Comparison of the Efficacy of 20% Topical Azelaic acid cream versus Topical Retinoid in the Treatment of Acne Vulgaris

Abstract

Objective: The aim of this study was to compare the therapeutic efficacy and side effects of azelaic acid cream 20% versus the topical retinoid (tretinoin cream 0.05%) in the treatment of acne vulgaris grade 1 and 2 as measured by the IGA severity scale.

Research methods: The number of patients who met the criteria for entry into the study was 48 patients who were randomly assigned to two groups, where the first group was treated with 20% azelaic acid cream once daily, while the second group was treated with topical application of the retinoid cream once daily in the evening, and the treatment period lasted for three months. Communication with 3 patients was lost, so the study was conducted on the data of the remaining 45 patients. Patients were followed up on a monthly basis during the treatment period, and at each review the severity of acne was evaluated, the number of comedones and inflammatory lesions was counted, in addition to evaluation of treatment response and side effects. Recurrence was also evaluated one month after the end of treatment.

Results: Azelaic acid was effective in reducing the mean severity of acne, the number of comedones and the number of inflammatory lesions with a statistically significant difference between the start and end of treatment. By evaluating patients at the end of the treatment period, there was no statistically significant difference between azelaic acid and topical retinoid in terms of therapeutic efficacy, and azelaic acid treatment was associated with fewer side effects and better tolerance. Relapse occurred by 22.2% in the azelaic group compared to 15.8% in the retinoid group.

Conclusions: Azelaic acid is an effective treatment for mild facial acne vulgaris which has shown significant improvement in statistical tests similar to topical retinoid with fewer side effects. It can be used as a first-line treatment for mild acne vulgaris or as a maintenance therapy after systemic therapy.