While acne was not something I had to deal with in my teenage years, it became a permanent fixture in my early 20s. In the decade since, I have tried just about every possible solution to curb its reappearance, from facials to antibiotics, prescriptions to all manner of topical skincare. In my extensive research on the latter, there were two ingredients that cropped up most frequently: azelaic acid and salicylic acid.
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Salicylic acid is a beta-hydroxy acid commonly found in exfoliating, blemish-busting formulas. Azelaic acid, meanwhile, is lesser-known but, as per the National Institute for Health and Care Excellence’s updated guidance, is a recognised treatment for moderate-to-severe acne and widely lauded by experts for its inflammation-calming properties.
The two ingredients, while on the surface may be called upon for similar spot-fighting reasons, work in different ways. “I tend to think of salicylic acid primarily as an excellent decongesting ingredient,” explains aesthetic doctor Dr Sophie Shotter, “whereas azelaic acid is more of a multi-tasking treatment for patients who experience inflammation, acne, redness and pigmentation.” She clarifies further, “Salicylic acid helps keep pores clear, while azelaic acid can help reduce inflammation.” But also stresses that for more significant acne, “evidence-based treatments such as topical retinoids may be more appropriate.”
So which are better suited for your concerns? Two experts delve into the azelaic acid vs salicylic acid debate and reveal all.
- What are azelaic acid and salicylic acid, how do they work and how do they differ?
- Which ingredient is more effective for acne?
- Which ingredient is more effective for other concerns like rosacea, inflammation and uneven texture?
- Who should use azelaic acid or salicylic acid?
- Can azelaic acid and salicylic acid be used in the same routine?
- What ingredients pair well with each acid? And which should not?
- Meet the experts
A chemical exfoliant, salicylic acid is renowned for its buffing properties. “Salicylic acid is a beta-hydroxy acid (BHA) that is effective for oily and congested skin,” confirms aesthetic physician Dr Ifeoma Ejikeme. “It works by helping to break down excess oil and dead skin cells within the pores, making it especially useful for blackheads, whiteheads and preventing future breakouts.” What’s more, she adds, “It also has anti-inflammatory properties, which can help reduce some of the inflammation associated with acne.”
Paula’s Choice
Skin Perfecting 2% BHA Liquid Exfoliant
- Why it’s Vogue-approved: A cult formula for a reason, this Paula’s Choice tonic removes dead skin cells and helps unclog pores, leading to clearer skin and fewer blackheads. It’s really effective for persistent acne, plus it’s brilliant for those with oily, blackhead-prone skin. I would err on the side of caution if you are particularly dry or sensitive, though – I have found that it can sometimes make my slightly reactive skin feel tight.
- Key ingredients: Salicylic acid, green tea extract and methylpropanediol
Azelaic acid works differently. “Azelaic acid is a dicarboxylic acid with anti-inflammatory, antimicrobial and an ability to normalise keratinisation,” says Dr Shotter. “In practical terms, this means it can help reduce inflammation associated with acne and rosacea, prevent pores from becoming congested and improve post-inflammatory pigmentation.” While salicylic acid will help remove pore-clogging elements, azelaic acid, as described by Dr Shotter, “inhibits tyrosinase, an enzyme involved in melanin production, which makes it especially useful for pigmentation concerns including post-inflammatory hyperpigmentation and melasma.”
Paula’s Choice
Azelaic Acid Booster
- Best azelaic acid for: visible impact on acne and rosacea
- Why it’s Vogue-approved: As one of the first skincare brands to extol the benefits of azelaic acid, this Paula’s Choice formula has earned its place on your bathroom shelf. It combines the named ingredient with salicylic acid and plant extracts to combat the impact of sun damage like dark spots, aid in the healing of post-breakout scars, calm redness and boost radiance. Its non-scented formula can be applied to those with sensitive skin, and it works particularly well for those with acne or rosacea to leave the complexion smooth and soft. There is a reason it has been lauded as a skin saviour.
- Key ingredients: Azelaic acid, salicylic acid and plant extract
- Calms redness
- Speeds up acne healing
- Brightens
- Quite thick for a serum
The term “acne” refers to blocked or inflamed pores, and under this banner are two main categories: non-inflammatory and inflammatory. Non-inflammatory acne includes whiteheads and blackheads, while inflammatory acne presents as pimples, papules, nodules and cysts. To determine which ingredient is better for acne, it is first important to consider what you are looking to treat and consider that both acids have their place as part of a wider acne treatment program, rather than being a standalone miracle solution. Dr Ejikeme stresses that “there isn’t one magic ingredient that will work overnight. Acne is a chronic condition that can be managed, rather than quickly cured, so consistency and a simple, targeted routine is key.”
