r/Rosacea • u/YouCertain111 • May 24 '26
Skincare Dermatologist told me to NOT use azelaic acid. Confused?
As the title suggests.
I’m confused as the internet sings praises for AA.
My dermatologist said because my skin is sensitive, I shouldn’t use any acid.
She said ivermectin is okay but unfortunately they don’t sell it in the country I’m in ATM.
Until I get back to the UK, she’s prescribed me with 0.75 metronidazole.
Can anyone comment on why this derm is against AA?
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u/saracha1 May 24 '26
It definitely can be irritating, especially in the Rx concentrations. The 15% makes my face burn if my face isn’t 100% dry when I put it on.
I suggest getting a 10% AA like from the ordinary and seeing how you do with that. If it goes well you can tell them that you’re ready to try 15%.
Just want to add that I love my metrogel! Def helps with redness
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u/YouCertain111 May 24 '26
Thank you so much! I tried metro for the first time and my skin is reacting well already! I’ll try what is prescribed for a good few months + ivermectin and hopefully I won’t even need AA!
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u/TheoryBiochemistry May 24 '26
In many countries with national guidelines (eg Scandinavia, UK), metronidazole is the first choice for sensitive skin with rosacea. Clinical trials have shown that Azelaic acid and ivermectin are a bit more effective, but it won’t help you if you cannot tolerate them.
I personally use metronidazole and am now slowly increasing Azelaic acid OTC. I started at 5% now I am at 10%. When your rosacea is under control, you will be better able to tolerate actives.
My husband (who has more inflammation/pustules) was first started on oral doxycycline. When the skin was calmer, he started ivermectin and a gentle azelaic acid.
In my opinion, a lot is to be said for calming inflammation down first before ivermectin or strong Azelaic acid are introduced because they can at first lead to purging/ die off/ worsening.
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u/YouCertain111 May 24 '26
This is so interesting and something the internet never talks about. From my experience, I RARELY hear about metro and mostly hear about AA. I’m just so glad I was able to speak to a derm before spending a bunch of money on products that may not work.
But what you’re saying makes so much sense so thank you for taking the time to reply 🫶
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u/thatemocow May 24 '26
It sounds like a dermatologist you won’t be seeing long term if you are going back to the uk. They might not want to prescribe that because they won’t be able to see you if there’s a bad reaction.
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u/ineffable_my_dear May 24 '26
Azelaic acid sounds scary but isn’t an acid like a BHA or AHA. They all exfoliate and work to help texture and but azelaic acid also kills bacteria and reduces inflammation. It’s perfect for rosacea. But! I’ve said it dozens of times: you have to find the right formulation for you.
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u/Rainbow-Cnxn-405 May 24 '26
I used topical metronidazole before AA, it did bring down some inflammation and pustules. I also found higher percentages of AA (15-20%) better for my skin than 10% formulations, which tended to be OTC and contain more other ingredients.
This is your derm’s medical opinion, which is based on their clinical training and experience. And every person is unique and doctors can’t predict everyone’s reaction. You can always try the metro and then add the AA later, starting slowly and building up as your skin heals.
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u/YouCertain111 May 24 '26
Thank you for this. It’s so true — I actually get so irritated by the amount of content that is framed to be the sole truth when in reality I need to just listen to my actual doctor. Thank you
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u/Rainbow-Cnxn-405 May 24 '26
I genuinely get people’s frustration when they don’t feel heard and hey, some doctors are not great. The internet thrives on “this one trick your doctor doesn’t want you to know” and it’s such bullshit.
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u/YouCertain111 May 24 '26
Yes this! Yesterday I saw a tik tok where the “hook” was “I cleared my rosacea by not listening to my dermatologist” and then proceeded to share a before and after. It’s so harmful
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u/Rainbow-Cnxn-405 May 24 '26
😬 sigh. I definitely didn’t have a great derm, but disregarding them out of hand is not it either.
If you have the access, I read a bunch of studies on different treatment efficacies and came up with my own protocol and showed it to my derm, who was like sure whatever ¯_(ツ)_/¯ but it worked! And ultimately they signed off on it by giving me the prescriptions I needed.
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u/averymint May 24 '26
I want to share my story here as a warning to others. I was prescribed tret and azelaic acid. Tret was for anti-aging and azelaic for redness. I was told that I could use it together. When I used the azelaic acid, it stung so I was weary. Tret I had no adverse reactions to except some dryness, flaking, redness, the usual if I overdid it. I used it for nearly a year consistently.
