The Ordinary's Azelaic Acid Suspension 10% for cystic acne, plus my skincare routine

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For some reason, after I moved to California back in December, I started to experience more breakouts than I'd had in a long time. They were worst on my chin, but also happened on my nose, cheeks, and forehead. I had a combination of inflammatory acne (the scabby, infected pores on the surface) and cystic acne (those deep, swollen, underground pimples)--the latter concentrated on my chin and upper lip. I don't know what caused my skin to react this way. Something hormonal? Climate? Different water? Since I couldn't prevent it, I decided to treat it.

I bought this tube of The Ordinary's Azelaic Acid (for some reason I spell azelaic wrong in a different way every single time) back in July when I made a small order from Well.ca and had it shipped to my sister in Canada. I mainly chose products based on what had the best reviews, because I was curious about the brand. In addition to this stuff, I ended up with their Caffeine Solution (reviewed here and passed on to a friend), Buffet (which I've finished and will review soon), and the Matrixyl + HA (which I'm currently using).

(I know there has been drama and bad publicity about Deciem, the parent company of The Ordinary, lately. I don't really know what to think of it, and since I bought this months before any of that happened, it wasn't a consideration. You can easily find out what's been going on with a Google search and make up your own mind.)

After I wrote my post about not having a use for The Ordinary's Vitamin C, I looked at this tube and kicked myself. Another brightening product? Really? Well, azelaic acid in fact has a number of functions, and perhaps what it's most often used for it to treat acne. For instance, it's typically part of the acne medication prescribed by Curology. Yet The Ordinary's description of the product on their US site doesn't mention anything about acne (though it does say it fights acne in Canada). They write, in in much more straightforward prose than is typical for them:

Found in grains, Azelaic Acid is produced naturally by yeast that lives on normal skin. It brightens the skin tone while visibly improving the evenness of skin texture and reducing the look of blemishes. It is a multi-functional support ingredient for all skin types and also acts as an effective antioxidant. This formula offers a very high 10% concentration of high-purity Azelaic Acid in a lightweight cream-gel system.

If it's often used for acne, why no mention of that here? I suspect it has to do with drug labeling laws. If a product claims to treat acne, then it's classified as a drug by the FDA and has to have "drug facts" and other information on its label. There are other regulations for products classified as drugs in the US as well. For instance, Paula's Choice sells two versions of its popular 2% BHA liquid with the exact same ingredients. One is labelled as an acne treatment and one isn't--the difference is in the labeling, not the product itself. (So buy whichever one you can find on sale.) Deciem, I assume, has chosen to avoid the extra burden of these regulations by simply not mentioning acne and relying on its unusually informed consumer base to know the properties of azelaic acid. (I don't fault them for going this route, although they might miss out on some potential customers.)

Fortunately, I read about azelaic acid for cystic acne somewhere (probably Reddit, but I can't find the exact post now) and was excited to find that I already had a tube of it in my hoard. According to Deciem, you only need to use a pea-sized amount each day, and they generally seem to advise applying it at night.

It's a fairly thick cream formula, and it dries in seconds, so you need to spread it quickly. I find it easier to use a patting motion than rubbing. It has a mildly unpleasant smell, kind of like the bedroom of a college boy with moderately-good hygiene, but it doesn't linger. I concentrate the product in the problem areas mentioned above, though as you will see in my skincare routine described below, the moisturizer I put on top probably causes it to be more evenly distributed across my face in the end. It's not gritty like The Ordinary's Vit C, and I don't feel any sensation at all on my skin when I apply it.

I decided to do a proper test of this product by applying it daily for a month without adding any other new products to my routine, limiting my use of strong actives like retinol for the first couple of weeks, and taking weekly photos of my skin. I wanted to keep going for at least a month, since my cystic acne breakouts tended to be worst the week before my period. I'm really glad I have documentation, because sometimes it can be hard to see progress without photographic evidence. When I took the last of the four photos below, I considered not even posting them, because I thought there hadn't been any real improvement over time. But I think the photos say otherwise. Left to right, weeks 1 (immediately before beginning azelaic acid) through 4 (all without any makeup):

The most dramatic improvement is, in fact, not really visible in these photos: the decrease in cystic pimples. I still get one or two during the week before my period (I'm actually in the second month of using the azelaic acid as I write this), but they are much smaller, less painful, and they disappear in just a few days instead of a couple of weeks (or more!). I just had one pop up a couple of days ago, and it's almost gone today.

The reason I thought there wasn't a visible improvement, despite being happy with the results, was that I still had an unusual amount of inflammatory acne on my chin. I've managed to get that under control too, though that's a topic for another post (spoiler: honey mask). I think you can see from the photos that even with remaining acne on my chin, nose, and forehead, the redness in those areas had decreased significantly with just the addition of the azelaic acid. Really, that should have been more obvious to me, because I've found myself needing to do less color correction/concealing (as described here) with continued azelaic acid use. (The one thing that's sticking around is that red scar/PIH/PIE mark in the middle of my top lip that was left behind by a cystic zit. If anyone has suggestions for fading it more quickly, I would be grateful.)

This is all very exciting for me! It's rare that I get such good results from a new product in this short a time. I thought I would list out my full skincare routine here, so that you can see where the azelaic acid fits in. As I've pointed out recently, you don't need to use nearly as many products as I do to have nice skin. I like to try new things and especially to review and blog about them, so I use more than I necessarily need. I haven't listed products I use sporadically like masks and oils. This is my daily routine.

Morning

Gentle cleanse (currently Paula's Choice Moisture Boost Cleanser or Simple Micellar Water)
Exfoliate with BHA (currently Paula's Choice 2% BHA Liquid)
Wait 5-10 minutes
Hydrating serum mixed with a couple of drops of niacinamide booster (currently The Ordinary Matrixyl 10% + HA and Paula's Choice 15% Niacinamide Booster)
Light Moisturizer (currently Clinique Moisturizing Gel)
Wait 10 minutes
Sunscreen (currently La Roche-Posay SPF 60 Fluid or Kinesys SPF 30)

Night

Double cleanse (currently Neutrogena Cleansing Oil and Simple Micellar Water)
Hydrating serum (currently Paula's Choice Redness Relief Serum)
Azelaic acid treatment (currently The Ordinary Azelaic Acid Suspension 10%)
Wait 5-10 minutes
Heavier moisturizer (currently Cetaphil Moisturizing Lotion or Origins Night-a-Mins Cream or Paula's Choice Hydrating Treatment Mask)

I think I still have another month or two worth of this azelaic acid in my tube, and I'll probably replace it with the same thing when it's empty. It's been an excellent addition to my routine. Besides Deciem's website, it's available places like Sephora and Well.ca ($10 off $40 CAD with code brutallyhonestbeauty--anyone can make a coupon code). But do you know of any other good, non-prescription sources of azelaic acid out there? Paula's Choice sells it outside of North America (I assume not here because of some of those drug regulations discussed above), though I'm hoping that some recent social media posts they're written about azelaic acid mean they'll offer it here soon, too.

UPDATE: Paula's Choice Azelaic Acid Booster is now available in North America.

Has anyone else had good (or bad?) results with azelaic acid? Did you use a prescription product?