Azelaic Acid + Tretinoin: Can You Use Them Together? | Dermatologist

Dr Dray

AI-assisted summary of Azelaic Acid + Tretinoin: Can You Use Them Together? | Dermatologist — original source. Check the original for full context.

Source published: 2026-09-22

Key ideas

Combining azelaic acid and tretinoin addresses acne and post-inflammatory hyperpigmentation through complementary, non-redundant pathways: retinoids normalize epidermal turnover while azelaic acid provides antimicrobial action and inhibits the tyrosinase enzyme. (3:22)
Clinical trial data in papulopustular rosacea demonstrates that once-daily azelaic acid achieves comparable reduction in inflammatory lesions to standard twice-daily dosing while cutting side effects and prescription refill costs in half. (4:13)
Topical retinoids are not strictly contraindicated in rosacea; they can promote dermal connective tissue remodeling and reduce surface corneocytes that harbor inflammatory Demodex face mites. (5:58)
Maximalist multi-serum regimens increase skin barrier irritation, which sabotages treatment by triggering inflammatory cascades that worsen both active acne breakouts and post-inflammatory hyperpigmentation. (9:21)

Detailed notes

## Background Published on YouTube by dermatologist Dr Dray on September 22, 2026, this video explores whether azelaic acid can be paired with tretinoin or other topical retinoids. According to the video description, Dr. Dray covers how these two ingredients function across acne, rosacea, and post-inflammatory hyperpigmentation, examining dosing frequencies, clinical evidence, and methods for mitigating irritation without overcomplicating skincare routines.

## TL;DR Dr. Dray details how azelaic acid and tretinoin operate through distinct, complementary biological pathways, making them a clinically potent combination for acne and post-inflammatory hyperpigmentation. Addressing application frequency, she highlights clinical data showing that once-daily azelaic acid can achieve comparable outcomes to twice-daily dosing with substantially less burning and barrier irritation, particularly in rosacea patients. She dispels myths regarding retinoid use in rosacea while stressing that active combinations should be approached conservatively rather than stacking products haphazardly. Ultimately, she recommends a streamlined regimen—such as azelaic acid with sunscreen in the morning and a retinoid at night—advising patients to master one active for several months before introducing another.

## Atmosphere & style The presentation is candid, grounded, and refreshingly no-nonsense, delivered with Dr. Dray's trademark blend of clinical pragmatism and wry humor. Speaking directly to the camera, she cuts through social media consumerism and algorithm-driven trends with blunt reassurance to 'stop overthinking' skincare. The experience feels like a grounded, stress-relieving consultation that liberates viewers from skincare anxiety and reframes skin health around patient consistency rather than complex routines.

## Bulletin - [03:22](https://www.youtube.com/watch?v=MYiOWPf354A&t=202s) Combining azelaic acid and tretinoin addresses acne and post-inflammatory hyperpigmentation through complementary, non-redundant pathways: retinoids normalize epidermal turnover while azelaic acid provides antimicrobial action and inhibits the tyrosinase enzyme. - [04:13](https://www.youtube.com/watch?v=MYiOWPf354A&t=253s) Clinical trial data in papulopustular rosacea demonstrates that once-daily azelaic acid achieves comparable reduction in inflammatory lesions to standard twice-daily dosing while cutting side effects and prescription refill costs in half. - [05:58](https://www.youtube.com/watch?v=MYiOWPf354A&t=358s) Topical retinoids are not strictly contraindicated in rosacea; they can promote dermal connective tissue remodeling and reduce surface corneocytes that harbor inflammatory Demodex face mites. - [09:21](https://www.youtube.com/watch?v=MYiOWPf354A&t=561s) Maximalist multi-serum regimens increase skin barrier irritation, which sabotages treatment by triggering inflammatory cascades that worsen both active acne breakouts and post-inflammatory hyperpigmentation.

