Can You Use Azelaic Acid with Oral A-Retinoids for Acne Scars? - Dermatology

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When considering the combination of azelaic acid and oral retinoids (like isotretinoin, commonly referred to as A-Retinoids), it is essential to understand the properties and effects of both treatments.
1. Using Azelaic Acid with Oral A-Retinoids: Azelaic acid is a dicarboxylic acid that is often used to treat acne and rosacea. It has anti-inflammatory properties and can help reduce the appearance of post-inflammatory hyperpigmentation (the dark spots left after acne heals). When used in conjunction with oral retinoids, azelaic acid can be beneficial. Oral retinoids work by reducing sebum production, normalizing skin cell turnover, and preventing clogged pores, while azelaic acid can help with inflammation and pigmentation issues. Therefore, using azelaic acid (20%) while on oral isotretinoin (20mg) is generally considered safe and can enhance the overall treatment of acne scars and pigmentation. However, it is crucial to monitor your skin's response, as both treatments can be potent and may cause irritation when used together.
2. Dealing with Breakouts During A-Retinoid Treatment: It is not uncommon for patients on isotretinoin to experience initial breakouts, including comedonal acne and cystic lesions. This phenomenon is often referred to as the "purging" phase, where existing clogged pores are brought to the surface. If you are considering additional treatments like needle extraction (often referred to as "needle cleaning") and the use of glycolic acid or other chemical exfoliants (like mandelic acid), it is essential to proceed with caution. While these treatments can help in managing acne, they may also increase the risk of irritation and sensitivity, especially when combined with isotretinoin.
In general, it is advisable to consult with your dermatologist before adding any new treatments to your regimen. They can provide personalized advice based on your skin type, the severity of your acne, and how your skin has been responding to isotretinoin.
Additional Considerations:
- Skin Sensitivity: Both isotretinoin and azelaic acid can cause dryness and irritation. It is crucial to maintain a gentle skincare routine, using hydrating and soothing products to mitigate these effects.

- Sun Protection: Both treatments can increase your skin's sensitivity to the sun. Daily use of a broad-spectrum sunscreen is essential to protect your skin from UV damage and prevent further pigmentation issues.

- Monitoring Side Effects: Keep an eye on any adverse reactions, such as excessive dryness, peeling, or redness. If you experience significant irritation, it may be necessary to adjust the frequency of application or discontinue one of the treatments.

- Long-Term Management: Acne scars can take time to improve, and combining treatments can be effective. However, patience is key, and ongoing communication with your healthcare provider will help ensure the best outcomes.

In conclusion, using azelaic acid alongside oral A-retinoids can be a beneficial strategy for managing acne scars and pigmentation. However, it is essential to approach this combination thoughtfully and under the guidance of a qualified dermatologist to ensure the best results while minimizing potential side effects.