Application of Azelik gel for acne, blackheads, post-acne, comedones and rosacea

Azelik is perhaps one of the most effective and frequently prescribed remedies for acne and acne on the face. When used correctly, you can significantly speed up the cleansing of skin rashes, as well as prevent new ones. The drug, due to its azelaic acid content, copes well with inflammatory processes that arise in the epidermis.

Azelik's action

The gel quickly penetrates the epidermis and has a number of beneficial effects:

• moderate anti-inflammatory;
• antioxidant;
• antimicrobial;
• antikeratic (prevents the coarsening of the epidermis and the formation of “goose bumps”);
• anti-pigment;
• sebum-regulating.

Its active ingredient, Azelaic acid, is a natural compound for the skin, formed during the oxidation of fatty acids. Due to this degree of “relatedness”, this substance penetrates well and quickly into the epidermis, but does not directly harm the cells themselves. For this reason, Azelik is safe, and most importantly, can be used for a long time. On the other hand, a long course is also possible due to the lack of formation of microbial resistance, as, for example, often occurs in bacteria to antibiotics.

Mechanism of action of azelaic acid

Back in the 70s, studies were conducted that proved that azelaic acid can fight hyperpigmentation.

Later, scientists found out that AK also has an anti-comedinal effect, and they began to include it in acne treatment courses.

AA competitively inhibits some enzymes that reduce oxygen, for example, thioredoxireductase, oxidoreductase, tyrosinase, etc. In addition, azelaic acid slows down the activity of the anaerobic glycolysis enzyme hexokinase, 5-reductase.

Azelaic acid is able to neutralize free radical forms of oxygen and slows down the process of their production by neutrophils, which indicates its antioxidant effect.

Without affecting the growth of normal cells, AA is an inhibitor of DNA synthesis and has a suppressive effect on the activity of mitochondria in tumor cells. Azelaic acid exhibits antibacterial activity against anaerobes and aerobes.

The possibility of its inclusion in anti-acne therapy is due to the fact that AA has anti-inflammatory, antibacterial, antiproliferative effects and affects many parts of the pathogenesis of acne. Resistance does not develop to azelaic acid.

Indications for use

According to the instructions for use of Azelik, there are only 2 official indications, namely:

• mild to moderate acne
• rosacea, including papulopustular form.

However, the spectrum of action of the drug is not limited to this. It can be used to treat acne, purulent and subcutaneous, fungal (as part of combination therapy) and microbial nature, blackheads and hair follicles not only on the face, but also on the back and other parts of the body.

Anti-inflammatory effect18

What remedy helps with acne on the face? Something that affects the main phases of acne pathogenesis. Inflammation is considered the primary factor in the development of acne, preceding hyperkeratosis9.

The anti-inflammatory effect of azelaic acid is based on several mechanisms18:

• suppresses UVB-induced production of pro-inflammatory cytokines interleukins;
• increases the expression of PPAR-γ, which leads to a slowdown in cell proliferation;
• reduces the level of free radical oxidation.

Contraindications

Azelik has only one general contraindication:

• hypersensitivity to the components of the drug.

As well as contraindications due to age:

• +12 years for acne treatment;
• +18 years - for the treatment of rosacea.

In children aged 12 to 18 years, Azelik® is used in the treatment of acne; no dose adjustment is required.

https://azelik.ru/instruktsiya/

So, if you doubt whether this drug can be used for a teenager, here is official confirmation - it is possible.

Also, I would not recommend the use of drugs with azelaic acid during pregnancy and breastfeeding. Because, according to research, it enters the systemic bloodstream. However, I have not found any evidence that the active substance can penetrate the placental barrier, but I am inclined to believe that it can more often than not.

Side effects

Despite the general safety of the drug, even in adolescents, all sources contain a lot of information about side effects. It’s good that it’s accessible and not hidden.

