When it comes to skincare, azelaic acid and tretinoin are two standout treatments known for their effectiveness in managing a variety of skin concerns. Azelaic acid, available in both prescription and over-the-counter forms, is well-known for its ability to lighten skin, reduce inflammation and address issues like acne, rosacea and hyperpigmentation. Tretinoin, a prescription-only retinoid, accelerates skin cell renewal to reduce acne, discoloration, fine lines and wrinkles. This guide will delve into how azelaic acid and tretinoin work, their benefits and how they can be used together for optimal results. Additionally, we'll provide tips for new users and highlight an easy and affordable way to get these treatments.

What is azelaic acid?

Azelaic acid (Finacea®) is a topical medication and belongs to a class of medications called dicarboxylic acids. It helps lighten skin and reduce inflammation, effectively addressing acne and discoloration caused by aging, sun exposure, rosacea and melasma.¹

This treatment is available in prescription and over-the-counter options. Prescription strength ranges from 15% to 20% and comes in cream, foam and gel.² Nonprescription strength formulas have less than 10% azelaic acid.³

In a clinical study, two-thirds of participants showed no signs of hyperpigmentation after 16 weeks of using azelaic acid. Additionally, nearly half of the participants reported that only 1% to 10% of their initial hyperpigmentation remained by the end of the trial. Azelaic acid is often favored by people of color because it doesn't lighten the overall skin tone like tretinoin or other anti-aging products.⁴

Azelaic acid 15% is available from RedBox Rx for $20 per month with the purchase of a 90-day supply.

What is tretinoin?

Tretinoin (Retin-A®) is classified as a retinoid. Retinoids accelerate the skin cell renewal process, helping uncover newer skin and unclog pores. Available only by prescription, tretinoin is used to treat acne and signs of aging such as fine lines, wrinkles and discoloration.⁵ It comes in four main formulas:⁶

• Gel in 0.01% and 0.025% strengths

• Cream in 0.025%, 0.05% and 0.1% strengths

• Lotion in 0.05% strength

• Solution in 0.05% strength

Tretinoin has been proven effective and safe for over 40 years in treating acne and signs of aging.⁷ In a clinical study, 72% of participants noted an improvement in hyperpigmentation after 24 weeks of tretinoin use.⁸

Long-term studies of tretinoin showed that participants who used the prescription cream for 12 months experienced a significant reduction in wrinkles and photoaging. These studies also indicated new collagen growth and a decrease in collagen breakdown.⁹

With RedBox Rx, tretinoin cream starts at $20 per month with the purchase of a 90-day supply.

What’s the difference between azelaic acid and tretinoin?

Both azelaic acid and tretinoin are effective at treating acne and signs of aging but have different mechanisms of action. Azelaic acid has anti-inflammatory and antioxidant properties to reduce breakouts and discoloration.¹⁰ Tretinoin is a retinoid and works by speeding up the skin cell renewal process to reduce clogged pores and even out skin tone.¹¹

Azelaic Acid vs. Tretinoin Comparison Chart

Can you use azelaic acid and tretinoin together?

Azelaic acid and tretinoin can be combined for faster and more pronounced results. In one study, combination treatment showed a faster and more pronounced improvement than using azelaic acid alone in the first three months. At the end of six months, the combination treatment also had higher reports of “excellent results.”¹²

When starting a new treatment or adding a skincare treatment to your routine, always start slowly. Your skin may be more prone to dryness, sunburn or irritation while on prescription skincare. Talk to your provider if you are experiencing side effects.

For best results, do not use any topical medications within one hour before or after using tretinoin. You may find using azelaic acid in the morning and tretinoin in the evenings as the most convenient routine. Using sunscreen and quality moisturizers can help reduce side effects and skin irritation.¹³

What are the side effects of azelaic acid and tretinoin?

When you start using azelaic acid and tretinoin, you may experience side effects. Side effects are generally mild. Please contact your medical provider if you experience any severe or bothersome side effects.

Common side effects of azelaic acid include:¹⁴

• Burning, stinging or tingling.

• Dryness, itching or peeling.

• Redness.

• Soreness.

• Swelling.

Common side effects of tretinoin include:¹⁵

• Burning, itching or stinging.

• Chapping or slight peeling.

• Discoloration.

• Redness.

• Dryness.

• Unusually warm skin.

How do you introduce azelaic acid or tretinoin into your skincare routine?

If you’re a new user of azelaic acid and/or tretinoin, follow these guidelines to achieve best results and minimize side effects.

Tips for using azelaic acid:¹⁶

• Apply a thin layer to clean, dry skin once or twice per day.

• If you have sensitive skin, you can apply it every other day.

• Follow with a hydrating moisturizer.

• Wear sunscreen of at least 30 SPF daily.

Tips for using tretinoin:¹⁷

• Clean face with a mild cleanser.

• Allow skin to dry for 20 to 30 minutes. Applying tretinoin to wet skin can cause irritation.

• Use a pea-size amount to apply a thin layer of product to face.

• Avoid washing skin for at least one hour after applying tretinoin.

• Apply moisturizer to reduce irritation.

• Wear sunscreen of at least 15 SPF daily.

How RedBox Rx can help

RedBox Rx makes accessing treatments for acne, anti-aging, melasma or rosacea easy and affordable.

Benefits of RedBox Rx include:

• Transparent, affordable, flat rates for medications starting at $20/month.

• $25 consultation with a U.S. licensed medical professional.

• No insurance required. HSA and FSA eligible.

• No office wait times or scheduling issues that are typical with physical medical practices.

• FREE shipping directly to you. One-time, monthly and quarterly subscriptions available.

Get started on your journey toward better skin with our online assessment for acne, anti-aging or rosacea.