Quick Comparison

Azelaic AcidNiacinamide
Typical ConcentrationOTC: 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: 2-10%. 5% is the most studied concentration and provides the best balance of efficacy and tolerability. Higher concentrations (10%) are available but may cause irritation in sensitive skin without proportional benefit. Apply morning and/or night.
ApplicationTopical (gel, cream, serum). Slightly gritty texture in some formulations. Apply to clean skin.Topical (serum, moisturizer, toner). Water-soluble. Stable in formulation. Compatible with most actives.
Research Papers9 papers10 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.

Niacinamide

Niacinamide is converted to NAD+ via the Preiss-Handler pathway—essential for cellular respiration, DNA repair (PARP), and sirtuin regulation. In keratinocytes, it upregulates serine palmitoyltransferase and fatty acid elongases, increasing ceramide synthesis and strengthening the barrier. It inhibits melanosome transfer by downregulating protease-activated receptor-2 (PAR-2) on keratinocytes—brightening without tyrosinase inhibition. In sebocytes, it normalizes lipid synthesis and reduces sebum (possibly via AMPK). Niacinamide inhibits NF-kB translocation, suppressing IL-1beta, TNF-alpha, and IL-8. It inhibits phosphodiesterase, increasing cAMP and modulating keratinocyte differentiation. These multi-pathway effects explain broad efficacy across barrier repair, brightening, acne, and anti-aging.

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).

Niacinamide

Common

Very well-tolerated at 2-5%. Flushing/redness at concentrations above 5% in some individuals.

Serious

None documented.

Rare

Contact dermatitis (uncommon). Old advice to avoid combining with vitamin C is largely debunked at product pH levels.

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