Here are some of them noted by people themselves:

• after applying the gel itching appears;
• burns the skin;
• stings the face;
• redness and irritation appear;
• peeling appears;
• The strangest thing is that even more acne appears.

What does the manufacturer write about this?

at the beginning of treatment, local irritation, hyperemia and peeling of the skin, burning, erythema, itching are possible, which usually cease during treatment; Possibly allergic skin reactions.

In many ways the same thing, it turns out that people are warned before use about possible side effects, which usually go away with further use. And how to prevent them from appearing or causing discomfort, read in the Application section.

Summarizing the above, I can say that clear contraindications are allergic reactions, especially of the immediate type: urticaria, Quincke's edema, etc.

After information about possible side effects in the form of dryness and flaking of the skin, the hand will involuntarily reach for a moisturizer. But not so fast! Not every cream will do. It is necessary to give preference to non-greasy creams without comedogenic components. After all, Azelik is used to treat existing pimples and there is no need to clog the pores with cream in order to also treat new pimples. An alternative to creams are fluids, milks and gels. Preference should be given to cosmetics that are suitable in composition, possibly pharmacy or professional cosmetics.

About correct use

Before applying Azelik to your skin, be sure to remove all makeup with a product specifically designed for this purpose and wash your face with a good cleanser.

If there are a lot of large acne vulgaris at the site of inflammation, it is recommended to wash such lesions with boric, sulfur or tar soap after the cleansing gel. After washing your face, pat your face dry with a clean paper towel to remove excess moisture. Now you can start applying.

Application

If you have acne, the first thing you should think about is hygiene. This is not only a wash, but also applies to everything that touches your face:

• scarf;
• jacket hood;
• sweater collar;
• pillowcase;
• hands of course.

Therefore, after washing, while your hands are still clean, you can apply Azelik with your finger. But it is better to use a hygienic cotton swab or a special spatula for creams.

When applying the gel with your hands, be sure to take care that you do not have to get it from somewhere, touching everything in your path with your hands.

For the whole face or just for spots?

The method of using Azelik gel depends solely on the condition of the skin at the moment. Based on how many rashes there are, whether they are located in groups or individually, it depends on how to apply the product - completely over a large area and the entire face or to problem areas individually.

When applied to healthy dermis, of course, there will be no harm (in rare cases, dryness may only appear). However, the consumption of the gel will increase by an order of magnitude, and it will run out faster. To avoid this, follow the rule: the pimple should be completely covered, but no more.

When absorbed, the drug will be slightly distributed over the surrounding area. Remember that a large amount of azelaic acid applied at one time will not replace its systematic application.

To rinse or not to rinse, that is the question...

Those who use Azelik for the first time may have a logical question about whether it needs to be washed off? Let's figure it out.

There are two fundamentally important points:

• the first is the adaptation of the skin and possible, although infrequent, allergies, and much more frequent chemical burns and irritations at the beginning of treatment;
• the second is the cumulative effect of azeleaic acid, i.e. the drug with it will be more effective, the more acid accumulates in the lesions (and microbes, by the way, too!).

Therefore, if you experience irritation and the feeling that a chemical burn has occurred, then the product must be washed off. Otherwise, it should not be washed off.

Application frequency

According to the instructions, Azelik must be applied to the affected area 2 times a day: morning and evening. There is no point in applying it more often; in this case, there will be no clinically significant improvements, but you can easily dry out the epidermis. In addition, it is also necessary to emphasize hygiene and proper skin care.

If treatment with other local drugs is carried out simultaneously, the final result will depend on the drugs themselves. In this case, application can be either joint or separate, and the frequency range is from 1 to 2 times a day. More details about combinations are written below in the “Analogues” section.

About the course of treatment

The duration of use of the drug directly depends on the condition of the skin and the frequency and extent of rashes. The more there are, the proportionally and longer the gel will have to be used.

