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Aze7.5
Azelainsäure – Forschung
Überwiegend Mechanismus / Beobachtung
18 begutachtete Studien
Was die Evidenz sagt
Überwiegend Mechanismus / Beobachtung
Die meisten Studien zu Azelainsäure sind mechanistisch oder beobachtend statt RCTs, die einen klinischen Effekt messen — betrachte die Ergebnisse als vorläufig.
Die meiste Evidenz stammt aus hochwertigen Meta-Analysen und randomisierten Studien, veröffentlicht 1989–2026 mit einer typischen Studiengröße von 215 Teilnehmenden.
Basierend auf 18 Studien · 3 Meta-Analysen · 5 RCTs · 4,212 Teilnehmende insgesamt
Konfidenz
Hohe Konfidenz
Nach Outcome
Safety profile
Überwiegend Mechanismus / Beobachtung5 Studien
Skin tone & pigmentationDeutliche Reduktion von Melasma und postinflammatorischer Hyperpigmentierung (am stärksten in verschreibungspflichtiger Konzentration) · 8-24 weeks
Überwiegend Mechanismus / Beobachtung5 Studien
Skin healthReduzierte entzündliche und komedonale Akneläsionen (am stärksten in verschreibungspflichtiger Konzentration) · 4-12 weeks · Klareres, beruhigteres, ebenmäßigeres Hautbild (reduzierte Rötung und Unreinheiten); ein dermatologischer Effekt, kein Feuchtigkeitseffekt · 8-15 weeks
Zu wenige bewertete Studien2 Studien
Hair & nails
Zu wenige bewertete Studien1 Studie
Wound & ulcer healing
Zu wenige bewertete Studien1 Studie
Aktives Forschungsgebiet
12 Studien in den letzten 5 Jahren · Neueste Meta-Analyse: 2026
198920072026
1Meta-Analysen=2,752 · very large study2025
Registration Protocol available via doi.org/10.1002/14651858.CD013550.
Kam KW, Mehraban Far P, Yim TW, Chen LJ, Mak CY, Young AL, supported by the Cochrane Eyes and Vision Review Group. · The Cochrane database of systematic reviews (2025)
We used fixed-effect meta-analysis to combine data and forest plots to assess heterogeneity, effect size, and direction.
Topical corticosteroids plus antibiotics probably result in greater reduction in corneal staining scores compared with antibiotics alone (MD -1.26, 95% CI -1.56 to -0.96; 1 study, 148 participants; moderate-certainty evidence).
However, this effect was not observed for tear breakup time when antibiotics alone are likely to perform better (MD -1.10, 95% CI -1.39 to -0.81; 1 study, 148 participants; moderate-certainty evidence).
This clinical review aims to equip physicians to diagnose acantholytic disorders and provide expert treatment recommendations based on emerging evidence.
Zhou MH et al. · Journal of the American Academy of Dermatology (2026)
Direct SERCA activators may hold potential for treatment of Darier disease.
This clinical review aims to equip physicians to diagnose acantholytic disorders and provide expert treatment recommendations based on emerging evidence.
Overall, adjunctive treatment with cosmeceuticals might reduce the side effect profile of standard therapies such as dryness, itching, scaling and erythema, promoting treatment compliance and improving acne outcomes.
Searle TN, Al-Niaimi F, Ali FR. · Skin health and disease (2026)
There is most evidence, in human clinical trials, to support the use of topical retinol, BPO and azelaic acid.
Further research with large-scale robust human clinical trials are required to go beyond in vitro studies.
Most research has focused on mild-to-moderate acne and few studies have looked at the use of cosmeceuticals in more severe acne.
The stability of formulations and varying contradictions may create obstacles to the use of topical vitamins.
Mukhopadhyay P et al. · Clinics in dermatology (2026)
Topical formulations of vitamins are usually well tolerated, but their side effects, such as irritation and a burning sensation, can be troublesome.
The formulation challenge is a significant limitation, as incorporating the active ingredient into an appropriate vehicle and delivering it to the desired site of action can be complicated for several vitamins.
The stability of formulations and varying contradictions may create obstacles to the use of topical vitamins.
Low rates of irreversible adverse events with PSAL may support trials in refractory cases, but long-term RCTs with larger sample sizes are required to evaluate durability and recurrence outcomes.
Chua KR et al. · The Australasian journal of dermatology (2026)
Pooled effect sizes were calculated using a random-effects model.
Change in MASI favoured triple combination cream (TCC) over PSAL therapy (MD = 1.82, 95% CI: 1.11, 2.52, I2 = 0%).
Post-inflammatory hyperpigmentation was more common in the PSAL group compared to topical creams (OR = 6.86, 95% CI: 1.47, 32.07, I2 = 0%) but had no difference with the Q-switched lasers (OR = 4.09, 95% CI: 0.62, 26.97, I2 = 0%).
Clinicians should also integrate local metabolic optimization with medical and lifestyle management to create the optimal wound healing environment for patients.
Other chemopreventive agents, such as systemic retinoids, may be considered in select high-risk patients but are limited by adverse effects.Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.
Nelson M MD, FAAFP et al. · FP essentials (2026)
Artificial intelligence tools and teledermatology show promise for triage and access but are not yet standard for population-level skin cancer screening.
Sun protection through public education, topical sunscreen application, UV protective clothing, and sun avoidance during peak UV hours remains the mainstay of skin cancer prevention.
Oral nicotinamide reduces new nonmelanoma skin cancers in high-risk immunocompetent patients.
8Meta-Analysen=21 · very small study2025
Brimonidine and oxymetazoline both have significant effects on reducing facial redness.
Gao X, Xiang W. · Actas dermo-sifiliograficas (2025)
Ivermectin is more effective than azelaic acid and metronidazole.
