Azelaic Acid
Azelaic acid
ALSO — NONANEDIOIC ACID
Does several useful things at once for skin that is inflamed and pigmenting simultaneously, which describes a great many people over thirty. The cheapest prescription in this register.
The marker is the strength the trials were actually run at. The bar is the span this register has recorded, approved and compounded together. Anything below the marker is a dose nobody has tested; anything above it is an assumption about a dose–response curve nobody has drawn.
The shaded band is the depth this molecule is understood to reach. Anything below it is out of scope, whatever the label says.
Mechanism
Normalises keratinisation, reduces reactive oxygen species and interferes with cathelicidin processing — the pathway now understood to be central to rosacea. Also a competitive tyrosinase inhibitor, which is why it turns up in pigment formulas.
HOUSE NOTES
- 15% is approved for rosacea and 20% for acne. Every other figure in this register — 17%, 14%, 10%, 6%, 4% — is an assumption about a dose-response curve nobody has drawn.
- The rosacea trials were the first programme in this register whose subjects had a mean age above thirty: 50.6, range 19 to 92. Two others have since joined it, and all three are diseases of midlife or later.
- Hypopigmentation has been reported. The label instructs monitoring in patients with dark complexions and concedes the drug has not been well studied in them.
- It stings. A foam vehicle is an attempt to soften that and nobody has published a comparison against the gel.
MEASURED ENDPOINTS
SUPPORTING RECORDS
Multicentre randomised, vehicle-controlled; mean subject age 50.6, range 19–92
N=961 · 12 WK · DOUBLE-BLIND
Multicentre randomised, vehicle-controlled; mean subject age 50.6, range 19–92
N=401 · 12 WK · DOUBLE-BLIND
Layering
- Broken or abraded skin
- Eyes and mucous membranes