Azelaic acid is a well-established topical agent used in dermatology, particularly for the treatment of lesions associated with acne vulgaris and papulopustular rosacea. Its efficacy is supported by numerous randomized controlled trials and meta-analyses, which have shown that azelaic acid can significantly reduce the number and severity of both inflammatory and non-inflammatory lesions. The mechanism of action for azelaic acid involves antimicrobial activity against Cutibacterium acnes (formerly Propionibacterium acnes), anti-inflammatory effects, and normalization of keratinization, which helps prevent the formation of comedones and other lesion types.

The U.S. Food and Drug Administration (FDA) has approved azelaic acid formulations (15% gel and 20% cream) for the treatment of mild to moderate acne and rosacea, reflecting its scientifically validated role in managing these conditions. Clinical guidelines from dermatology organizations also recommend azelaic acid as a first-line or adjunctive therapy for acne and rosacea lesions. Adverse effects are generally mild, with localized skin irritation being the most common complaint. Thus, the use of azelaic acid for lesion treatment is strongly grounded in scientific evidence and is widely accepted in clinical practice.