What Is Azelaic Acid?
Azelaic acid is a naturally occurring organic compound produced by several types of grasses and found in trace amounts in humans. Although an acid, it’s very mild. Much weaker than vinegar, for example.
Azelaic acid is FDA approved as a topical preparation to treat mild to moderate inflammatory acne vulgaris.
What is it Used For?
Azelaic acid’s most common use is in the treatment of acne and rosacea. Products such as Azelex, Finacea and Skinoren, which have azelaic acid as the main active ingredient, have been shown to be effective in the treatment of mild to moderate cases of acne (comedonal acne and inflamed acne).
It ‘s also used in various skin care products to stop bacterial skin growth, remove unwanted skin pigmentation, and as a skin lightening treatment and alternative to chemical peels.
Of course, most importantly for our purposes, it’s also used for treating androgenetic alopecia (pattern baldness). Azelaic acid can be found in numerous hair growth shampoos, conditioners and hair tonics that claim to be able to stimulate hair growth, and/or help make hair grow thicker, fuller and shinier.
The most popular products for pattern baldness containing azelaic acid are (in no particular order):
– Xandrox: topical 5% Minoxidil solution with azelaic acid formulated by Dr. Richard Lee
– Lipogaine: topical 5% Minoxidil solution with azelaic acid (as well as a host of other ingredients claimed to promote hair growth and halt hair loss, including: retinol, saw palmetto extract, beta-sitosterol, apple polyphenol and B vitamins)
– ReMox III & IV: topical 15% Minoxidil solution with Azelaic acid and a handful of other active ingredients formulated by Dr. Oscar Klein
– Crinagen: a natural topical 5% Azelaic acid solution formulated by Dr. Nasser Razack. Apart from the Minoxidil (which it doesn’t have), Crinagen contains many of the same ingredients as Lipogaine, with the notable addition of zinc (refer to the study below). Incidentally, Dr. Razack also wrote a rather comprehensive book on the subject of hair loss called ‘Conquering Hair Loss: A Complete Medical Guide to Hair Loss Assessment Prevention and Restoration’, which is worth a read.
– Procerin XT: natural topical solution with azelaic acid as the main active ingredient (no Minoxidil). Other ingredients claimed to promote hair growth and halt hair loss, include: Saw Palmetto Extract, Grape Seed Extract, Oleic Acid and Zinc Sulfate.
– Revivogen: another natural topical solution with azelaic acid as the main active ingredient (no Minoxidil). The ingredient list is similar to Crinagen.
Of the above, I’ve personally tried both Crinagen and Revivogen. A trusted friend (and hair loss advisor) of mine has tried Procerin XT and provided some very positive feedback. Each of these three products will be the subject of future articles.
How Does it Work?
There are a number of theories regarding Azelaic acid’s mode of action.
The first mode is an extension of Azelaic acid’s supposed role in a plant’s defensive response to infection or disease. Similarly, azelaic acid may have an antimicrobial effect in humans. As some theories implicate fungal infections in hair loss, it’s postulated that azelaic acid may also work in this way in the follicles in the scalp.
The second mode of action is said to be via moderation of inflammatory effects. Azelaic acid causes a histamine release, which is a major factor in the chain of reactions that leads to inflammation. Again, inflammation in the hair follicle has been cited as a possible cause of pattern baldness.
However it is the last mode of action that is pointed to as the most likely, as it directly addresses the leading causal theory of pattern baldness: DHT. Azelaic acid has been shown to be an effective 5-alpha reductase inhibitor, which in turn decreases the levels of DHT (dihydrotestosterone) in the scalp.
How Effective Is Azelaic Acid for Hair Loss?
A research report by Stamatiadis in the British Journal of Dermatology in 1988 suggested that azelaic acid is a potent inhibitor of 5-alpha reductase. The study also found that when combined with zinc sulphate and Vitamin B6 at very low concentrations, which had been shown to be ineffective alone, a 90% inhibition of 5 alpha-reductase activity was obtained.
Interestingly, Zinc is a vitamin that is also used in other disorders related to excess dihydrotestosterone, such as acne and prostatic disease. If one extrapolates (always dangerous), you might conclude that if it aids in treating these types of androgen dependent conditions, then it may also aid in the treatment of Androgenetic Alopecia (see also my article ‘Can Vitamins Really Grow Hair?‘)
Cost and Availability of Azelaic Acid
Generic azelaic acid is inexpensive and widely available. Pure azelaic acid creams are generally available as prescription only medications for acne and rosacea. However, there are numerous over the counter topical products for hair loss and other conditions that include azelaic acid; many of them marketed as naturopathic medications. The cost for these can vary considerably depending on the medication.
If you’re interested in preparing your own treatment at home (with all the usual cautions) then you can find information on how to do just that here.
Azelaic Acid Side Effects
Azelaic acid is well tolerated in most people. Topically applied azelaic acid is not readily absorbed into the blood stream and systemic reactions are therefore rare (see also ‘Hair Loss Treatment Side Effects: The Importance of Local vs Systemic’).
The most common side effect is mild skin irritation, occurring in 1-5% of patients. In rare cases, patients may experience more serious skin irritations, occurring in less than 1% of patients. Some patients have noted a lightening of the skin.
Hair Today There Tomorrow View
Whilst azelaic acid is undoubtedly effective in the treatment of acne, this does not necessarily translate to hair loss. Despite the encouraging studies supporting efficacy for hair loss, there are numerous limitations in the way these were conducted.
The 1988 study, for example, was performed ‘in vitro’ (i.e. outside a living organism), and I’m not aware of any studies since that have bridged the very real gap between theory (in vitro) and practice (in humans).
That said, azelaic acid continues to be included in a variety of hair loss formulations for its presumed complementary mode of action with other active ingredients, such as minoxidil. The minoxidil is included to stimulate hair growth while the azelaic acid is included to inhibit the DHT which causes the hair loss.
In my next article, a review of Crinagen, I’ll discuss further whether or not azelaic is effective. In the meantime, I’d appreciate hearing your experiences and thoughts on azelaic acid’s effectiveness in the comments section below.
To see what worked for me go here.
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