Should I Use Azelaic Acid or Tretinoin?

If your main goal is softening fine lines, smoothing rough texture and fading sun damage, choose tretinoin. In a two-year placebo-controlled trial, it improved wrinkles and dark spots. Azelaic acid has not been tested for aging in randomized trials. Azelaic acid fits better if you are pregnant or trying, have rosacea bumps, or your skin cannot tolerate a retinoid. For acne, a six-month trial of 289 people found little or no difference in results between the two, and azelaic acid caused fewer side effects.

Which one should I use for my skin goal?

Pick the cream that matches what you want to change, not the one that sounds stronger. Tretinoin is the choice for lines, texture and sun damage. Azelaic acid is the choice for pregnancy, rosacea bumps, melasma and skin that reacts badly to retinoids.

Does tretinoin help wrinkles more than azelaic acid?

No trial has compared the two creams for wrinkles, but only tretinoin has been shown to work on them. In a two-year placebo-controlled trial, 0.05% tretinoin cream improved fine wrinkles, coarse wrinkles and dark spots on sun-damaged faces.

Azelaic acid's effect on skin aging has not been tested in randomized trials. Its strong evidence is for acne, rosacea and melasma.

Tretinoin is a prescription vitamin A cream. It speeds up how fast the cells lining your pores turn over. The Retin-A label lists acne as its approved use, and the wrinkle evidence comes from trials like the two-year one above.

Be realistic about sagging. Tretinoin works on the surface of your skin, and it does not replace lost volume. In r/30PlusSkinCare, a 37-year-old woman wrote that she had used "Tretinoin for about 10 years" and "SPF 50 every single day for years." She still noticed "much deeper marionette lines and nasolabial folds," the lines that run from the corners of the mouth toward the chin and from the nose to the mouth. The top reply said "no amount of creams and 'drink more water' suggestions will stop volume loss."

If your goal is smoother skin with fewer fine lines and sun spots, our clinical team can prescribe tretinoin when it fits.

Is azelaic acid as good as tretinoin for acne?

For blackheads and whiteheads, azelaic acid matched tretinoin in the one trial that compared them, and it was gentler. Adult acne is common at this age. One US study found acne in 35.2% of women aged 30 to 39 and 26.3% of women aged 40 to 49.

In that six-month trial, 289 people with blackhead-and-whitehead acne used either 20% azelaic acid cream or 0.05% tretinoin cream. Both cut the number of clogged pores. Azelaic acid caused fewer local side effects, such as irritation.

A Cochrane review rated that comparison as moderate-quality evidence. It concluded that azelaic acid probably makes little or no difference to results compared with tretinoin. That means neither one was shown to beat the other, which is not the same as being identical.

If acne is your only concern, the gentler cream may be easier to stick with. If you also want help with lines and sun damage, tretinoin covers both goals with one prescription.

Which one can I use while pregnant or breastfeeding?

Azelaic acid is the pregnancy-friendly choice. The Finacea label says very little reaches the bloodstream from your skin, so using it during pregnancy is not expected to expose the baby to the drug.

Dermatology guidance says to avoid topical retinoids, including tretinoin, during pregnancy. The Retin-A label says no adequate studies have been done in pregnant women. It says to use tretinoin in pregnancy only if the potential benefit justifies the potential risk. It also says anyone who is pregnant, might be pregnant or is nursing should check with her prescriber before using it. Tell your clinical team if you are pregnant, trying or breastfeeding.

For breastfeeding, azelaic acid is naturally present in breast milk. The Finacea label says that when you use it as prescribed, it is unlikely to change the levels in your milk, so it is not expected to expose the baby.

What side effects do azelaic acid and tretinoin cause?

Both can irritate your skin at first. Tretinoin tends toward redness and peeling, and azelaic acid tends toward itching and stinging.

Tretinoin can cause redness and peeling where you apply it, and some discomfort or peeling in the early days. If the irritation is strong, the Retin-A label says to use it less often or stop for a while.

About half an inch of tretinoin cream or less should cover your whole face at night. Every morning, put on a moisturizer that won't clog pores or one with sunscreen. The label says tretinoin has caused severe irritation on skin with eczema, so tell your clinical team if you have it.

Azelaic acid goes on in a thin layer twice a day. It can itch, burn or sting, usually during the first few weeks, according to the Finacea label.

The same label lists two less common warnings for azelaic acid. There are isolated reports of lighter patches of skin, so women with darker skin should watch for early signs. Worsening asthma has also been reported.

If you want smoother skin with fewer fine lines and sun spots, take the quiz so our clinical team can see whether tretinoin fits your plan.