Azelaic acid 10%, 15% or 20%: which strength?

Azelaic acid comes in three main strengths, and each one has a different level of evidence behind it. The 15% gel and foam are FDA-approved for rosacea. The 20% cream is FDA-approved for acne. Both need a prescription in the U.S. Products at 10% and below are sold in stores, carry no FDA approval, and have only small studies. This guide explains what each strength is approved for, what the studies found, and how to read the number on a label. For an overview of the ingredient, see what azelaic acid is.

The prescription strengths

Strength and form	FDA-approved for	Directions on the label	Main evidence
20% cream	Mild to moderate acne with red, swollen bumps	Thin film, twice a day	U.S. acne trials reported on its label
15% gel	Red bumps and pus bumps of mild to moderate rosacea	Thin layer, twice a day	Two 12-week trials, 664 adults
15% foam	Red bumps and pus bumps of mild to moderate rosacea	Thin layer to the whole face, twice a day	Two 12-week trials, 1,362 adults

DailyMed, the U.S. National Library of Medicine's database of drug labels, files all three as prescription drug labels and lists each under an FDA approval number. MedlinePlus sums up the split: the gel and foam are used for rosacea, and the cream "is used to treat the pimples and swelling caused by acne."

The percentage is the share of azelaic acid by weight. The 15% gel label says "each gram of azelaic acid gel contains 0.15 gm of azelaic acid." So a 20% cream holds 0.2 grams of azelaic acid in each gram.

The three labels share most of their directions. Wash and pat the skin dry, apply a thin layer, wash your hands afterward, and keep the product away from the eyes, the mouth and the moist skin inside the nose. The gel and foam labels add that makeup can go on once the product has dried.

Outside the U.S., the rules can differ. NICE, which writes acne guidance for England, defines topical azelaic acid in its guideline as a product at "15% azelaic acid" or "20% azelaic acid." A pharmacist can tell you what is sold where you live.

Is 15% or 20% stronger in practice?

The percentage matters, and so does the base the acid sits in. In a lab test described on the 20% cream label, 3% to 5% of the applied dose entered the top layer of skin. A 2024 review in Clinical, Cosmetic and Investigational Dermatology says a gel can raise the share absorbed through the skin to 8%, and that absorption "is influenced by concentration and dosage form." So two products with the same percentage can behave differently.

In practice, the two are used for different problems. A 2026 review in Skin Health and Disease says "concentrations of 15% have superseded the 20% formulations that caused dry skin and irritation." Both strengths have been tested in rosacea. A 2006 review in Archives of Dermatology found the 20% cream and the 15% gel both appear effective for rosacea bumps.

No trial Skinli found compared 15% and 20% directly for the same condition.

The evidence for 10% and lower

Store products usually contain less azelaic acid. The 2024 review says "the concentration of AZA used in cosmetic products is typically lower and often combined with other ingredients," and adds that some 15% and 20% skin care products are also sold.

The studies at 10% are small:

• A special 10% hydrogel for acne. A 2021 trial in Pharmaceutics compared a 10% hydrogel made with tiny azelaic acid crystals against 20% cream, twice a day for 8 weeks. Success rates were 36.51% with the 10% hydrogel and 30.37% with the 20% cream, and side effects were few and mostly mild. This hydrogel was built in a lab to push more azelaic acid into the skin, so its result applies only to that formula.
• A 10% cream for rosacea. The 2024 review lists an 8-week study of 30 people with mild to moderate rosacea who used a cream with 10% azelaic acid, glutathione and glycerol. Bump counts fell by 63%. The study had no comparison group, so the cream's share of that change is unknown.

DailyMed also lists some store creams at 10% to 15% as nonprescription products in a category it calls "unapproved drug other." That label means the product is sold without FDA approval. The approved gel, foam and cream labels include trial results, and the store listing Skinli read has none.

How to read a store label

Store products differ from each other more than the prescription ones do. A few checks help:

• Find the percentage. Look in the product name and the list of active ingredients. The prescription labels state it as a share of weight, such as 15% w/w.
• Count the other ingredients. The 15% store cream listing Skinli read on DailyMed names azelaic acid alongside ten other active or plant ingredients, including lavender oil. When a product holds many ingredients and your skin reacts, it is hard to tell which one caused it.
• Look for exfoliating acids. The prescription labels ask users to avoid "peeling agents." DailyMed lists store products that combine azelaic acid with salicylic acid, such as an azelaic acid and salicylic acid peel. The American Academy of Dermatology says salicylic acid "exfoliates the skin," meaning it loosens and removes the top layer of dead cells. The exfoliant guide explains why that matters.
• Read the directions. That store listing says to apply a thin layer morning and evening, avoid the eyes and use sunscreen during the day. The 15% gel label reports no reactions to sunlight in its human safety studies, and daily sunscreen is still part of any routine for acne marks.

Before you use a new product on your whole face, test it on a small area first. The guide to patch testing explains how.

Higher strengths are for clinics

The 2024 review describes azelaic acid at 30% used as a chemical peel, applied for 10 minutes every two weeks in a clinic. In one study, 35 people with acne had six of these peels and had less oil and fewer acne lesions afterward. Peels at these strengths are procedures done by trained staff, and they are outside what anyone should use at home.

Which strength for which goal

Goal	What the sources used	Where to read more
Mild to moderate acne	20% cream (FDA-approved); NICE accepts 15% or 20%	Azelaic acid for acne
Rosacea bumps	15% gel or foam (FDA-approved)	Azelaic acid for rosacea
Dark marks after acne	15% gel and 20% cream in trials	Azelaic acid for dark spots
Melasma	20% cream in trials	Melasma

For flat acne marks, Skinli's 12-week plan uses an azelaic acid 10% cream, a pea-sized amount once a day in the morning from week 5, before sunscreen. The plan's acne gels, adapalene 0.1% and benzoyl peroxide 2.5%, go on at night. The free Skinli acne plan decides from a photo whether the mark cream is needed.

Side effects at each strength

Each label reports its own trial results:

Product	Most common reactions in trials
20% cream	Itching, burning, stinging and tingling in 1% to 5% of patients
15% gel	Burning, stinging or tingling 29%; itching 11%; dry or scaly skin 8%
15% foam	Skin pain (burning, stinging, tenderness) 6.2%; itching 2.5%

These numbers cannot be compared directly. The trials studied different people, with acne or rosacea, and the gel label itself says rates from one drug's trials "cannot be directly compared to rates in the clinical trials of another drug." The gel and cream labels both say irritation usually comes in the first weeks, and the cream label says it commonly settles with continued use.

All three labels also carry the same warning about skin color. There have been isolated reports of lighter patches after azelaic acid, and the labels ask people with darker skin to watch for early signs. The pregnancy guide covers what the labels say for pregnancy and breastfeeding.

How to choose a form

Strength is one choice, and the form is another. Gels, creams, foams and serums feel different and suit different skin. The gel, cream or serum guide compares them.

When to ask a doctor

Ask a doctor or dermatologist if you want a 15% or 20% product, if your acne or rosacea has not improved after 12 weeks of steady care with a store product, or if you have deep, painful acne. A doctor can also check whether your redness is rosacea, which the approved 15% products are made for. Skinli gives general education. A doctor is the right person to diagnose and treat your skin.