Azelaic Acid Singapore: Uses and Strengths

Azelaic acid is a topical acid used for acne, rosacea and pigmentation such as melasma and post-acne marks. In Singapore, lower-strength cosmetic products are sold over the counter, while the medicated 20% cream is a prescription-only medicine. It works gradually, is usually well tolerated apart from early tingling, and is used alongside daily sunscreen.

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Key Facts
What is azelaic acid and what does it do?
What does the evidence show?
Who should avoid azelaic acid?
Is azelaic acid available in Singapore?
Prefer Not to Use WhatsApp?
Questions Patients Actually Ask
Azelaic acid vs niacinamide: which should you use?
Azelaic acid for pigmentation: what it can and cannot do
Availability in Singapore

Key Facts

What it is: A naturally occurring dicarboxylic acid used for acne, rosacea and pigmentation, with antibacterial, anti-inflammatory and pigment-modulating effects.
Also called: Nonanedioic acid
Pairs with: Sunscreen, niacinamide, gentle moisturisers, tranexamic acid; can be used alongside retinoids with care
Who should take care: People with a known allergy to azelaic acid or the product's base should avoid it.
In Singapore: It depends on strength and product.

What is azelaic acid and what does it do?

Azelaic acid is a dicarboxylic acid produced naturally by the yeast Malassezia and made synthetically for skincare and medicines. It reduces the growth of acne bacteria, normalises how cells line the pore, and calms inflammation, which is why it is used in acne and in the papules and pustules of rosacea. It also inhibits tyrosinase and preferentially affects overactive melanocytes, so it can lighten melasma and post-inflammatory hyperpigmentation without bleaching normal skin. It does not increase sun sensitivity in the way retinoids can, and it does not contribute to antibiotic resistance. Mild tingling on first use is common and usually settles. [1]

A woman by a window, hand resting against her cheek, skin evenly lit

“It does not increase sun sensitivity in the way retinoids can, and it does not contribute to antibiotic resistance.”
Dr Sin YongOn why azelaic acid is chosen

What does the evidence show?

A Cochrane systematic review found azelaic acid more effective than placebo for acne, though the certainty of evidence was low to moderate. Randomised trials support 15% gel for papulopustular rosacea, and comparative trials in melasma suggest 20% azelaic acid performs similarly to 4% hydroquinone in several studies, with variable quality. Reviews describe a favourable safety profile, with stinging and itching as the main side effects.

Who should avoid azelaic acid?

People with a known allergy to azelaic acid or the product's base should avoid it. Those with very sensitive skin or active eczema may find the tingling uncomfortable. Rarely, lightening of skin in darker skin types has been reported, so watch for patchy change. Pregnancy use should be discussed with a doctor, although it is often considered a lower-risk option.

Is azelaic acid available in Singapore?

It depends on strength and product. Medicated azelaic acid creams and gels at 15–20% are regulated as medicines in Singapore; the 20% cream is listed as a prescription-only medicine on the National Drug Formulary, so it is obtained through a doctor. Lower-strength azelaic acid or its derivatives appear in some cosmetic products. Check with a doctor or pharmacist which category a product belongs to.

If a dark patch, breakout or irritation is not responding to what you are using, the next step is a diagnosis rather than another product. See the Skin A–Z library for related ingredients.

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Questions Patients Actually Ask

What is Azelaic Acid used for?+

A naturally occurring dicarboxylic acid used for acne, rosacea and pigmentation, with antibacterial, anti-inflammatory and pigment-modulating effects.

Who should avoid Azelaic Acid?+

Can Azelaic Acid be combined with other skincare?+

It is commonly paired with Sunscreen, niacinamide, gentle moisturisers, tranexamic acid; can be used alongside retinoids with care; introduce one new active at a time and stop if irritation develops.

Can I buy azelaic acid over the counter in Singapore?+

Lower-strength azelaic acid products, commonly around 10%, are sold as cosmetics and can be bought over the counter. The medicated 20% cream is listed as a prescription-only medicine on Singapore's National Drug Formulary, so it is obtained through a doctor. If you are unsure which category a product belongs to, a doctor or pharmacist can confirm it.

Can I use azelaic acid during pregnancy?+

Azelaic acid is often considered one of the lower-risk topical options in pregnancy, because little of it is absorbed through the skin. Even so, any treatment used in pregnancy or while breastfeeding should be discussed with your doctor first, and that conversation is especially worthwhile for a prescription-strength product.

