Azelaic acid hyperpigmentation treatment

Azelaic acid is a naturally occurring dicarboxyl-ic acid (1,7-heptanedicarboxylic acid) that has demonstrated beneficial therapeutic effects in the treatment of acne and several disorders of hyperpigmentation [48]. There are minimal effects on normally pigmented human skin, freckles, senile lentigines, and nevi. The cytotoxic and antiproliferative effects of azelaic acid may be mediated via inhibition of mitochondrial ox-idoreductase activity and DNA synthesis. Disturbance of tyrosinase synthesis by azelaic acid may also influence its therapeutic effects. Azelaic acid can be used as a hypopigmenting agent in patients sensitive to hydroquinone. 

With antibacterial and anti-inflammatory properties, and the ability to stabilize keratinization, azelaic acid is an effective alternative in the treatment of mild to moderate acne in patients who cannot tolerate benzoyl peroxide or topical retinoids.3,21 It also has a hypopigmentation effect that may prove effective in patients who are prone to post-inflammatory hyperpigmentation resulting from acne.22... 

Azelaic acid is a newer treatment for hyperpigmentation, primarily for post-inflammatory hyperpigmentation. It works by blocking the activity of tyrosinase and does not cause photosensitivity of the skin or residual changes in the skin. There is decreased incidence of allergic reactions associated with azelaic acid. Corticosteroids also block the activity of tyrosinase. Corticosteroids are used in combination with other drugs to minimize the side effects. The combination of azelaic acid and hydrocortisone acetate (10%) may also be useful in the treatment of post-inflammatory hyperpigmentation of skin... 

Topical treatments for melasma usually include tyrosinase inhibitors, with or without tretinoin or one of its precursors. Azelaic acid is also a viable treatment option. A corticosteroid can be combined with it to counter any potential active inflammation. Lasers, intense pulsed light (IPL), dermabrasion and microdermabrasion have also been suggested, but often cause post-inflammatory hyperpigmentation. TCA can be an excellent treatment for melasma it eliminates the melanin stored in the papillary dermis and epidermis (Figure 13.8). Mesotherapy has been recently reputed as an effective treatment of melasma. ... 

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