Azelaic acid and tretinoin: Get a customized formula

Table of Content:
How to get a prescription? | Where can I get a customized formula? | How to use them together? | Differences | What is azelaic acid and what is it used for? | Side-effects | Precautions | What is tretinoin and what is it used for? | Side-effects | Precautions

Azelaic acid and tretinoin are both key players in the battle against acne. Individually, they are both effective in reducing acne breakouts and improving overall skin health. However, when combined, their synergistic effects amplify their individual benefits, leading to a more comprehensive approach to treat acne.

The formation of acne breakouts is linked to four main factors: sebum production, how the follicles’ skin cells behave, the presence of bacteria in the hair follicles, and the surrounding inflammation. Azelaic acid is effective for treating acne because it targets all these factors involved in acne development¹.

Tretinoin, also known as all-trans retinoic acid, is a proven treatment for mild-to-moderate acne as a comedolytic agent. It can be used alone or in combination with an antibacterial such as azelaic acid 15% or 20%. Tretinoin effectively stimulates the growth of new cells, helps unclog pores, and promotes the proper flow of sebum. Tretinoin also possesses anti-inflammatory properties, making it effective in addressing both non-inflammatory and inflammatory acne lesions^2.

In this article, we dive into the specific properties of azelaic acid and tretinoin and the synergy that arises when they are used together. We will also tell you how you can get a prescription for tretinoin and azelaic acid.

How to get a prescription for azelaic acid and tretinoin?

You can get a prescription for Azelaic acid and tretinoin in a combined formula by having  a photo consultation with an online dermatologist which is only $59. This process takes less than five minutes and you need to answer a few questions of your condition, upload photos of your skin and mention the medications you wish to obtain. 

Your dermatologist will review your case and in 1-2 days you will get your prescription. You can then buy your customized formula via Skin Medicinals.

Where can I get a customized formula with tretinoin and azelaic acid?

Your online dermatology provider can prescribe a customized formula through Skin Medicinals that includes tretinoin and azelaic acid for acne or anti-aging. 

How to use tretinoin and azelaic acid together?

If you are not using a customized formula with tretinoin and azelaic acid together, follow these simple steps on how to apply these two ingredients in your skin care routine for acne or anti-aging.

According to Dr. Alpana Mohta, expert dermatologist, when using both tretinoin and azelaic acid, it is important to use them correctly to maximize their benefits and minimize the potential for skin irritation. 

You should remember to always apply tretinoin during the night as it is photosensitive

1. Cleanse your skin with a gentle cleanser to remove any dirt, oil, or impurities.
2. Apply a moisturizer to prevent irritation
3. Apply in a thin layer to the entire face or affected areas. Use clean fingertips to spread it evenly and avoid applying it too close to the eyes, nostrils, or mouth.
4. Allow the tretinoin to fully absorb into your skin (usually takes about 20-30 minutes). This waiting period helps to minimize the potential for interactions or decreased effectiveness when layering with other products
5. Apply a thin layer of azelaic acid to the entire face or affected areas, gently massaging it into the skin until fully absorbed
6. If desired, you can apply a second layer of moisturizer after the azelaic acid has absorbed. Choose a non-comedogenic, fragrance-free moisturizer that is suitable for your skin type 
7. Alternatively you can apply tretinoin and azelaic acid on different nights to minimize irritation

According to Dr Mohta, the order of application of  the two active ingredients does not affect their efficacy. You can use either one first, followed by the other. As a general guideline, Dr. Mohta recommends layering these products from thinnest to thickest. For instance, if you are using an azelaic serum and a tretinoin cream, apply the azelaic serum first, followed by the tretinoin cream. Always remember to apply moisturizer first regardless of the order of the products.

How do azelaic acid and tretinoin complement each other?

What is azelaic acid and what is it used for?

Azelaic acid is a topical medication in the form of creams, gels, or foams that is primarily used for the treatment of acne, rosacea and hyperpigmentation³.

Azelaic acid needs a prescription for higher concentrations and can be bought over the counter for lower concentrations.

How to get a prescription for azelaic acid?

To get a prescription for azelaic acid, you can consult a board-certified dermatologist via Miiskin. Price for the consultation is $59 and medication refills are only $39.

Benefits of azelaic acid

Azelaic acid, a naturally occurring dicarboxylic acid,  is a potent antimicrobial against acne-causing bacteria,  it is comedolytic, and it has anti-inflammatory properties that help reduce redness and swelling associated with acne⁴. It also aids in the normalization of keratinization, preventing the blockage of pores that often contributes to acne development. 

• Antimicrobial effect: Azelaic acid has the ability to inhibit the growth and reproduction of acne-causing bacteria⁵.
  
• Regulates sebum production: Azelaic acid has been shown to inhibit the enzyme responsible for converting testosterone to dihydrotestosterone (DHT). By inhibiting its production, azelaic acid may help reduce sebum levels⁶.
  
• Helps target hormonal causes of acne: In a similar fashion to Winlevi, azelaic acid also blocks the activity of 5 alpha-reductase, an enzyme that converts testosterone into dihydrotestosterone (DHT)⁷. High levels of DHT are associated with increased sebum production and the development of acne⁸. By inhibiting this conversion, azelaic acid helps to reduce the effects of androgens on sebum production, helping to manage acne symptoms⁹.
  
• Helps to prevent the excessive buildup of keratin: Overproduction of keratin, a protein naturally found in the skin,  can contribute to the formation of clogged pores and skin blemishes. Azelaic acid helps slow down the excessive growth of keratinocytes which can promote healthier skin and improve conditions like acne and hyperpigmentation¹⁰.
  
