What do systematic reviews say?

Azelaic acid vs adapalene

It is very uncertain whether azelaic acid changes participants' global self‐assessment of acne improvement Improved to… compared with adapalene (very low certainty).

• Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha‐hydroxy acid) for acne 2020 · Cochrane Headline outcomes only
  RR 0.89 [0.68, 1.17]
  1 study · 55 participants
  Very low

Azelaic acid vs tretinoin

Azelaic acid showed no clear difference in participants' global self‐assessment of acne improvement Good to… compared with tretinoin (moderate certainty).

• Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha‐hydroxy acid) for acne 2020 · Cochrane Headline outcomes only
  RR 0.94 [0.78, 1.14]
  1 study · 289 participants
  Moderate

Azelaic acid vs benzoyl peroxide

Azelaic acid probably leads to lower participants' global self‐assessment of acne improvement Good or… compared with benzoyl peroxide (moderate certainty).

• Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha‐hydroxy acid) for acne 2020 · Cochrane Headline outcomes only
  RR 0.82 [0.72, 0.95]
  1 study · 351 participants
  Moderate

Azelaic acid vs clindamycin

Azelaic acid showed no clear difference in participants' global self‐assessment of acne improvement Good or… compared with clindamycin (low certainty).

• Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha‐hydroxy acid) for acne 2020 · Cochrane Headline outcomes only
  RR 1.13 [0.92, 1.38]
  1 study · 229 participants
  Low

Azelaic acid vs placebo

• Interventions for rosacea 2015 · Cochrane Headline outcomes only
  no estimate extracted
  5 studies · 1245 participants
  High

Azelaic acid vs topical metronidazole

• Interventions for rosacea 2015 · Cochrane Headline outcomes only
  no estimate extracted
  3 studies · 491 participants
  Low

Doxycycline 40 mg + azelaic acid gel vs doxycycline 40 mg + metronidazole gel

Doxycycline 40 mg + azelaic acid gel showed no clear difference in physician‐assessed improvement in rosacea severity Investigator's… compared with doxycycline 40 mg + metronidazole gel (high certainty).

• Interventions for rosacea 2015 · Cochrane Headline outcomes only
  RR 1.08 [0.93, 1.27]
  1 study · 207 participants
  High

Doxycycline 40 mg + azelaic acid gel vs doxycycline 40 mg + metronidazole gel

The review found no eligible studies for this question.

• Interventions for rosacea 2015 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found