You shouldn’t be afraid of this, azelaic acid has a beneficial effect on the epidermis (if you don’t have allergies, and you will know about it right away) and it can be used for a long time, including several months in a row. In this case, it is better for teenagers to consult a dermatologist. After the course, it is necessary to take a break before repeating the course of treatment, but sometimes it happens that the skin is healed and the need disappears.

Acne is one of the most common skin diseases in daily dermatological practice. Acne accounts for 22-32% of all cases of dermatological pathology [1]. The progressive course of acne, tolerance to therapy, and cosmetic imperfections sharply reduce the quality of life of patients, causing significant discomfort and psycho-emotional disorders [2].

Pathogenesis

Many dermatologists consider acne to be a disease of “transitional” age - these are the so-called “physiological acne”, which resolve spontaneously. Indeed, about 60% of acne resolves on its own or requires minor intervention. The consequences of resolved acne can be expressed in the form of scars and persistent hyperpigmentation, which are difficult to treat. Early treatment of acne prevents scarring and reduces emotional stress. In 40% of cases, acne can last for years, especially in women, causing significant discomfort, scarring, and psychological breakdowns. Thus, it has been shown that in the USA, 50% of women suffer from acne at the age of 29, 35% at the age of 30, 26% at the age of 40 and 15% at the age of 50 [3]. The long course of the disease leads to depression, which is especially pronounced in women [4]. In this regard, the international association of doctors, Global Alliance to Improve Outcomes in Acne, currently proposes to consider acne as a chronic disease [2].

The causes of chronic acne have been studied by many groups. It is believed that the chronic release of androgens by the adrenal glands, a decrease in local immunity, leading to colonization of the skin by the bacteria Propionibacterium acnes

, certain forms of acne (conglobate, keloid or inverse acne, pustules, scalp folliculitis, abscessive and erosive folliculitis and Hoffmann's perefolliculitis) predispose to a chronic course of the disease. Analysis of factors predisposing to the development of acne showed that the most significant parameters are: the presence of the disease in the family (complicated medical history), obesity or overweight, and early sexual development [5-8]. No associations of other parameters (age, gender, skin color, environmental factors, age of the first episode of the disease, genetic mutations, atypical and usual localization of lesions, relationship with the menstrual cycle, seasonal variability, smoking, diet) with the severity of acne have been identified [5-8 ]. With inverse acne, 93% of patients have a history of smoking and 77% are obese [4].

A 2014 expansion study in the UK compared the genomes of 1,900 patients with severe acne with the genomes of 5,100 healthy people. As a result, three loci were identified (11q13.1, 5q11.2 and 1q41) associated with acne [9]. All three loci contain the genes for the transforming growth factor β (TGF-β) signaling pathway proteins OVOL1, FST and TGFB2. Patients have reduced transcription of these genes. TGF-β is one of the main agents that suppress the hyperactivation of cells of the immune system and endothelium. In addition, TGF-β controls sebocyte differentiation. A high level of TGF-β ensures the maintenance of sebocytes in an undifferentiated state. A low level of the factor leads to differentiation of sebocytes, increased expression of the FADS2 and PPARγ genes, which are responsible for the synthesis of characteristic lipids of sebocytes and lipid accumulation, which in turn contributes to the development of acne [10, 11].

TGF-β is one of the regulators of the expression of endothelial ectonucleoside triphosphate diphosphohydrolase (NTPDase), which regulates the local response of Langerhans cells to pathogens ( P. acnes

) through the hydrolysis of adenosine tri- and diphosphate to adenosine [12]. Adenosine, in turn, is a suppressor factor that inhibits the activity of any cells. Thus, in mice with the NTPDase (CD39) gene deleted on Langerhans cells, irritants caused severe inflammation [13]. In addition, limited studies [14] have shown a possible association of acne with interleukin-10 (IL-10) and tumor necrosis factor α (TNF-α) gene polymorphisms. IL-10 also has a suppressive effect on Langerhans cells, and TNF-α is an inducer of CD39 expression [12].