## Key takeaways - [00:37](https://www.youtube.com/watch?v=MYiOWPf354A&t=37s) Azelaic acid is a multifunctional dicarboxylic acid with anti-inflammatory, antimicrobial, and pigment-regulating properties FDA-approved for acne, rosacea, and melasma. - [02:17](https://www.youtube.com/watch?v=MYiOWPf354A&t=137s) Tretinoin functions via retinoic acid receptors to normalize epidermal desquamation, clearing microcomedones and stimulating dermal collagen synthesis to combat photoaging. - [03:22](https://www.youtube.com/watch?v=MYiOWPf354A&t=202s) Pairing tretinoin with azelaic acid aligns with AAD guidelines by targeting cutaneous conditions through separate, complementary biological pathways rather than redundant mechanisms. - [03:22](https://www.youtube.com/watch?v=MYiOWPf354A&t=202s) The combination is particularly potent for post-inflammatory hyperpigmentation, as azelaic acid inhibits tyrosinase directly while tretinoin accelerates the shedding of existing pigment pools. - [04:13](https://www.youtube.com/watch?v=MYiOWPf354A&t=253s) Prescription 15% azelaic acid gel is labeled for twice-daily application, but once-daily use offers comparable clearance for papulopustular rosacea with markedly less stinging, dryness, and erythema. - [04:13](https://www.youtube.com/watch?v=MYiOWPf354A&t=253s) Once-daily dosing reduces prescription consumption by half, making medical management substantially more affordable and sustainable for sensitive-skin patients. - [05:58](https://www.youtube.com/watch?v=MYiOWPf354A&t=358s) Retinoids can be used cautiously in rosacea to support tissue remodeling and clear cellular debris that harbors Demodex mites, dispelling the myth that the ingredient class is entirely off-limits. - [07:51](https://www.youtube.com/watch?v=MYiOWPf354A&t=471s) An effective daily regimen can be kept simple: apply azelaic acid in the morning under sunscreen, and apply tretinoin at night followed by moisturizer if needed. - [07:51](https://www.youtube.com/watch?v=MYiOWPf354A&t=471s) When using azelaic acid twice daily, layering it immediately before or after tretinoin at night is acceptable, and the combined base vehicles often render a separate night cream unnecessary. - [07:51](https://www.youtube.com/watch?v=MYiOWPf354A&t=471s) Prescription topicals are tested in clinical trials as standalone treatments; stacking them with numerous cosmetic serums risks vehicle incompatibility and increases irritation. - [09:21](https://www.youtube.com/watch?v=MYiOWPf354A&t=561s) Managing skin disease is medical care that requires individual personalization rather than a rigid, maximalist social media 'cookbook approach.' - [11:04](https://www.youtube.com/watch?v=MYiOWPf354A&t=664s) The framework for pairing azelaic acid with tretinoin applies equally to other retinoids, including adapalene, tazarotene, trifarotene, and over-the-counter retinol or retinaldehyde. - [12:39](https://www.youtube.com/watch?v=MYiOWPf354A&t=759s) For photoaging, topical retinoids carry the primary body of evidence, whereas azelaic acid acts mainly as a tone- and texture-supporting adjuvant rather than a primary anti-aging therapy. - [13:16](https://www.youtube.com/watch?v=MYiOWPf354A&t=796s) Skincare newcomers should introduce only one active ingredient at a time and evaluate results consistently for three full months before considering layering an additional active.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=MYiOWPf354A&t=0s) Introduction: The Buzz Around Combining Actives

Dr. Dray opens the discussion by welcoming viewers back and addressing a pervasive skincare dilemma: many individuals already using a prescription topical retinoid like tretinoin frequently encounter online recommendations advocating for pairing it with azelaic acid. Because social media skincare discourse constantly hypes the combination as a powerhouse duo, questions naturally arise regarding whether combining them is actually necessary, whether they truly work well together, and what frequency is required to achieve noticeable clinical results.

The goal of the video is to cut through the confusion, demystify the science behind both ingredients, and provide clear, dermatological guidance on whether to use them in tandem or alone. Rather than following blanket internet advice, Dr. Dray emphasizes evaluating your skin's unique tolerance and specific conditions to determine if a multi-ingredient approach is genuinely worth the investment.

[00:37](https://www.youtube.com/watch?v=MYiOWPf354A&t=37s) What Does Azelaic Acid Do? Mechanisms and Benefits

Azelaic acid is a dicarboxylic acid renowned in dermatology for its multi-functional versatility. It possesses anti-inflammatory, antimicrobial, and pigment-modulating properties, earning FDA-approved status as a prescription intervention for three widely divergent skin concerns: acne vulgaris, rosacea, and melasma. In acne management, azelaic acid suppresses inflammatory pathways, reduces the bacterial load of *Cutibacterium acnes* (*C. acnes*), and provides mild exfoliation that helps keep follicular units clear of microcomedones.