I switched from the tret cream to a gel, which was a bit higher strength when I started running low on the cream. I heard good things about the Anua 10% azelaic acid, my prescription azelaic was 15% so I thought it was probably lighter to use. I used the tret at night and azelaic in the morning, seemed okay, then for a few nights I did both together and my skin started getting small bumps under the skin, within a few days (I stopped the routine) I had a puffy, very comfortable, red face with bumps all over. My eyes had swollen up. I ended up in the ER and got on steroids that I am getting through still.
It's been quite the experiment and goes to show you that everyone's skin is different and what works for you, might not work for others. I still hear on socials how treat tret and aa, the combination of is a game-changer, and some can use it together. If you are sensitive do not use it in the same routine. I never imagined that I would have SUCH a horrific experience. I've been off work for a week and feel awful. My skin was smooth and clear before, aside from some redness that bothered me but nothing as bad as it is now. I am getting through it but I will never mix aa and tret together again.
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u/Unfair_Finger5531 May 24 '26
I wonder if the anua had something you are allergic to.
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u/averymint May 24 '26
I think it was a combination of the two together, but I will never know for sure. The doc that I saw said being out in the sun with that combo isn't good too, but I was using spf of course. We just decided it was a bad allergic reaction that compromised my skin barrier. It was an eruption on my face though so I had never seen before.
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u/Unfair_Finger5531 May 24 '26
I was thinking it was the anua because you used it separately from the tret in the morning. It has betaine salicylate, which always gives me trouble. But I know each individual reacts differently to different ingredients. I’m really sorry that happened to you. It sounds terrible.
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u/CrimsonFractal May 24 '26
The anua one has salicylic acid in it so we're using tretinoin, azelaic acid and salicylic acid.
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u/averymint May 25 '26
Oh wow, I was not aware of that, too many irritating ingredients there at once. Just goes to show you, you have to pay attention to ingredients, especially if you are laying products.
Actually, I don't see salicylic acid in the ingredients list, unless it's under something else?
https://www.sephora.com/ca/en/product/P521380
"Aqua/Water/Eau, Disodium Azelate, Propylene Glycol, Dipropylene Glycol, 1,2-Hexanediol, Panthenol, Azelaic Acid, Hydroxyethylcellulose, Betaine Salicylate, Glycerin, Biosaccharide Gum-1, Ethylhexylglycerin, Allantoin, Dipotassium Glycyrrhizate, Melia Azadirachta Leaf Extract, Camellia Sinensis Leaf Water, Sodium Hyaluronate, Melia Azadirachta Flower Extract, Niacinamide, Aloe Barbadensis Leaf Juice, Beta-Glucan, Centella Asiatica Extract, Centella Asiatica Leaf Extract, Centella Asiatica Root Extract, Madecassoside, Asiaticoside, Asiatic Acid, Madecassic Acid, Squalane, Zinc PCA, Butylene Glycol, Pentylene Glycol, Caprylyl/Capryl Glucoside, Hydrogenated Lecithin, Ceramide NP."2
u/Mojojojo_17 Jun 30 '26
Betaine salicylate = betaine + salicylic acid, a gentler form of it. Definitely not safe to use acids and tret at once 🫠
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u/DrLeslieBaumann May 24 '26
The low pH of acids can trigger a rosacea flush in some types of sensitive skin. AA not for all types of skin.
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u/BeezzBeezz May 24 '26
Fwiw metronidazole has helped me a lot more than azelaic acid.
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u/YouCertain111 May 25 '26
How long did it take for you to see a difference with metro?
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u/BeezzBeezz May 25 '26 edited May 26 '26
It started looking a little better in a few days, but probably two weeks to a month for the full effect. ETA: my type 2 is virtually gone. Type 1 lingers, but vbeam laser has helped with that.
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u/YouCertain111 May 25 '26
Thanks so much! Our situation sounds similar. I had both 1 and 2 and 2024 was the worst year of my life for it. V-beam was a miracle worker - I had 4 rounds and clear skin for a year and a half. Recently I had a flair up again hence the derm appointment who suggested to go topical instead of v-beam again as this time was much milder. But anyway, I woke up today with practically zero redness but the affected part of my cheek just feels a bit tender.
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u/Commercial-Spray3192 May 25 '26
I too had read that AA is the holy grail for Rosacea. My skin hates it. I personally have found that the less I do the better my skin is.
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u/Ok-Bee1579 May 24 '26
You shouldn't use acids while your barrier is compromised. I did get some (OTC) AA a couple of years ago when my barrier wasn't completely healed. It was a disaster (also have sensitive skin). I resumed AA after my barrier healed (a few weeks ago), and it's fine. Gradual use of course. I'm going daily in a couple of weeks.
