Azelaic acid vs benzoyl peroxide for acne
Every row cites its source. Where a cell reflects our own reading of the evidence rather than an external source, the row says so.
The default OTC acne drug against the prescription dicarboxylic acid, on the direct trial and the practical differences.
| Aspect | Azelaic acid | Benzoyl peroxide | Source |
|---|---|---|---|
| Direct trial | 15% gel matched BPO 5%: median inflamed-lesion reduction 70%, 351 patients, 4 months | Equivalent efficacy in the same trial | source |
| Irritation in that trial | Distinctly less local burning and irritation than BPO | More irritating than azelaic acid, less than nothing else tested | source |
| Regulatory route | Prescription only (no OTC monograph slot for azelaic acid) | OTC monograph ingredient at 2.5 to 10%: legal without prescription | source |
| Resistance | Does not induce P. acnes resistance per the European program review | Also resistance-sparing; commonly combined with antibiotics for that purpose | source |
| Pregnancy | Recommended as baseline therapy in pregnancy | Recommended as baseline therapy in pregnancy (both named in the same review) | source |
| Beyond acne | Also carries rosacea approval and melasma trial data | Acne only | source |