In addition to genetic predisposition, diet plays a big role in the formation of acne. The association of acne with excess body weight, early puberty, and high stature is known [5-8]. In a study by C. Berkey et al. [14] describe the results of the Growing Up Today Study, conducted with the participation of 13,000 English schoolchildren, which showed a high correlation of milk consumption with weight gain. Further observation of these children allowed us to establish a direct connection between milk consumption, increased body weight and the occurrence of acne [15, 16].

It is clear that the pathogenesis of acne is associated with increased sebum production and an imbalance of lipids in the secretion of the sebaceous glands. Colonization of P. acnes

may be a trigger of inflammation through activation of Toll-like and protease receptors on innate immune cells, which leads to the synthesis of antimicrobial peptides and interleukins. However, it is known that the formation of comedones and the development of inflammation can also occur under sterile conditions [17]. The inflammatory process in the area of ​​the pilosebaceous follicle leads to the development of follicular hyperkeratosis and obstruction of the ducts of the sebaceous glands (microcomedone, comedo).

Summarizing the features of acne pathogenesis, we can distinguish two groups of factors that are involved in the development of the disease. In the first case, these are factors mediated to a greater extent by high levels of hormones, increased body weight, a dairy diet and, as a result, increased activity of the sebaceous glands; in the second, these are factors mediated primarily by genetic reasons. Lack of TGF-β production leads to sebocyte differentiation and increased lipid production, as well as decreased CD39 expression and decreased hydrolysis of the energy carriers ATP and ADP, which together create an energy-rich lipid depot.

Acne therapy

Microbiological and endocrinological examinations are not mandatory when making a diagnosis and choosing therapy [2]. The main pathogen most commonly cultured in acne is the gram-positive bacterium P. acnes

, which are a normal part of the skin flora.
In some patients, nodular and pustular elements are caused by various gram-negative microflora. In these cases, conventional antibacterial therapy for acne is ineffective, which may require microbiological studies to select therapy [18] (see figure)
.

Figure 1. Algorithm for diagnosing and treating acne.
It should be noted that most acne patients have normal hormone levels. Since sebum secretion is stimulated by androgens and correlates with serum dehydroepiandrosterone sulfate (DHEA) levels, a relationship between these parameters can be assumed. However, even elevated androgen levels in severe acne are within the physiological norm, which casts doubt on the direct cause-and-effect relationship between hormone levels and the presence of acne [19]. It is highly likely that there is an unknown factor that plays a significant role in the initiation of acne against the background of increased androgen levels. At the moment, endocrinological testing is indicated only for patients with signs of androgen excess: menstrual irregularities, excess male pattern hair growth, androgenic alopecia, infertility, acanthosis nigricans, obesity [18].

Women with symptoms of hyperandrogenism may experience late-onset acne that is resistant to treatment. If hormonal testing is necessary, it is recommended to determine the hormonal spectrum of the blood: the level of 17-hydroxytestosterone, DHEA, luteinizing and follicle-stimulating hormones. In general, for women with signs of peripheral hyper- or hypoandrogenism, the use of combined oral contraceptives in combination with other acne treatments is an effective treatment method [20].

Therapeutic methods of combating acne consist of treating the affected areas, preventing complications (scars, dyschromia) and suppressing the emergence of new lesions. Treatment of acne is determined by the severity of the pathological process and the nature of its course. Topical therapy is the standard treatment for acne and is prescribed to patients regardless of the severity of the disease. External treatment includes the use of retinoids, benzoyl peroxide (BPO), topical antibiotics, combination drugs, azelaic acid (AA) [18].

