Azelaic Acid: a targeted solution for hyperpigmentation better than hydroquinone?

When it comes to fading hyperpigmentationa nd melasma, hydroquinone has long been the gold standard active. Unfortunately, hydroquinone comes with a host of problems from irritation to the dreaded “halo effect”. This is why today it’s a firmly “prescription only” ingredient that cannot be used without dermatologist guidance under limited time.

Given hydroquinone’s limitations, people have been researching for alternatives. In a sea of skincare actives claiming to give you brighter and more even skintone, azelaic acid is a standout contender. So in this blog post, let’s dive into how azelaic acid work to brighten your skin, how it’s different than hydroquinone, and how to best incorporate the top azelaic acid serums into your routine.

The Mechanism: Nuke approach vs. “targeted

One of the key differences between the two actives is how they interact with your skin cells. To understand why azelaic acid is interesting, we have to look at specifically how they interact with your melanocytes, the pigment producing cells.

How hydroquinone work on your melanocytes

Hydroquinone is incredibly effective, but it is aggressive. In vitro (cell culture) research shows that hydroquinone doesn’t ust inhibit pigment production, it can actually directly affect the internal structures of melanocytes, eventually causing cell death.  This is why hydroquinone is considered the “nuke” option. Now, it’s worth remembering that these cell culture studies have hydroquinone in close, direct contact with melanocytes. Whereas in real life, melanocytes sit much deeper in the skin. So this aggressive melanocyte sniping behavior is more of a “worst case scenario” look. That said, it is why hydroquinone is a prescription-only ingredient that isn’t recommended to incorporate into your routine for the long haul.

How azelaic acid work on your melanocytes

On the other hand, in vitro research on azelaic acid shows that it appears to be taking a more “targeted” approach. Azelaic acid also has a cytotoxic effect on melanocytes, but interestingly primiarily just on the malignant melanocytes, while largely leaving healthy melanocytes alone. In in a nutshell, azelaic acid doesn’t have the same nuke effect on melanocytes, it moduclates the overreactive ones. This selective behavior is why azelaic acid can be the preferred treatment of choice for people with darker Fitzpatrick skin types, long-term maintenance therapy, and those who want a gentler alternative to hydroquinone.

Azelaic Acid vs. Hydroquinone: what the data says

Now, in vitro research is great for an insight on how an active ingredient might work in skin. In these studies, the ingredients are in direct contact with cells of interest. This doesn’t necessarily always translate directly to real life applications. Here’s what the clinical studies say:

A 2023 systemic review studie that looked at multiple studies compariting azelaic acid and hydroquinone for melasma treatment found that azelaic acid performed generally speaking on par in terms of reducing melasma severity scores.

In a large, 24 week study in particular:

• ~65% of azelaic acid users achieved good/excellent improvement

• ~73% of hydroquinone users achieved good/excellent improvement

• Roughly 60–66% in both groups saw lesion size reductions greater than 50%

Interestingly, azelaic acid was not dramatically less irritating than hydroquinone. Some irritation appears related to an skin acclimation period and often subsides with continued use.

When to reach for Azelaic Acid instead of Hydroquinone

Based on these findings, 20% prescription azelaic acid treatment can perform roughly comparable to prescription 4% hydroquinone. Hydroquinone seems to give you a better shot at more drastic, visible results. But if you’re looking for results with long term management, azelaic acid can be the superior choice.

Actives Combinations ot Maximize your Results

Now, the catch with azelaic acid is that the vast majority of data lies in the 15% to 20% prescription level. However, if you’re looking to just try out the actives first, you’ll see most easily accessible options are typically around 10%, which means actives combination strategies often deliver better results. Here are some clinical and practical pairings you should try:

Azelaic Acid + Retinoids

A small clinical study combining 10% azelaic acid with tretinoin reported substantial MASI score reductions over 24 weeks. Retinoids help accelerate cell turnover and improve penetration.

Azelaic Acid + AHAs

Studies comparing azelaic acid plus glycolic acid versus hydroquinone showed competitive outcomes in moderate to severe hyperpigmentation, especially in Fitzpatrick III+ skin.

Azelaic Acid + Tranexamic Acid

Tranexamic acid targets pigmentation through a different inflammatory pathway, making it a logical complement.

Chemists’ Top Azelaic Acid Shopping Tips

Ready to grab an azelaic acid serum to test out yourself? The chemists tested some of the best kbeauty azelaic acid serums and suspension treatments so you don’t have to test them all

Azelaic Acid Shopping Inspiration

Here are some of the products we tested in the podcast. For lost beginners, the Anua serum is the easiest starting place. For well formulated suspension type formulas, check out the Inkey List or Naturium.

Final Verdict: is Azelaic Acid Better than Hydroquinone?

he honest answer: it depends on your goals and risk tolerance.

Choose hydroquinone (with dermatologist guidance) if:

• You want the highest chance of rapid, dramatic lightening

• You’re treating stubborn melasma under medical supervision

Choose azelaic acid if:

• You prefer a gentler, longer-term strategy

• You have a darker skin tone and want lower risk of pigment complications

• You’re building a multi-ingredient routine

Both ingredients are effective tools. The key is matching the strategy to your skin, expectations, and timeline. Even with aggressive regimens, most studies show that visible improvement rarely begins before 8 weeks. Hyperpigmentation treatment is a marathon, not a sprint. Consistency, patience, and sun protection matter more than any single ingredient!

References

Jimbow, K., Obata, H., Pathak, M. A., & Fitzpatrick, T. B. (1974). Mechanism of depigmentation by hydroquinone. Journal of Investigative Dermatology, 62(4), 436-449.

Pathak, M. A., Ciganek, E. R., Wick, M., Sober, A. J., Farinelli, W. A., & Fitzpatrick, T. B. (1985). An evaluation of the effectiveness of azelaic acid as a depigmenting and chemotherapeutic agent. Journal of investigative dermatology, 85(3), 222-228.

Albzea, W., AlRashidi, R., Alkandari, D., Sadan, M., Alkandari, A., Alkanderi, J. J., ... & Alanazi Sr, S. (2023). Azelaic acid versus hydroquinone for managing patients with melasma: systematic review and meta-analysis of randomized controlled trials. Cureus, 15(7).

Baliña, L. M., & Graupe, K. (1991). The treatment of melasma 20% azelaic acid versus 4% hydroquinone cream. International journal of dermatology, 30(12), 893-895.

Gan, C., & Rodrigues, M. (2024). An update on new and existing treatments for the management of melasma. American journal of clinical dermatology, 25(5), 717.

Kakita, L. S., & Lowe, N. J. (1998). Azelaic acid and glycolic acid combination therapy for facial hyperpigmentation in darker-skinned patients: a clinical comparison with hydroquinone. Clinical therapeutics, 20(5), 960-970.