• Reduces hyperpigmentation: Azelaic acid inhibits the activity of tyrosinase (an enzyme involved in the production of melanin, which is responsible for skin pigmentation) and other oxidoreductase enzymes^11.

Common side-effects of azelaic acid

• Skin irritation/rash
• Burning
• Dryness
• Redness
• Peeling
• Stinging
• Swelling¹²

Precautions and warning when using azelaic acid

Be aware that hypopigmentation (a lightening of the skin) may occur while using this medicine. If you have dark skin, use caution.

This medicine is considered safe to use during pregnancy and lactation, however it has the potential to cause allergic reactions. If you experience itching skin, trouble breathing, or large, hive-like swelling on any parts of your body, seek immediate medical attention.

It is important that you have regular visits with your doctor to monitor any potential side effects of this medicine. If your acne does not improve within four weeks, or if it worsens, make sure to check with your doctor.

If you do not see your rosacea improvement within 12 weeks, or if it gets worse, consult your doctor¹³.

What is tretinoin and what is it used for?

Tretinoin, also known as all-trans retinoic acid, is a topical medication that belongs to the class of retinoids. It is derived from vitamin A and is commonly used in dermatology for the treatment of acne, photoaging, fine lines, wrinkles and face roughness^14. 

Tretinoin is available in different formulations such as creams, gels, and lotions. To help you and your dermatologist in determining which formulation may be more suitable to address your particular skin condition, understand the differences between tretinoin cream and gel, their special qualities, and the various brands available.

How to get a prescription for tretinoin?

Consult a board-certified dermatologist for $59 and request your tretinoin prescription.

Benefits of tretinoin

Tretinoin is widely used in dermatology due to its well-established efficacy  and versatility in treating various skin conditions. However, tretinoin is a prescription medication and should only be used under the guidance of a healthcare professional.

• Promotes skin rejuvenation: Tretinoin promotes the turnover of skin cells and stimulates collagen production. This can lead to smoother skin texture, improved fine lines and wrinkles, and a more youthful appearance¹⁵.

• Reduces hyperpigmentation: Tretinoin can help fade dark spots and hyperpigmentation caused by sun damage, acne scars, or other skin conditions. It promotes the shedding of pigmented cells and encourages the growth of new, evenly pigmented cells¹⁶.

• Repairs sun damage: Tretinoin can help repair some of the damage caused by long-term sun exposure. It encourages the shedding of damaged skin cells and stimulates the production of new, healthier cells^17.

• Regulates sebum production: Tretinoin helps to normalize sebum production by influencing the activity of sebaceous glands and reducing the production of excess sebum. Excessive sebum is linked to the development of acne, by regulating this, tretinoin can help manage acne and promote clearer skin^18.

• Reduces acne scarring and improves overall skin appearance: Clinical assessment showed that regular use of tretinoin shows improvements in acne scars, pore size, skin moisture, vascularization, and skin firmness and elasticity^19.

Common side-effects of tretinoin

• Burning/stinging
• Itching
• Skin peeling of the skin
• Lightening or darkening of the skin
• Redness 
• Unusual dryness 
• Warm sensation²⁰

If you have sensitive skin, you can consider using Altreno, a new tretinoin formulation that is more gentle on the skin causing side effects in only 1% of patients. 

Precautions and warning when using tretinoin

Always follow the instructions given by your doctor. According to Dr. Mohta, during the first few weeks, you may experience skin irritation and temporary worsening of acne, known as the tretinoin purge. It may take up to 12 weeks to see significant improvement. If your skin becomes very irritated, consider switching to Altreno and if you don’t notice any improvement within 8 to 12 weeks, consult your doctor.

Tretinoin cannot be used by children under 12 years of age, pregnant or nursing women. Women should use contraception when using tretinoin as it is considered teratogenic. 

Do not use any other topical products in the same area as tretinoin one hour before or after application, unless specifically instructed by your doctor. Using incompatible products may reduce the effectiveness of tretinoin or cause skin irritation.

Protect the treated areas from excessive sun exposure, wind, and cold weather. Your skin may become more sensitive and prone to sunburn, dryness, or irritation, especially during the first few weeks. Remember to apply sunscreen with SPF 50 every morning and reply when outdoors. Wear protective clothing and hats, and apply moisturizers or creams frequently.

Lee este artículo en Español: Ácido azelaico y tretinoína ¿Para qué sirven?

References:
https://pubmed.ncbi.nlm.nih.gov/2534550/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225141/
https://pubmed.ncbi.nlm.nih.gov/1712709/
https://www.sciencedirect.com/topics/neuroscience/azelaic-acid
https://pubmed.ncbi.nlm.nih.gov/2534550/
https://jddonline.com/articles/azelaic-acid-evidence-based-update-on-mechanism-of-action-and-clinical-application-S1545961615P0964X
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969667/
https://jddonline.com/articles/azelaic-acid-evidence-based-update-on-mechanism-of-action-and-clinical-application-S1545961615P0964X
https://www.mayoclinic.org/drugs-supplements/azelaic-acid-topical-route/side-effects/drg-20062084
https://www.ncbi.nlm.nih.gov/books/NBK557478/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791161/
https://pubmed.ncbi.nlm.nih.gov/9774029/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225141/
https://pubmed.ncbi.nlm.nih.gov/15075042/
https://www.mayoclinic.org/drugs-supplements/tretinoin-topical-route/side-effects/drg-20066521

---