AA is a dibasic saturated carboxylic acid, which is formed naturally on normal skin during lipid metabolism and is found in small quantities (4-90 ng/ml of blood) in the human body [19]. After application to the skin, AK preparations easily penetrate the epidermis and dermis. Up to 4% of the total dose enters the systemic circulation. AA has moderate anti-inflammatory, antioxidant, antimicrobial and antikeratinizing effects. Due to the presence of two carbon groups, AA is able to form complexes with divalent cations of calcium and magnesium, cofactors of enzymatic reactions, and also bind free radicals [19]. There is evidence that AK suppresses melanin synthesis by inhibiting the enzyme tyrosinase, which may be undesirable with long-term use of AK in patients with dark skin color due to the appearance of depigmentation [21]. On the other hand, for fair-skinned patients, the effect of AA tyrosinase inhibition is used to treat post-inflammatory hyperpigmentation [22]. AA also has an antiandrogenic effect, suppressing the synthesis of type I 5α-reductase, which leads to a decrease in the content of dehydrotestosterone in sebocytes, thereby normalizing the processes of keratinization and sebum secretion [23]. It has been shown that AA eliminates hyperkeratosis at the mouth of the sebaceous gland follicle, apparently reduces the thickness of the epidermis, and with long-term use leads to normalization of the differentiation process of epidermal cells [24].

There is data on bactericidal action against gram-positive and gram-negative microorganisms, including antibiotic-resistant strains [25]. In the literature of recent years, there is information on the antifungal effect of AK. in vitro experiments

It has been shown that 1% AA has an effect on fungi of the genus
Pityrosporum ovale and Candida albicans
, which are resistant to antibiotics, and resistance to AA itself does not develop in microorganisms even with prolonged exposure [26].

AA is widely used in the treatment of acne. According to clinical studies [2, 27], AK is effective both as monotherapy and in combination with antibiotics, retinoids and BPO. AK in the form of monotherapy can be recommended for maintenance therapy, for the treatment of comedonal acne, papulopustular acne of mild to moderate severity. Efficacy and favorable safety characteristics are important advantages of AKs in long-term treatment. When comparing the effectiveness of AK with BPO, local retinoids, also prescribed in the form of monotherapy, a similar therapeutic effect was shown. Thus, in the work of H. Gollnick et al. [28] presented data from 2 clinical studies examining the effectiveness of 15% AA gel compared with 5% BPO gel and 1% clindamycin gel, which included 351 and 229 acne patients. The authors showed that when using the drugs for 4 weeks, an effectiveness of 70% was achieved in reducing the number of inflammatory elements in all groups. Side effects in the form of local burning and irritation were more pronounced in the group of patients using BPO than in the group with AK. Minimal side effects were observed in the group of patients who used clindamycin gel for treatment. In a study by G. Stinco et al. [29] studied the sebostatic effect of AA, adapalene and BPO in the treatment of 65 patients with moderate acne. Using sebumetry, the level of sebum secretion in the facial area was assessed. All drugs used had a comparable therapeutic effect. The level of sebum in all areas of the face (forehead, chin, cheek) decreased more in patients who used AA (14, 14 and 15%, respectively). In the group of patients using BPO, there was also a decrease in sebum (10, 10 and 25%), while adapalene had no effect on the amount of sebum on the forehead (0.2%), on the cheeks it decreased by 7%, and on the chin increased by 6% [29]. Thus, this study showed that there is no correlation between clinical effectiveness and reduction in sebum levels in various areas of the face in patients with acne. The authors concluded that AK is an effective topical agent for the treatment of acne, which has a pronounced sebostatic effect. When studying the safety of topical medications, a trend toward better tolerability/safety of AA compared to topical retinoids and BPOs was noted.

AA is also used to treat rosacea. Two multicenter, double-blind, randomized studies involving 670 patients with papulopustular rosacea were conducted in 2003 to study the effectiveness of monotherapy with 15% AA gel. The gel was applied twice a day. Both studies showed a significant therapeutic effect of AC, expressed in a decrease in the number of inflamed elements (58% versus 40%), improvement in erythema (44% versus 29%), and improvement in the overall disease severity index (62% versus 40%) [30]. No significant side effects were observed during the studies.

