Azelaic Acid 15% Gel: The Versatile Foundation of Combination Therapy in Mild to Moderate Rosacea in Various Patient Types

Rosacea is a common, chronic dermatologic condition occurring predominantly in adult, white individuals of Celtic or Northern European ancestry. However, rosacea can also occur in people with skin of color and is often misdiagnosed in these patients. Rosacea is thought to have a multifactorial pathophysiology. Thus, an optimal foundation therapy should provide mechanisms of action that address these multiple pathophysiologic factors and have the ability to be easily combined with additional therapeutic modalities. Azelaic acid has anti-inflammatory and antimicrobial effects and has demonstrated clinical efficacy in treating both subtype 1 and subtype 2 rosacea in combination with other pharmacologic agents and laser therapy. It is also useful in addressing the hyperpigmented macules commonly seen in patients with skin of color who have inflammatory disorders such as rosacea. The objectives of this article are to review the rationale for first line use of azelaic acid and to evaluate the versatility of azelaic acid combined with various therapeutic regimens for mild to moderate rosacea in patients with different skin types.