Azelaic Acid, Ivermectin, and Metronidazole for Skin Health
Azelaic acid, ivermectin, and metronidazole are three active pharmaceutical ingredients used to treat various skin conditions. Each ingredient works in a different way to control common skin issues like acne, rosacea, and hyperpigmentation.
Understanding Azelaic Acid
Azelaic acid is a naturally occurring saturated dicarboxylic acid found in grains like wheat, rye, and barley. It is also produced naturally by Malassezia furfur yeasts present on normal skin.
In skin care and medicine, azelaic acid is used to treat acne and rosacea due to its ability to target acne-causing bacteria, reduce inflammation, and help treat discoloration and dark spots.
How Azelaic Acid Works
Azelaic acid works in multiple ways to improve common skin concerns:
- Antimicrobial effects that kill acne bacteria like Propionibacterium acnes
- Anti-inflammatory effects that reduce redness and swelling
- Exfoliating effects to remove dead skin cells
- Reduces keratin production to prevent blocked hair follicles
- Lightening effects to inhibit melanin synthesis and treat hyperpigmentation
Using Azelaic Acid for Healthy Skin
Azelaic acid is available in prescription 15-20% formulas and over-the-counter products with lower concentrations around 10%. It can be used:
- As a stand-alone topical treatment for rosacea, acne, melasma and uneven skin tone
- In combination with other acne medications like benzoyl peroxide or retinoids
- Applied once or twice per day after cleansing and before moisturizers
- Used continuously or cycled (for example 2 weeks on, 1 week off)
Azelaic acid is generally well-tolerated. Potential side effects may include dryness, stinging, itching, and skin flaking when first starting use.
Ivermectin for Inflammatory Skin Conditions
Ivermectin is a medication originally approved to treat certain parasitic infections in humans and agricultural uses in animals. Recently, topical ivermectin lotion was approved to treat inflammatory lesions from rosacea.
Mechanisms of Ivermectin
Ivermectin helps improve inflammatory skin disorders through these key mechanisms:
- Antiparasitic effects that kill Demodex mites linked to rosacea flares
- Anti-inflammatory properties from inhibiting immune cell activation
- Ability to reduce cytokine and chemokine production involved in inflammation
- Regulation of T-cell and macrophage activity
Using Ivermectin Lotions and Creams
Ivermectin lotion 0.5% received FDA approval to treat inflammatory lesions from rosacea based on clinical trials showing efficacy. It is applied as:
- A thin layer once daily to clean, dry skin
- Use alongside sunscreen in the morning
- A length of time based on physician recommendation
Ivermectin creams with lower concentrations are also sometimes used off-label for other inflammatory skin disorders like acne. But proper dosage is important when using ivermectin topically.
Metronidazole for Rosacea and Acne
Metronidazole is a prescription antibiotic and antiprotozoal medication used to treat certain bacterial and parasitic infections. In both oral and topical forms, it's also prescribed for inflammatory skin conditions.
How Metronidazole Works
Metronidazole helps treat acne and rosacea lesions through the following mechanisms:
- Antimicrobial activity against acne bacteria Propionibacterium acnes
- Anti-inflammatory effects that reduce redness and swelling
- Antiprotozoal action against Demodex mites that provoke rosacea flares
- Potential anti-rosacea effects by modifying gut microbiome
Using Topical Metronidazole
Metronidazole comes as a topical cream, gel, or lotion containing 0.75-1% concentration. It is applied to affected areas usually once or twice daily. Treatment guidelines include:
- Wash face before use and allow skin to dry
- Apply a thin layer of topical metronidazole
- Use for the full treatment duration, usually 6-12 weeks
- Avoid applying to eyes, lips, mucous membranes
Potential side effects can include skin irritation, dryness, stinging, and facial redness or rash.
Comparing the Three Ingredients
Azelaic acid, ivermectin, and metronidazole overlap in their uses for acne and rosacea. But there are some differences among the three ingredients:
Treatment Uses
- Azelaic acid: acne, rosacea, melasma, hyperpigmentation
- Ivermectin: inflammatory rosacea lesions
- Metronidazole: inflammatory acne, papules and pustules
Formulations
- Azelaic acid: topical creams, gels, foams
- Ivermectin: topical lotion
- Metronidazole: topical cream, gel, lotion
Side Effects
- Azelaic acid: usually well tolerated with mild stinging or itching possible
- Ivermectin: generally well tolerated
- Metronidazole: sometimes causes skin irritation or dryness
Overall, azelaic acid has the widest range of uses while metronidazole and ivermectin target specific rosacea and acne symptoms.
Using Azelaic Acid, Ivermectin, and Metronidazole Together
In certain cases, these ingredients may be used together to provide synergistic benefits:
- Azelaic acid and ivermectin to treat papules and pustules while also improving rosacea redness and flushing
- Azelaic acid and metronidazole to combat acne while also reducing pigmentation from old acne scars
- Metronidazole for active breakouts and azelaic acid for residual dark spots
However, combining multiple active ingredients does increase the risk of dryness, irritation, and sensitivity. It's important to monitor skin closely and adjust your regimen as needed under professional care.
Using with Benzoyl Peroxide or Retinoids
These ingredients may also be combined with benzoyl peroxide or retinoids like tretinoin to enhance acne-fighting effects. But benzoyl peroxide can decrease efficacy if applied at the same time. Staggering applications is best.
Lifestyle Tips for Optimizing Treatment
Certain lifestyle measures can help maximize results when using azelaic acid, ivermectin or metronidazole:
Protect Skin from the Sun
FAQs
What skin conditions can azelaic acid treat?
Azelaic acid is used to treat acne, rosacea, melasma, and overall skin discoloration and dark spots.
How does ivermectin help rosacea?
Ivermectin works by killing Demodex mites that aggravate rosacea and reducing inflammation through effects on immune cells and inflammatory mediators.
What are metronidazole uses for skin?
Metronidazole treats inflammatory lesions from rosacea and acne due to its antimicrobial effects on acne bacteria and antiparasitic action against Demodex mites.
Can these ingredients be used together?
Yes, azelaic acid, ivermectin and metronidazole may be used together in certain combinations to provide synergistic benefits. But combining actives does increase risk of irritation.
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