Medik8
Press & Clear Pore-Refining 2% BHA Tonic
- Why it’s Vogue-approved: Described by Medik8 as a daily tonic, this toner certainly serves as a remedy for blemish-prone skin. Unlike the vast majority of BHA toners, it is formulated at a neutral pH to keep the skin’s natural microbiome balanced while retaining the exfoliating power of salicylic acid, making it suitable for sensitive, acne-prone skin. Sweep across the skin after cleansing in the morning and evening, and prepare to reap the rewards.
- Key ingredients: Encapsulated 2% salicylic acid (bha), polylysine, 2% tranexamic acid, fermented rice extract
For whiteheads and blackheads, the experts detail that salicylic acid is the better of the two for “its ability to exfoliate and help unclog pores, which makes it a great choice for comedonal acne,” details Dr Shotter. Dr Ejikeme adds, “It belongs to the same family of medicines as aspirin and has anti-inflammatory properties, while also helping to reduce excess oil and clear congestion within the pores.” She advises looking for a formula with 2 per cent salicylic acid when curating a routine for acne-prone skin. This, she reveals, should start with a foaming cleanser “that cleanses without stripping the skin,” then she says, “introduce a 2 per cent salicylic acid cleanser or serum a few times a week and follow with a lightweight, non-comedogenic moisturiser and daily sunscreen.”
CeraVe
Blemish Control Face Cleanser with 2% Salicylic Acid & Niacinamide for Blemish-Prone Skin
Why it’s Vogue-approved: CeraVe’s blemish cleanser contains its signature ceramides, alongside hectorite clay to reduce sebum on the skin, 2 per cent salicylic acid to target dead cells and blackheads, and niacinamide for a healthy skin barrier.
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The Inkey List
Salicylic Acid Cleanser
- Why it’s Vogue-approved: This formula is living proof that a cleanser can target breakouts without making skin feel squeaky clean. Alongside 2 per cent salicylic acid, a zinc compound helps manage excess oil, while allantoin lends the lightly foaming formula a soothing edge. Since it’s rinsed off, it offers a gentler introduction to salicylic acid than many leave-on treatments, making it particularly useful for oily or combination skin that’s new to exfoliation.
- Key ingredients: 2 per cent salicylic acid, zinc compound, 0.5 per cent allantoin
Inflammatory acne is a different story, although you can use them both in harmony. “Azelaic acid is an excellent option because it addresses both inflammation and follicular keratinisation,” Dr Shotter tells me. As for hormonally-influenced acne, neither ingredient addresses the cause of its formation but may improve the appearance of the manifestation of spots and congestion. In this case, Dr Shotter recommends a “proper medical assessment and a treatment specifically addressing its cause.”
Medik8
Blemish SOS
Best azelaic acid for: a targeted spot treatment
Blemish-busting is what this targeted product from Medik8 is all about. Unlike many other spot treatments on the market, it is designed not to dry out your skin, but to support in the appearance of blemishes by reducing redness with a supercharged trio of acne-fighting favourite salicylic acid, skin barrier-protecting and oil-regulating niacinamide and the buzzy azelaic acid to remove bacteria. Blemish SOS fits seamlessly among both AM and PM routines, without pilling under makeup. Only a very small amount is needed.
There is a long list of benefits that are often linked to azelaic acid and salicylic acid, including rosacea, reducing redness, post-inflammatory hyperpigmentation (acne marks), melasma, discolouration, controlling excess oil, skin texture and minimising the appearance of pores. The experts break down which acid is better suited for each concern.
- Rosacea and redness: Rosacea is defined by Dr Ejikeme as a “chronic skin condition that primarily affects the face and can cause redness, flushing, visible blood vessels and sometimes small, red, pus-filled bumps. When visible, it appears on areas of the face, such as the nose, cheeks and chin.” In this case, both experts agree that azelaic acid is a great option. “Skin that has rosacea will feel more sensitive but often has an oily component. The tendency can be to want to dry out the skin with strong products.” Which is where azelaic acid shines. It is more easily tolerated, so it can calm inflammation without causing further irritation.
- Post-inflammatory hyperpigmentation (acne marks): When blemishes are taking an age to heal, azelaic acid is one of Dr Shotter’s favourite ingredients “because we can simultaneously address the acne and the pigmentation it leaves behind.”
- Melasma and discolouration: In the case of melasma, it may take a more complex treatment (“it usually requires a broader approach,” says Dr Shotter, “particularly meticulous photoprotection”), but azelaic acid is often spotlit by derms as part of a routine, and the same is true for discolouration.
- Minimising the appearance of pores: While pore-shrinking is used flippantly in the industry, there is no ingredient that can actually shrink the size of a pore. However, Dr Shotter likes salicylic acid to “clear material from within a pore, making enlarged or congested pores appear less prominent”.
- Excess oil and uneven texture: In these cases, salicylic acid can play a role, especially for excess oil as it is a decongestant. For uneven texture, it can help if “texture is related to congestion and excess keratinisation,” reveals Dr Shotter.