An analysis of data from clinical studies and reviews, which included studies since 2004 collected in the Ovid, MEDLINE, and EMBASE databases, showed that BPO, topical antibiotics and retinoids in various combinations are effective and safe in the treatment of moderate to moderate acne [31]. There are practically no studies comparing the effectiveness of various combinations and the price/effectiveness balance. In addition to these drugs, drugs are used, which include topical dapsone, salicylic acid and AK, topical zinc preparations, the effectiveness of which has also been proven in clinical studies [31]. European acne treatment guidelines recommend a combination of adapalene and BPO; clindamycin and BPO; erythromycin and tretinoin; erythromycin and isotretinoin, erythromycin and zinc [32].

The European Guidelines for Acne Therapy draw the attention of clinicians conducting clinical trials to the criteria for assessing the best clinical effectiveness of a particular combination. One clinical study specifically examined the level of improvement that patients rate as a treatment effect and showed that patients considered treatment successful if the number of lesions decreased by 10-15% [33]. This limit can be used to compare the effects of therapy with different combinations: a drug is considered more effective if the number of lesions is reduced by more than 10% compared to monotherapy or other combinations [33]. In general, monotherapy with retinoids, AA or BPO is recommended for comedonal acne. For papulopustular acne, the treatment of choice is BPO in combination with adapalene or clindamycin [2, 32]. AC, BPO, topical retinoids as monotherapy or systemic antibiotics in combination with adapalene may also be recommended for the treatment of this form of acne [2]. For severe forms of pustular, nodular and conglobate acne, AK is used in combination with systemic antibiotics [2].

When comparing the effectiveness of various drugs for topical treatment of comedonal acne, the effectiveness of AK is at the level of drugs such as BPO, adapalene, isotretinoin and tretinoin [2].

The combination of drugs enhances the therapeutic effect, affects several stages of pathogenesis simultaneously, reduces resistance to antimicrobial agents and shortens treatment time. Many researchers note not only the possibility of combining AK with various drugs, but also show the greater effectiveness of combination therapy in the treatment of acne and rosacea.

The effectiveness of combinations of AA with retinoids, topical antibiotics and BPO was shown in a study in the treatment of mild to moderate papulopustular acne [34]. The same effect with combination therapy (AK with systemic antibiotics) is noted by researchers in the treatment of rosacea. Thus, a multicenter, two-phase study examined the effectiveness of combination therapy with 100 mg oral doxycycline and 15% AA gel in phase I, followed by maintenance therapy with AA alone in phase II for the treatment of patients with severe and moderate forms of papulopustular rosacea [35]. In phase I of the non-randomized study (n=172), the drugs were used twice a day for 12 weeks; phase II was conducted in a double-blind manner. The phase II study included patients who received phase I therapy for at least 4 weeks and achieved a reduction in the number of inflammatory lesions by more than 75% ( n

=136). Patients were divided into groups receiving AA or placebo for an additional 24 weeks. The number of inflammatory foci, the index of overall disease severity, the presence of erythema and spider veins were assessed. By 12 weeks of phase I therapy, 81% of patients achieved a 75% reduction in acne, and 64% of patients were cured. In phase II, AA therapy had a significantly better effect than placebo; 75% of patients remained in remission in the AC group during 6 months of maintenance therapy. There were no significant side effects in either group.

In a study by J. Del Rosso et al. [36] also demonstrated the effectiveness of this combination in the treatment of rosacea. Pilot comparative study ( n

=207) the effectiveness of 15% AA gel or 1% metronidazole gel in combination with the anti-inflammatory drug doxycycline at a dose of 40 mg daily for 12 weeks showed comparable effectiveness of both protocols.

