azelaic acid: clinical use

Prescribing considerations

• Confirm the diagnosis and select a formulation licensed for the intended indication.
• Local irritation is common early in treatment.
• Finacea has evidence for adolescent acne, but its rosacea indication is not established in people under 18.
• Consider excipient sensitivity with dermatitis or persistent irritation.

Contraindications and cautions

• Hypersensitivity to azelaic acid or any formulation excipient.
• Avoid contact with eyes, mouth and other mucous membranes.
• Use caution in pregnancy, breastfeeding and patients with asthma because worsening asthma has rarely been reported.

Monitoring

• Assess local tolerability, adherence and clinical response.
• Review worsening acne or rosacea, persistent irritation, hypersensitivity or asthma symptoms.
• Routine laboratory monitoring is not specified in the selected product information.

Clinical pharmacology

Azelaic acid has antimicrobial, keratinisation-normalising and anti-inflammatory activity. Skin penetration is greater through damaged skin, but systemic absorption after topical application is low; absorbed azelaic acid is excreted unchanged or metabolised by beta-oxidation.

Formulation and product differences

• Skinoren is a cream licensed for acne vulgaris.
• Finacea is a gel licensed for mild to moderate papulopustular facial acne and papulopustular rosacea.
• Both contain benzoic acid and propylene glycol, which may contribute to local irritation; Skinoren cream also contains cetostearyl alcohol, which can cause contact dermatitis.
• Occlusive dressings are specifically discouraged with Finacea gel.

Gel

Route: Cutaneous

Strengths: 15%