azelaic Acid Suspension is a creamy formula with a 10% Azelaic acid concentration.

You may have to visit your doctor for a higher concentration if you find over-the-counter products ineffective.

For those more prone to oily skin, a cleanser with a low percentage of salicylic acid like the Neutrogena Oil-Free Acne Fighting Face Wash is a great way to get started and see how your face responds.

Finally, if you prefer a spot treatment, FAB Pharma BHA Acne Spot Treatment Gel 2% Salicylic Acid has shown great results in reducing blemishes. Again, higher concentrations can be prescribed by your doctor if your acne is more moderate than mild!