Can You Use Azelaic Acid With Niacinamide?

Why this verdict

Azelaic acid is an acne and rosacea treatment with antibacterial, anti-inflammatory and pore-clearing effects. In the US, a 20% cream is approved for acne and 15% gel and foam products are approved for rosacea, all by prescription; lower strengths are sold as cosmetics. The 2024 AAD guideline gives azelaic acid a conditional recommendation for acne.

Niacinamide is a form of vitamin B3 used for oiliness, redness and barrier support. It is not an FDA acne drug, but it has some supporting evidence: a 1995 trial found a 4% niacinamide gel performed comparably to 1% clindamycin gel for inflammatory acne. It is generally well tolerated.

There is no known chemical conflict between the two, and neither is a strong oxidizer or unstable in the way benzoyl peroxide or vitamin C can be. The thing to watch is that burning, stinging, tingling and itching are among the most common side effects listed on the azelaic acid 20% label. Adding niacinamide does not change that, and introducing both at once makes it hard to tell which product your skin dislikes.

People who find retinoids too irritating sometimes use azelaic acid instead. A dermatologist can help you decide whether it fits your acne type.