Hair Loss

Azelaic Acid for Hair Growth: 2021 Review

Maybe you’ve heard that azelaic acid could be a powerful way to fight hair loss but you’re not sure if it’s true or not.

In this article you’ll learn if there is any truth behind these claims using scientific studies, you’ll learn the best way to use azalea acid for your hair, and how to avoid any side effects along the way.

A Quick Chemistry Rundown

A molecule of azelaic acid.

Azelaic acid is an organic compound with the chemical formula of C9H16O4. It is also known as nonanedioic acid due to it having nine carbons. You can count these carbons on the illustration bellow; they are the pointy, unlabeled ridges.

As you can see, the last carbon on each end is double bonded to an oxygen (O) as well as singe bonded to a hydroxyl (OH). This gives it two carboxyl functional groups (-COOH), making it a part of the crystalline dicarboxylic acid family (1). Dicarboxylic acids are used in the production of many products, such as:

  • Food
  • Fragrances
  • Polyamides
  • Lubricants
  • Adhesives
  • Polyesters
  • Pharmaceuticals

Azelaic acid also has a free oxygen radical, the scavenger activity of which theoretically reduces inflammation (3).

Azelaic Acid in Nature

Of the dicarboxylic acids, azelaic acid is the most well-known. It is produced by Malassezia furfur, a harmless fungi present on everyone’s skin, and is found in (3):

  • Whole grain cereals
  • Rye
  • Barley
  • Animal products

In plants, azelaic acid plays an important role in responding to infection by serving to signal for the production of inflammation fighting components such as salicylic acid (4).

Learn more about salicylic acid shampoos here.

In humans, azelaic acid also naturally plays an important role in fighting infections. Some of its properties are as follows (3):

  • Antibacterial
  • Anti-oxidant
  • Comedolytic, which means it breaks down pore blockages
  • Keratolytic , which means it breaks down warts and other tough, rough skin blemishes
  • Anti-inflammatory

Current Pharmacological Uses for Azelaic Acid

According to the Food and Drug Administration’s Pharmacological Class Index, azelaic acid is attributed to the following physiological effects (6).

  • Decreased Protein Synthesis
  • Decreased Sebaceous Gland Activity

Since this molecule has many properties that work to reduce skin damage, several companies have created azelaic acid topical creams to treat mild to moderate inflammatory acne and rosacea. Brand names for this FDA approved product in the United States include (7):

  • Azlex
  • Finacea
  • Finacea Plus

Azelaic Acid’s Role as an Inhibitor of 5α-Reductase Activity

Steroid 5α-reductase is an enzyme that catalyzes the reaction which transforms testosterone into dihydrotestosterone (DHT) (10). The androgen DHT is five times as potent as testosterone and plays an important role in the development of men’s sexual characteristics, including the development of hair on the chin, back, and chest.

However, DHT is actually detrimental to the growth of hair on the scalp, playing a key role in male pattern baldness. Thus, finding molecules that inhibit the ability of steroid 5α-reductase to create DHT is of great importance to dermatologists specializing in hair regrowth.

A 1988 study published in the British Journal of Dermatology used an in vitro assay to test the effects of zinc and azelaic acid on the steroid 5α-reductase activity in human skin (12).

Through the experiment, Dr. Stamatiadis and his research team determined that azelaic acid could completely inhibit 5α-reductase activity at a concentration of 3 millimoles per liter. Even more interesting, the researchers found that when azelaic acid, zinc, and vitamin B6 were added together at very low concentrations, it resulted in a 90% inhibition of 5α-reductase.

Dr. Stamatiadis concluded that zinc sulphate combined with azelaic acid could potentially be an effective treatment of androgen related ailments.

Study Involving the Effect of Azelaic Acid on Alopecia Areata

The immune-mediated disease aopecia areata (AA), the scientific term for spot baldness, currently has no known cure. There are currently no FDA approved medication for tackling this type of genetic alopecia that contain azelaic acid.

Still, while azelaic acid has not been completely proven to treat this condition (8), there are promising studies involving this compound in relation to hair maintenance and regrowth.

In a pilot study concerning azelaic acid’s possible use in managing spot baldness, Dr. Sasmaz and Dr. Arican performed an experiment comparing azelaic acid and anthralin for the therapy of patchy alopecia areata (9).

Azelaic acid has been used to treat this condition in the past, but until this research came out, there had been no controlled studies to evaluate the effectiveness of this treatment. Anthralin is a proven irritant treatment for the management of symptoms associated with alopecia areata, making it a good baseline to determine the usefulness of other novel treatments.

