Azelaic acid for rosacea

Azelaic acid (Finacea) is approved for rosacea. It may decrease the bumps, skin thickness and redness. It is also approved for acne.

The brand names for it are Finacea, Azelex, Finacea Plus, and Finevin. It's a naturally-occurring acid from grains.

To treat acne, it kills bacteria and also decreases keratin production. Keratin is just a name for the proteins making up the epidermis, and hyperkeratinization along with excess sebum, can block pores.  

Now, keratinization is a necessary process--it's just the conversion of cells into keratin--but when it's excessive, then skin forms a thicker, harder layer. It doesn't slough off the way skin should. That is the problem in rosacea.

Cathelicidins, which are produced in the skin and increase inflammation, are also increased in rosacea. Azelaic acid decreases production of cathelicidins, resulting in less inflammation.

Inflammation is not always a bad thing. It signals the body to respond to infection, for example, but when inflammation is chronic, like it is in rosacea, it leads to damage, irritation, and redness instead.  That's not a healthy look.

So in rosacea, the decrease in keratinization will lessen the skin thickening that occurs. By decreasing inflammation, the redness is also improved.  Skin also turns over as it should, revealing newer skin that is smoother and clearer.  

For some patients, Finacea leads to increased facial hair growth. Its mechanism of action is probably that it decreases hair loss, rather than actually stimulating hair growth. In fact, it's now being sold in combination with minoxidil (Rogaine) for hair growth!  I don't think you have to worry that you'll grow a beard by using Finacea!

Some people even use Finacea in combination with retinoids. That could lead to excessive dryness, so be careful about that, but the combination makes some sense. Finacea decreases the hyperkeratinization from occurring while retinoids encourage the skin to slough off. Ultimately, you could probably get by with just Finacea or maybe switch back and forth on alternate days.  I think that the risk of irritation is greatly increased if you use both on the same day.

One bonus to Finacea compared to retinoids is that it won't make you more likely to burn in the sun.  Don't go too wild with that and spend a day at the beach sans sunscreen and burn your new, soft, beautiful skin, but you don't have to slather up for casual sun exposure.