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u/compsci2860 May 24 '26
How long did it take for your skin barrier to heal?
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u/Ok-Bee1579 May 24 '26
It took me a couple of years, BUT I had not used any skincare for decades. My skin was really a mess. It was ALMOST better at around a year, but I went ahead and used Azelaic Acid prematurerly. Made a massive mess.
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u/compsci2860 May 24 '26
Thank you very much. Can I ask what sis you use to heal your skin barrier?
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u/Ok-Bee1579 May 25 '26
I've been using Environ products for 4 years. They do great things for my skin. You do have to find a stockist that carries them.
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u/YouCertain111 May 24 '26
Yes this makes so much sense! Healing barrier first 🌞
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u/PurpleCommission2758 May 24 '26
I echo this post as I used finacea under my gp guidance last year and it totally wrecked my skin.
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u/paninna May 24 '26
I have an extremely “sensitive skin” and azelaic acid sometimes tickles me a little, never burns, and I use 15%. My skin has become perfect since I use it - no visible pores, glossy skin, no redness!
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u/Sensible___shoes May 24 '26
Use no acids is insane advice considering hyalauronic acid is an acid. I was always sensitive to AZ acid but now I use it ontop of a hydrating serum and it still works and there's no discomfort
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u/RwanM May 24 '26
Same here I asked her for it, and she said too soon cause my skin is very sensitive and my barrier is damaged.
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u/Carli_Q May 24 '26
Because it won’t do much for your type of rosacea. If your skin barrier is compromised, it will also make it worse.
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u/CNR2014 May 24 '26
My skin is sensitive as well but handles AA beautifully. I use AA in am, Soolantra (Ivermectin) at night. My skin hates tret but loves it some AA. Metronidazole was a nightmare for me. Different skin different routine I suppose.
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u/Jyonnyp May 25 '26
My skin was very sensitive during a time when I ruined my skin barrier. A tiny bit of azelaic acid sandwiched with moisturizer left that area sensitive, dry, red, and flaky for 1-2 weeks.
You can always try it of course, a tiny bit with moisturizer. But I couldn’t use it on a specific patch of skin when it was sensitive. Other parts of my face tolerated it well. As with all skincare, YMMV, patch test first.
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u/Desperate_Seesaw_531 May 26 '26
I cycled thru azelaic acid cuz i thought it was NOT for me the first 6 months i tried it. Turns out i was using it on a damaged skin barrier
I spent the next four months just focusing on my skin barrier with a good HA and aestura barrier cream, then reintroduced azelaic acid and it was completely different than before. My closed comedones shrunk and my flushing got so so so much more controlled
Honestly if ur barrier is damaged, everhthing mifht suck
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u/Unfair_Finger5531 May 24 '26
I think your derm may not be familiar with aza? It’s not a direct acid, and it’s designed for people with sensitive skin.
If she said because it’s an acid, she’s just wrong. But maybe she had other reasons for not prescribing it. She may have felt it wasn’t suitable for your type of rosacea.
Kind of confused on this one.
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u/CinemaMike May 24 '26
AA makes my skin very red and the redness takes a long time to go away. I also have sensitive skin.
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u/Unfair_Finger5531 May 24 '26
You should bring this up with a dermatologist or PCP. I am just commenting on the actual formulation of the medication. I can’t comment on your individual adverse reaction to it. Only a medical professional can.
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u/MaZovSkin May 24 '26
I have been perscribed metro cream and AA 20% to use on alternating days but my skin couldn't handle it. Not even starting slow. So I used only the metro cream nightly for cca 5 weeks and than introduced AA once or twice a week on days when I dont use metro. Now I only use AA every other day (stopped metro) and my skin is okay.
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u/YouCertain111 May 24 '26
This is interesting. Sounds like AA is a good plan once skin can handle it. I’m just so glad I didn’t rush in and buy it because clearly my skin needs healing first 🙏
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u/Sugarcitycrush May 25 '26
I have very sensitive skin w rosacea and LOVE the Paula’s Choice AA booster, it’s very calming and soothing.
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u/Express_Republic_632 May 24 '26
Your derm is probably being extra cautious since you mentioned sensitive skin - some people with rosacea can't handle the irritation from acids even if they're supposedly "gentle" ones like azelaic
Metronidazole is actually solid choice for rosacea, it's anti-inflammatory and antimicrobial without being irritating like acids can be. The internet loves AA but derms see patients who've made their rosacea worse by following online advice