In this cutting edge experiment, Dr. Sasmaz and Dr. Arican recruited 31 subjects who were afflicted with patchy alopecia areata. None of these subjects had used any alopecia treatments within at least the past month. After a baseline of demographic and clinical characteristics were taken into account, the subjects were randomly assigned one of two groups.

Both groups were similar in terms of demographic and clinical characteristics which could have potentially tainted baseline treatment response and, thus, the study results. The first group was told to apply 20% azelaic acid cream to the affected portion of scalp daily for 12 consecutive weeks.

The second group was told to apply 0.5% anthralin cream to the affected portion of scalp daily for 12 consecutive weeks. Then, there was an 8-week follow up during which time no cream was applied to see whether whatever results the treatment created could be maintained.

All study participants completed the experiment as instructed and no serious adverse events occurred during this time.

At the end of this cumulative 20 week period, Dr. Sasmaz and Dr. Arican examined the efficiency of this novel azelaic acid treatment by conducting a clinical examination on the subject participants.

During this examination, each of the subject’s scalps were awarded a Terminal Hair Regrowth Score on a scale from 0 to 2. In this scale, a 0 indicated an inadequate response, a 1 indicated a partial response, and a 3 indicated a complete response. At week 20, the Average Terminal Hair Re-growth Scores were as follows:

Azelaic acid group

  • 27 (Margin of Error: +/- 0.9)

Anthralin group

  • 37 (Margin of Error: +/- 0.8)

This shows both subjects who applied 20% azelaic acid and subjects who applied 0.5% anthralin finished the study with similarly positive results. Since the Average Terminal Regrowth Scores were all over 1, there was a demonstrative overall response to treatment.

In fact, a complete response was observed in 53.3% of cases in the azelaic acid cream group and 56.2% of cases in the anthralin cream group. In addition, subjects who were recorded as having a complete response had no new bald patches develop during the study period, suggesting that the azelaic acid treatment could help control the condition outside of the treated area.

Dr. Sasmaz and Dr. Arican concluded that, while more research into the subject was definitely needed, azelaic acid could be an effective topical therapy for patchy alopecia areata since it yielded similar results to the proven effects of anthralin.

This study is not without its faults, however. Dr. Sasmaz and Dr. Arican used a fairly small sample size in their experiment. In addition, there was no reported follow up for the study to assess the long term effects of treatment. Even the use of anthralin as a comparison tool has been questioned by other scientists due to a lack of certainty in its usefulness (8).

How to Try Out Azelaic Acid Yourself

Since there are promising results linking azelaic acid to a drop in DHT levels and a reduction of alopecia areata symptoms, it may be worth your while to try this product out for yourself.

It is recommended that you add azelaic acid to your normal regime rather than substituting it as a treatment, especially if you are currently using an FDA approved hair product such as Minoxidil or Propecia. There are a variety of topical products you can buy which contain azelaic acid:

  • Scalp creams and conditioner for alopecia containing azelaic acid
  • The FDA approved acne creams I mentioned earlier in the article
  • Shops selling natural supplements often have vials containing azelaic acid

Apply the cream or other topical solution daily for the best results.

Learn more about Lipogaine which contains minoxidil and azelaic acid.

Possible Side Effects and Warnings

While azelaic acid works for most people with no complications, this product is not recommended for those with sensitive skin or eczema.

This product is also not recommended for people with darkly pigmented skin because the effects of azelaic acid on people with dark complexions are not yet fully known (14).

Though azelaic acid has a very low toxicity, there have been cases in which mild skin irritation has occurred. Do not apply this cream to the eyes, mouth, nose, or genitalia. Keep the area on which you applied azelaic acid uncovered. Never apply azelaic acid to skin that has been effected by elements that cause inflammation or redness including (13):

  • Sunburn
  • Windburn
  • Excessive dryness
  • A wound

If you have one or more of the following side effects after starting this treatment, contact your doctor immediately:

  • Severe burning, stinging, or warmth
  • Severe itching or tingling
  • Severe redness, dryness, peeling, or other irritation
  • Changes in skin color


Azelaic Acid is a novel treatment for baldness that many people swear by, though more research is needed to prove whether the product is clinically effective.

Based on your skin conditions and current state of alopecia, you can determine whether you would like to add an azelaic acid cream to your daily hair maintenance regime.

Without further evidence to prove the effectiveness of Azelaic acid we recommend sticking to FDA approved treatments and consulting a qualified medical professional or hair loss specialist if you’re worried about hair loss.

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You can follow a few hair hygiene tips to make your hair less likely to fall out: Avoid hairstyles that pull on the hair - Avoid high-heat hair styling tools - Don't chemically treat or bleach your hair - Use a shampoo that's mild and suited for your hair - Use a soft brush made from natural fibers - Try low-level light therapy.

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