Beyond clearing active breakouts, one of azelaic acid’s standout virtues is its exceptional ability to treat and prevent unwanted post-inflammatory hyperpigmentation (PIH). When acne lesions heal—particularly in deeper Fitzpatrick skin types—they frequently leave behind stubborn, long-lasting dark spots. Azelaic acid offers a strategic "two for one" advantage: it calms the underlying inflammatory breakout while simultaneously targeting pigment production. It accomplishes this by directly inhibiting tyrosinase, the rate-limiting enzyme utilized by melanocytes to synthesize melanin. Because inflammation is a primary catalyst triggering excess pigment deposition, azelaic acid's dual anti-inflammatory and tyrosinase-inhibiting properties make it a formal recommendation in the American Academy of Dermatology (AAD) acne guidelines.

- **Classification:** Dicarboxylic acid with antimicrobial, anti-inflammatory, and pigment-regulating properties. - **Target Microorganism:** Reduces colonization by *Cutibacterium acnes*. - **Mechanism against Hyperpigmentation:** Directly inhibits tyrosinase in melanocytes while curbing inflammatory drivers of post-inflammatory hyperpigmentation. - **Prescription Indications:** Formally utilized for acne vulgaris, papulopustular rosacea, and melasma.

[02:17](https://www.youtube.com/watch?v=MYiOWPf354A&t=137s) What Does Tretinoin Do? Cellular Turnover and Anti-Aging

Tretinoin is a potent prescription topical retinoid that functions by binding to retinoic acid receptors and altering gene expression within epidermal and dermal cells. Its primary biological effect is normalizing epidermal cell differentiation and turnover. By regulating cellular desquamation, tretinoin corrects abnormal follicular plugging, effectively clearing both closed comedones (whiteheads) and open comedones (blackheads). Beyond acute acne clearance, retinoids serve as an essential maintenance therapy, sustaining remission and preventing future microcomedones through persistent anti-inflammatory and keratoregulating effects.

Outside of acne, tretinoin remains the gold standard in topical anti-aging and photodamage repair. It stimulates dermal fibroblasts to ramp up collagen synthesis, thereby improving skin firmness and smoothing fine lines and wrinkles. Furthermore, tretinoin accelerates epidermal shedding to disperse concentrated melanin pools, helping fade solar lentigines (sun-induced age spots), mottled hyperpigmentation, and persistent textural roughness caused by cumulative lifetime ultraviolet radiation exposure.

- **Primary Mechanism:** Modulates gene expression to normalize epidermal turnover and desquamation. - **Acne Applications:** Reverses follicular hyperkeratinization (comedolysis) and functions as long-term maintenance therapy. - **Collagen & Aging:** Upregulates dermal collagen production to mitigate fine lines, wrinkles, and tactile roughness. - **Pigment Effects:** Hastens epidermal cell renewal to shed superficial age spots and sun-induced discoloration.

[03:22](https://www.youtube.com/watch?v=MYiOWPf354A&t=202s) Why Combine Them? Complementary Mechanisms of Action