The study of the effectiveness of combinations of AK with other topical agents in the treatment of acne has been shown in many domestic and foreign studies. In a multicenter, randomized, double-blind study conducted with the participation of 150 patients with moderate acne, the effect of 5% AA gel, 2% clindamycin gel, and their combination (clindamycin in the morning, AA in the evening) was assessed [37]. Treatment was carried out for 12 weeks, every 4 weeks the number of inflammatory and non-inflammatory elements, the severity index (ASI) was calculated, and the patients' assessment of the effectiveness of the therapy was recorded. It was shown that ASI significantly decreased in all three groups of patients. A decrease in ASI was observed in all study groups (48, 32 and 64% in the clindamycin, AA and concomitant therapy groups, respectively). However, in the group of combined therapy with AA and clindamycin, the effectiveness of treatment was more pronounced. Subjective patient assessment also correlated with ASI scores.

A similar study was conducted by the same group to evaluate the effectiveness of combination therapy for acne using a combination of 5% AA gel and 2% erythromycin gel [38]. The study included 147 patients with moderate acne; the duration of treatment was 12 weeks. In all three therapeutic groups (AK, erythromycin and combination therapy) the effect was significant. The combination of drugs was more effective compared to monotherapy. The result regarding the registration of side effects was quite unexpected: in the combination group, where patients received two drugs together, the proportion of side effects was lower compared to the erythromycin and AK monotherapy groups (27, 54 and 45%, respectively).

Currently, the management strategy for patients with acne includes not only active treatment methods, but also subsequent maintenance therapy using auxiliary treatments and/or cosmetics to maintain acne in remission. When choosing cosmetics to determine skin type, it is recommended to use non-invasive dermatological research methods - sebumetry, corneometry, pH-metry. This allows control over the prescription of optimal skin care products for patients with acne [39].

The introduction of AA into the composition of products used to cleanse the skin can effectively suppress the formation of inflammatory foci. Thus, in a limited, randomized, double-blind, 8-week study involving 13 patients with acne, the effect of using skin cleansers that included the therapeutic drugs triclosan, salicylic acid and AA was studied [40]. For control, conventional skin cleansing preparations were used. The comparison was carried out by assessing the effectiveness of using these products 2 times a day on the left and right sides of the face. It turned out that both a conventional cleanser and a product with therapeutic agents, which included AA, reduced the number of lesions, but only the therapeutic agent reduced the number of inflammatory elements, which was confirmed by histological studies.

In cosmetology, AK is actively used as a peeling for problematic, porous skin and for the treatment of post-inflammatory hyperpigmentation.

One study examined the effect of superficial AA peeling on sebum secretion in various areas of the face in 11 women aged 49-71 years. Peeling was done 5 times with an interval of 2 weeks. The sebum level was measured with a sebumeter. It was shown that AA increases the level of sebum in the U-zone, but does not increase it in the T-zone of the face [29]. As facial skin ages, an increase in the amount of sebum can have a cosmetic effect. AK is also used for pre-peeling preparation and post-peeling skin care in the complex treatment of mild to moderate acne and non-inflammatory post-acne. The use of peelings in combination with drug treatment of acne allows you to achieve a quick, lasting effect [41].

In the arsenal of a Russian doctor today there are several drugs containing AK, one of them is 15% Azelik

(Akrikhin).
Azelik
also contains squalane, which restores the barrier properties of the skin and improves the tolerability of the drug.
Squalane is a high-quality emollient that does not have comedogenic properties; it fills the spaces between the scales of the stratum corneum of the epidermis, softens and eliminates the feeling of tightness, and deeply moisturizes the skin. The effectiveness of the combination of AA with moisturizers was studied in a multicenter open study ( n
= 102) “Skin Condition Assessment” of patients with rosacea. The study compared the effect of applying a moisturizer after using 15% AK gel on one side of the face for 7 days. Assessment of the cumulative severity index showed a significant increase in effectiveness when using a combination of AA and a moisturizer in the treatment of rosacea [42].

Conclusion

AK is widely used in the practice of dermatologists and cosmetologists. Data from Russian and foreign studies allow us to conclude that AK is highly effective in the treatment of acne, rosacea and post-acne. A number of advantages, such as the presence of anti-inflammatory, antibacterial, antikeratinizing, antiandrogenic and antityrosinase effects, allow us to consider AK as an optimal topical remedy for the treatment of acne and the elimination of cosmetic problems associated with this disease.

