Quick Comparison
| Azelaic Acid | Benzoyl Peroxide | |
|---|---|---|
| Typical Concentration | OTC: 10% (The Ordinary). Prescription: 15% gel (Finacea for rosacea), 20% cream (Azelex for acne). Apply twice daily. Well-tolerated but may sting/itch initially. Full effects at 8-12 weeks. | Concentrations: 2.5%, 5%, 10%. 2.5% is as effective as 10% for most people with significantly less irritation. Apply as a thin layer to acne-prone areas. Short-contact therapy (apply for 5-10 minutes then rinse) reduces irritation while maintaining efficacy. Bleaches fabrics — use white towels and pillowcases. |
| Application | Topical (gel, cream, serum). Slightly gritty texture in some formulations. Apply to clean skin. | Topical (wash, gel, cream, spot treatment). Short-contact therapy: apply 2.5% for 5-10 minutes, then rinse — reduces irritation while maintaining antibacterial activity. |
| Research Papers | 9 papers | 9 papers |
| Categories |
Mechanism of Action
Azelaic Acid
Azelaic acid exhibits multi-modal activity: (1) Tyrosinase inhibition—competitively inhibits tyrosinase selectively in hyperactive melanocytes (melasma, PIH) while sparing normal ones; may involve mitochondrial enzyme interference in dysregulated melanocytes. (2) Antimicrobial—bacteriostatic against Cutibacterium acnes by inhibiting bacterial protein synthesis. (3) Comedolytic—normalizes follicular keratinization, reducing hyperkeratinization and corneocyte cohesion; may modulate keratinocyte differentiation. (4) Anti-inflammatory—scavenges ROS, inhibits neutrophil free radicals, reduces pro-inflammatory cytokines. Inhibits 5-alpha-reductase in sebocytes, potentially reducing sebum. Multi-pathway activity explains efficacy in acne, rosacea, and hyperpigmentation. Safe during pregnancy.
Benzoyl Peroxide
Benzoyl peroxide decomposes on skin, generating benzoic acid and reactive oxygen species (peroxyl and hydroxyl radicals). Cutibacterium acnes is an obligate anaerobe thriving in oxygen-depleted follicles; BPO-derived oxygen creates an aerobic environment while free radicals cause non-specific oxidative damage to bacterial membranes, proteins, and DNA. Because this does not target a specific bacterial pathway (unlike antibiotics), C. acnes cannot develop resistance—BPO remains effective indefinitely. Mild comedolytic activity through oxidative effects on follicular keratin. Anti-inflammatory effects from neutrophil modulation. 2.5% achieves similar bacterial kill to 10% with less irritation.
Risks & Safety
Azelaic Acid
Common
Stinging, burning, itching on initial application (usually subsides within 2 weeks). Mild dryness.
Serious
None. Safe during pregnancy and breastfeeding.
Rare
Allergic contact dermatitis, hypopigmentation (rare at cosmetic concentrations).
Benzoyl Peroxide
Common
Dryness, peeling, redness, bleaching of hair, towels, and clothing.
Serious
Allergic contact dermatitis (uncommon but can be severe — patch test first).
Rare
Severe allergic reaction with swelling.
Full Profiles
Azelaic Acid →
A dicarboxylic acid naturally produced by yeast on the skin. Azelaic acid is a true multi-tasker that treats acne, rosacea, and hyperpigmentation simultaneously. It is one of the few active ingredients considered safe during pregnancy, and it uniquely targets only abnormal melanocytes — meaning it brightens dark spots without lightening normal skin. Effective for both inflammatory acne and post-inflammatory hyperpigmentation (PIH).
Benzoyl Peroxide →
The most effective OTC acne treatment and one of the few topical treatments that kills acne-causing bacteria (C. acnes) without promoting antibiotic resistance. Benzoyl peroxide works through oxidation — it releases oxygen into pores, creating an environment where anaerobic bacteria cannot survive. It is one of three first-line acne treatments (alongside adapalene and salicylic acid) recommended by dermatological guidelines.