Azelaic acid has a better efficacy profile than metronidazole according to included studies.
Minocycline turned out to be effective improving the symptoms of rosacea.
Rational selection and engineering of carriers, particularly DES-integrated polymeric and lipid systems, can mitigate solubility and permeability limitations, enhance skin targeting, and reduce irritation in the treatment of acne and rosacea.
Petrovici AG, Spennato M, Bîtcan I, Péter F, Cotarcă L, Todea A, Ordodi VL. · Pharmaceuticals (Basel, Switzerland) (2025)
Across indications, 15-20% azelaic acid (AzA) formulations produced clinically meaningful improvements with mild, transient local irritation.
For rosacea, the 15% gel formulation was comparable to metronidazole in reducing papules, pustules, and erythema while maintaining negligible systemic exposure.
In melasma and other dyschromias, 20% cream demonstrated efficacy similar to hydroquinone, exhibiting a favorable safety profile.
Delgocitinib cream resulted in an improvement in the transcriptomic profile of lesions and may have potential as a topical treatment for FFA.
Martin A et al. · The Journal of investigative dermatology (2026)
After 12 weeks, expression of the T helper 1-related biomarker CXCL9 was significantly downregulated (-3.10; P < .05), whereas there were nonsignificant reductions in CXCL10 (-2.60; P < .1) and IFN-γ (-1.49; P = .22) in lesions treated with delgocitinib cream but not cream vehicle.
Delgocitinib-treated lesions had a small but significant mean improvement in transcriptomic profile (4%; P < .001), whereas lesions treated with cream vehicle worsened (33%).
Topical 0.02% tacrolimus in combination with prednisolone may represent a safe adjunctive strategy in high-risk PK.
Izquierdo L Jr et al. · International ophthalmology (2026)
Graft rejection occurred in 15 of 41 eyes (36.6%), with 60% of these episodes being reversible and 40% irreversible.
The remaining 26 eyes (63.4%) maintained clear grafts without signs of rejection.
The most frequent high-risk clinical features were corneal neovascularization in 21 eyes (51.2%), ocular surface disease in 9 eyes (21.9%), and persistent inflammation in 7 eyes (17.0%).
There was high quality evidence to support the effectiveness of topical azelaic acid, topical ivermectin, brimonidine, doxycycline and isotretinoin for rosacea.
van Zuuren EJ, Fedorowicz Z, Carter B, van der Linden MM, Charland L. · Cochrane Database Syst Rev (2015)
Cochrane review of 106 RCTs (13,631 participants) of rosacea treatments with GRADE quality assessment
Azelaic acid was more effective than placebo for papulopustular rosacea, rated HIGH-quality evidence (participant-assessed RR 1.46, 95% CI 1.30 to 1.63)
Trials comparing azelaic acid head-to-head with metronidazole gave contradictory results on which is superior
Use of 15% azelaic acid gel twice daily for 15 weeks demonstrated significant superiority over using 0.75% metronidazole gel in improving principal signs of rosacea.
Elewski BE, Fleischer AB Jr, Pariser DM. · Arch Dermatol (2003)
Multicenter, double-blind, randomized head-to-head trial in 251 patients with moderate papulopustular rosacea over 15 weeks
Azelaic acid beat metronidazole on inflammatory-lesion reduction (-72.7% vs -55.8%, P<.001) and erythema improvement (56% vs 42%, P=.02)
Neither treatment improved telangiectasia; both were well tolerated with no serious adverse events
BPO + CLN demonstrated greater efficacy than AzA in the treatment of mild-to-moderate acne vulgaris and has a positive tolerability and safety profile.
Schaller M, Sebastian M, Ress C, Seidel D, Hennig M. · J Eur Acad Dermatol Venereol (2016)
Randomized assessor-blinded head-to-head trial (215 patients) of benzoyl peroxide 3%/clindamycin 1% vs azelaic acid 20% over 12 weeks
Azelaic acid did reduce lesions (inflammatory -65.3%, total -53.9%) but was significantly less effective than BPO+clindamycin (-78.8%, -69.0%; P<0.0001)
Azelaic acid caused more application-site reactions (35.8% of patients) than BPO+clindamycin (15.7%) — the key acne counter-evidence
Azelaic acid (20%) was significantly more effective than 2% hydroquinone but not when compared to 4% hydroquinone.
Rajaratnam R, Halpern J, Salim A, Emmett C. · Cochrane Database Syst Rev (2010)
Cochrane review of 20 RCTs (2125 participants) covering 23 melasma treatments; pooling limited by heterogeneity
Azelaic acid 20% beat 2% hydroquinone (RR 1.25, 95% CI 1.06 to 1.48) but showed NO significant advantage over 4% hydroquinone (RR 1.11, 95% CI 0.94 to 1.32)
Authors concluded the overall quality of melasma trials was generally poor — a key limit on the depigmenting claim
AZA is an inhibitor of tyrosinase, mitochondrial respiratory chain enzymes and DNA synthesis, and is a scavenger of harmful free radicals and inhibits the production of reactive oxygen species by neutrophils.
Sauer N, Oślizło M, Brzostek M, Wolska J, Lubaszka K, Karłowicz-Bodalska K. · Postepy Dermatol Alergol (2023)
Reviews azelaic acid's mechanisms: anti-inflammatory, antioxidant, and antimicrobial activity against Cutibacterium acnes
Tyrosinase inhibition plus a selective effect on hyperactive melanocytes underlies its use in melasma and post-inflammatory hyperpigmentation
Commercial topical formulations contain 5% to 20% azelaic acid (cosmetic and drug status); topical use is well tolerated with mild, transient local irritation