How long does azelaic acid take to work?+

Azelaic acid works gradually. Clinical trials in acne, rosacea and melasma typically assess response over months rather than weeks, and pigment tends to change more slowly than inflamed spots. Mild tingling in the first days is common and usually settles. If there has been no change after a reasonable trial, it is worth having the diagnosis checked.

Medically reviewed by Dr Sin Yong, MBBS (NUS), MRCS (Edinburgh) · Last updated 7 September 2026 · Editorial policy

Azelaic acid vs niacinamide: which should you use?

Azelaic acid and niacinamide do different jobs, so the choice depends on the problem rather than on which is stronger. Azelaic acid is the more targeted of the two: it acts on acne bacteria, on the way cells line the pore, on inflammation and on overactive pigment cells. Niacinamide is a form of vitamin B3 that supports the skin barrier and reduces the transfer of pigment to surface cells.

For acne, the papules of rosacea, melasma or post-acne marks, azelaic acid has the stronger evidence, with trials of the medicated strengths in each. For a sensitised barrier, mild redness or slightly uneven tone, niacinamide is often the gentler starting point.

They are not competitors and are commonly used together. A typical pairing is azelaic acid at one time of day and a niacinamide moisturiser at another, with sunscreen every morning. Introducing one new active at a time makes it easier to tell which one is responsible if irritation develops.

If a dark patch or breakout has not responded to either after a reasonable trial, the next step is a diagnosis rather than a third product, because some pigment sits too deep for any topical to reach.

Azelaic acid for pigmentation: what it can and cannot do

Azelaic acid can lighten pigment that comes from overactive melanocytes, such as melasma and the dark marks left after acne, but it works slowly and cannot reach every type of pigment. It inhibits tyrosinase, the enzyme that makes melanin, and acts preferentially on overactive pigment cells, so it does not bleach normal skin.

Comparative trials in melasma suggest that 20% azelaic acid performs similarly to 4% hydroquinone in several studies, although the quality of that evidence varies. It is often chosen for skin that does not tolerate stronger lighteners, and because it does not increase sun sensitivity in the way retinoids can.

What it cannot do is shift pigment lying deep in the dermis, such as Hori's naevus, or keep pigment away without sun protection. In Singapore's climate, ultraviolet and visible light keep stimulating melanin, so daily broad-spectrum sunscreen is part of any plan that includes azelaic acid.

Rarely, lightening of the surrounding skin has been reported in darker skin types, so patchy change is worth reporting. Where pigment has not responded, the type is diagnosed before laser or prescription treatment is considered.

Azelaic acid compared with other options for pigmentation and acne-prone skin
Option	What it does	What it cannot do	Typical recovery	Who it tends to suit
Azelaic acid (medicated 15–20%, or lower-strength cosmetic products)	Calms inflammation, reduces acne bacteria, normalises the pore lining and inhibits tyrosinase in overactive pigment cells	Clear deep dermal pigment quickly or replace sun protection	Applied at home; tingling or itching on first use is common and usually settles	Acne, the papules of rosacea, and melasma or post-acne marks, including skin that does not tolerate stronger lighteners
Niacinamide	Supports the skin barrier and reduces the transfer of pigment to surface skin cells, with a mild calming effect	Act on acne bacteria or match the evidence base of medicated pigment treatments	Applied at home; usually well tolerated, with occasional flushing or irritation	Barrier support and mildly uneven tone; often layered with azelaic acid
Hydroquinone (prescription medicine)	Strongly inhibits melanin production	Be used indefinitely without supervision	Used under medical supervision; irritation is possible	Melasma or stubborn pigmentation within a doctor's plan
Topical retinoids	Normalise cell turnover in the pore and speed the shedding of pigmented surface cells	Calm rosacea; they can irritate and increase sun sensitivity, and are avoided in pregnancy	Applied at home; dryness and peeling in the early weeks	Acne and texture, with pigment as a secondary target
Tranexamic acid	Interferes with signals that stimulate pigment cells; used mainly for melasma	Treat acne; the oral form needs a doctor's assessment and prescription	Topical forms are usually well tolerated; oral use is medically reviewed	Melasma, often alongside azelaic acid and sunscreen
Pico laser (in clinic)	Fragments pigment in the skin with very short pulses	Treat acne or replace daily sunscreen	Varies with settings and skin type; discussed before treatment	Pigment that topical treatment has not shifted, once its type has been diagnosed