Is Azelaic Acid an Effective Cure for Melasma?

Azelaic acid is one component in melasma treatment. I recommend Melarase creams for my patients, followed by once monthly MelaPeel facial peels for my melasma patients. 

For my patients with more sensitive or rosacea prone skin I generally recommend Azelaic acid in addition to hydroquinone and IPL therapy (depending on skin type).  The lightening effect with azelaic acid is more subtle than with the more aggressive therapies but if the patient is diligent in the use and very patient I think improvement can be made.  It is important to note that improvement with any melasma regimen may take 3-6 months and that unless sunlight and extra hormones (estrogen medications) are avoided it can be much harder and frustrating to treat. 

Azeleic acid may help control but not cure melasma. There is no real cure for melasma at the moment-- just management. Azeleic acid has a skin brightening affect that may help fade dark marks but it is not generally the first line treatment--hydroquinone, when available, is.

 Azelaic acid has both anti-inflammatory properties as well as the ability to inhibit one of the steps in the production of melanin pigment in the skin.  Although it is not my first choice for treating melasma, it certainly can help.  It will work more effectively with retinoic acid (tretinoin) as you mentioned.  Hope this helps. 

Yes in rare situations AA can help - The Ordinary makes a good solution for only $8.Melasma is a very common cause of skin pigmentation. It can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours. This forms the foundation of all treatments. 



I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams or Meladerm. I start my patients on laser (low dose Q switch or Picosure) as this has shown to decrease pigment production by decreasing the activity of the cells that produce pigment. Laser itself is not aimed at ‘blasting’ pigment, but to slow down the rate of melanin production. Another laser I use is the Clear and Brilliant in the 1927 Permea setting combined with creams. IPL should never be used to treat mixed melasma as it often worsens the condition (this is termed ‘Rebound Melasma’) 



In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient according the type of melasma. Majority of patients will have mixed dermal and epidermal melasma. Approach melasma as a medical condition and not a cosmetic concern, and the success rate will be much higher. 

Consult a Board Certified Laser dermatologist with a special interest in disorders in pigmentation as well as one who has experience in treating all skin types, including darker Ethnic skin. 



All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia. Real Self Advisory Board