Medicube
Zero Pore Pads
- Why it’s Vogue-approved: Medicube’s Zero Pore Pads have a lot going for them. Namely, Dr Chang likes that the exfoliating pads are both easy to use and gentle on the skin, thanks to the combination of “low-dose AHA and BHA to refine pores and smooth texture,” she says. The alpha hydroxy acids are courtesy of both lactic acid (arguably the gentlest AHA out there) and fruit extracts, while white willow bark serves as a natural source of BHA. They’re also dual-sided so that you can use the textured side for additional physical exfoliation or a soft, smooth side for hydration.
- Key ingredients: Lactic acid, white willow bark extract, cypress tree leaf extract
- Type: Chemical and physical
- Size: 70 or 100 pads
“Salicylic acid is better suited to oily, congested skin,” explains Dr Ejikeme. “It helps to remove excess oil and dead skin cells, making it particularly useful for enlarged-looking pores, blackheads, whiteheads, breakouts and uneven skin texture.” When it comes to sensitive skin, however, azelaic acid is more easily tolerated and is particularly helpful when there are multiple of the above concerns. Dr Shotter tells me, “Azelaic acid is particularly useful when a patient has several concerns simultaneously, for example, acne alongside redness and post-inflammatory pigmentation.” It is considered to be safe to use during pregnancy too.
The Inkey List
SuperSolutions 10% Azelaic Acid Serum
Best azelaic acid for: minimal ingredients
There is a solid 10 per cent of azelaic acid contained within The Inkey List’s formula that spotlights the ingredient and keeps added extras to a minimum. This can allow you to customise the skincare cocktail that you apply to your skin, where only redness-camouflaging green colour particles and soothing allantoin are set alongside the star azelaic acid. If you have gone too harsh with other actives, this acts as a calming layer to restore the skin.
Beware of overloading the skin with active ingredients, no matter your skin type. “More treatment isn’t necessarily better treatment,” she stresses. “A compromised skin barrier can produce redness, burning and inflammation that patients sometimes mistakenly interpret as their skin needing even more exfoliation when often what it needs is barrier support.”
While they can be used together, both experts want to make clear that their introduction should be staggered. “Split use day and night to improve tolerance,” suggests Dr Ejikeme. Azelaic acid can be used in the morning to help reduce redness, and salicylic acid can be used as a cleanser in the evening.”
Allies Of Skin
Azelaic & Kojic Advanced Clarifying Serum
Best azelaic acid for: blemish-prone, irritated skin
There is not just azelaic acid starring in this serum from Allies of Skin. The brand has packed kojic acid in the formula too, as well as retinol-alternative bakuchiol, liquorice and other powerhouse elements that make this a staple for blemish-prone, irritated skin. The azelaic works to fade scars and control sebum, while the kojic calms and brings antioxidant shielding. The rest of the ingredients supercharge these benefits to even out the skin tone, fight acne breakouts and minimise the appearance of pores. Plus, it remains ever gentle, lightweight, easily absorbed and non-greasy.
As these are both acids, a cautious approach is advised. “One of the biggest mistakes I see with skincare is the assumption that combining more active ingredients will produce faster results,” says Dr Shotter. “In reality, over-treatment can damage the skin barrier, create inflammation and make the skin look considerably worse.” The ideal then is to introduce one ingredient at a time, starting slow to build tolerance and consider concentration and formulation – including what ingredients it is paired with (more on that below).
Azelaic acid is generally well-tolerated, which means it can pair well with many different ingredients. Dr Shotter recommends layering it with skin barrier-supporting components like ceramides, glycerin and hyaluronic acid. She also believes niacinamide and azelaic acid are a good combination when dealing with inflammation, pigmentation and barrier support.
Salicylic acid requires more care and attention so as not to over-exfoliate the skin. “Salicylic acid similarly works well within a simple routine containing good moisturising and barrier-supporting ingredients,” continues Dr Shotter. You should, according to Dr Ejikeme, be particularly wary about other exfoliating actives like glycolic, lactic, and mandelic acid.
For acne, layering salicylic acid with retinoids, a comedolytic treatment with extensive scientific research behind their benefits, may be advised to reduce blackheads and closed comedones, but as is always the case when dealing with retinol and its vitamin A-derived counterparts, introduce these gradually to prevent irritation. “Combining several potentially irritating actives can cause excessive dryness, peeling and irritant dermatitis,” warns Dr Shotter. And always, no matter what ingredient you are using, follow with SPF. “Daily broad-spectrum sunscreen is fundamental, particularly when we’re treating post-inflammatory pigmentation or melasma,” she concludes.
- Dr Sophie Shotter is an aesthetic doctor on behalf of Allergan Aesthetics
- Dr Ifeoma Ejikeme is a general medicine consultant and aesthetic physician