Methods of using Azelik

The choice of method of application is based on the number of rashes and their severity. For a full effect on the skin, it is necessary to use the drug correctly.

For acne

Azelik is one of the most popular and often prescribed by dermatologists for the treatment of acne. Since it is not addictive, and it is well tolerated and has a high safety profile, it can be used both for single pimples, in people who do not suffer from skin diseases, and for massive lesions, for example, in people with acne.

This drug shows good results both in the treatment of subcutaneous acne and inflammation with a protruding purulent head. Because it acts on a very wide range of microorganisms (like many antibiotics combined). But its effect is bacteriostatic (inhibits the growth of bacteria), and therefore is not a panacea.

For acne

Acne is a type of acne that is more severe and is classified as a separate disease. It is also referred to as acne if the causative agent is C. acnes (can also be staphylococcus and others). Azelik for acne is prescribed if the severity of the disease is not higher than average and, as a rule, as part of complex therapy, so that such treatment is truly effective.

For acne itself, the drug is one of the drugs of choice, in mono- or complex therapy, since its high activity against these particular bacteria has been proven.

For comedones and blackheads

Azelaic acid, which is part of azelica, lightens blackheads well. However, this only happens until you stop using it. After all, these formations are constantly being formed, therefore the fight against them must be regular. To get the maximum effect, you need to pay attention to proper and regular cleansing of the epidermis and nutrition.

This remedy is also quite effective in the fight against comedones. Moreover, both with inflamed forms (without pus), subcutaneous forms, and ordinary dark sebaceous plugs.

For post-acne and age spots

Azelik is one of the most effective * drugs for lightening pigmentation, and more specifically for post-acne and age spots of other origin. Including seborrheic nature. This drug evens out skin tone by affecting pigment cells - melanocytes, as it normalizes their work. Also by improving the processes of cell renewal and exfoliation, preventing keratinization.

Fighting acne: treatment with Azelik® gel

Azelik® gel is based on 15% azelaic acid. Thanks to the micronized substance, it easily overcomes the stratum corneum, dissolving in the channels of the sebaceous glands and between skin cells. In addition to the main component, the composition includes the emollient squalane1, which helps soften and moisturize the skin.

Azelik® has a complex effect, affecting several links in the pathogenesis of acne, although the main blow is to bacteria and follicular hyperkeratosis. Azelik® has the following 2.5 actions:

• reduces the synthesis of fatty acids, which contribute to the appearance of acne;
• suppresses the development of abnormal melanocytes, which are the cause of hyperpigmentation, that is, it has a depigmenting effect.

Approximately 2.5 cm of Azelik® gel is enough to treat the entire face. In patients with acne, the first signs of improvement usually become noticeable after 4 weeks. To get the best results, use the drug for several months5.

Analogs

This popular medicine has many analogues.

Among them are:

• analogues in composition or structure;
• according to the effect they have, having other active components - non-structural.

Analogs in composition contain azelaic acid as the main active ingredient. Only funds registered in Russia are listed here.

For convenience, we will divide them into:

• creams: Azix-derm;
• skinclear;
• skinoren.

Replacement for azelic in the form of the drug

Let's compare to find out how different forms of medicinal products will affect the properties. And we will draw a conclusion about which one will be more effective.

In the form of a cream

Among the identical products: Skinoren, Skinoklira and Azix-derma, there are slight differences in composition.

The first two products are almost 99% identical, but Azix Derm contains silicone oil and appropriate emulsifiers. This means that it is highly likely to clog pores. And overall the efficiency will be less. However, the drying effect on the skin will be less.

As a gel

To compare, as well as draw conclusions about which of them is better, Azelik, Skinoren, or Skinoklir and to understand their differences, we will use a summary table for a visual demonstration.