When evaluating whether to pair tretinoin with azelaic acid, Dr. Dray emphasizes that the two ingredients are distinct rather than redundant. They tackle skin dysfunction through completely separate, complementary physiological pathways. In clinical practice and per AAD acne treatment guidelines, pairing therapies with differing mechanisms of action is the preferred strategy because it attacks cutaneous disease from multiple angles simultaneously.

```mermaid flowchart TD accTitle: Complementary Mechanisms of Tretinoin and Azelaic Acid accDescr: Diagram illustrating how tretinoin and azelaic acid utilize distinct cellular pathways to resolve acne and post-inflammatory hyperpigmentation.

subgraph Retinoid["Tretinoin (Retinoid)"] R1["Normalizes Epidermal Turnover"] R2["Prevents Follicular Plugging"] R3["Accelerates Pigment Shedding"] end

subgraph Azelaic["Azelaic Acid (Dicarboxylic Acid)"] A1["Inhibits Tyrosinase Activity"] A2["Antimicrobial against C. acnes"] A3["Suppresses Inflammatory Cascades"] end

subgraph Outcomes["Targeted Clinical Outcomes"] T1["Acne Clearance & Prevention"] T2["Resolution of Dark Marks (PIH)"] end

R1 --> T1 R2 --> T1 A2 --> T1 A3 --> T1

R3 --> T2 A1 --> T2 A3 --> T2 ```

In an acne routine, tretinoin focuses on unclogging pores and preventing retention hyperkeratosis, while azelaic acid provides antimicrobial defense against bacteria and downregulates inflammation. When dealing with post-acne dark marks, their combined synergy is equally striking: tretinoin speeds up cell turnover to purge pooled pigment and suppresses upregulated melanin pathways, while azelaic acid shuts down the tyrosinase enzyme at the source. This convergence produces faster, more comprehensive clearance than either ingredient can typically deliver on its own.

[04:13](https://www.youtube.com/watch?v=MYiOWPf354A&t=253s) Twice-Daily vs. Once-Daily Azelaic Acid and the Rosacea Trial

A frequent question patients ask is whether azelaic acid truly requires twice-daily application. While prescription formulations (such as 15% gel) are officially labeled for twice-daily dosing, Dr. Dray clarifies that a rigid two-times-a-day schedule is not an absolute requirement for every patient or condition. Individual tolerability and clinical context often warrant a more flexible approach.

To illustrate this, she highlights a small clinical trial examining papulopustular rosacea. In the study, investigators compared once-daily application against the standard twice-daily regimen over a 12-week period. The results demonstrated that once-daily azelaic acid was clinically comparable to twice-daily dosing for reducing inflammatory papules and pustules. Crucially, applying it once daily led to substantially less burning, stinging, erythema, and dryness—side effects to which rosacea patients are uniquely susceptible. Furthermore, once-daily application makes the medication significantly more economical, as patients use half as much product and require far fewer prescription refills over time.

For acne and hyperpigmentation, the clinical evidence comparing once-daily versus twice-daily dosing is less clearly demarcated, and prescribers typically instruct patients to use it twice daily. Nevertheless, Dr. Dray observes that many real-world patients achieve excellent clinical outcomes using it only once a day—whether due to cost concerns, sensitive skin, or simple misunderstanding of label instructions.

[05:58](https://www.youtube.com/watch?v=MYiOWPf354A&t=358s) Debunking the Myth: Can You Use Retinoids with Rosacea?

Dr. Dray tackles a widespread skincare myth: the belief that individuals with rosacea can never, under any circumstances, use a topical retinoid like tretinoin. While rosacea-prone skin is inherently fragile, reactive, and prone to flushing, clinical evidence shows that topical retinoids can actually provide therapeutic value for the condition. Retinoids stimulate dermal remodeling, reinforce connective tissue, and impart anti-inflammatory benefits that help stabilize vascular and tissue reactivity.

Additionally, retinoids eliminate dead surface corneocytes that can otherwise create an hospitable environment for *Demodex* face mites, an organism recognized as an inflammatory trigger in papulopustular rosacea. Over-the-counter retinoid alternatives, such as cosmetic retinol and retinaldehyde, have also demonstrated utility in normalizing epidermal proliferation and downregulating inflammatory cascades, helping clear persistent inflammatory papules. Dr. Dray acknowledges that navigating the initial retinization process can be difficult for rosacea patients, requiring close monitoring for irritation, but emphasizes that the ingredient class is not categorically off the table.

[07:08](https://www.youtube.com/watch?v=MYiOWPf354A&t=428s) When Would You Use It Twice a Day?

Deciding on the frequency of azelaic acid application ultimately hinges on the diagnosis, prescription instructions, and individual barrier tolerance. If a patient is managing acne or stubborn hyperpigmentation and their dermatologist prescribed a twice-daily regimen, adhering to that recommendation is the best initial course.

However, adjustments should be made based on skin response: - **Papulopustular Rosacea:** If a patient cannot tolerate twice-daily application due to severe stinging, dryness, or irritation, stepping down to once-daily dosing provides an evidence-backed alternative that maintains clinical efficacy while sparing the skin barrier. - **Acne and Pigmentation:** Patients instructed to apply it twice daily who struggle with cost or mild irritation can discuss tapering to once daily with their prescriber once disease control is established. - **Individual Reassessment:** Therapeutic schedules are not static; dosing frequency can always be re-evaluated over time to balance efficacy, financial cost, and skin comfort.

[07:51](https://www.youtube.com/watch?v=MYiOWPf354A&t=471s) How to Build the Routine: Application Order and Keeping It Simple

When it comes to layering tretinoin and azelaic acid, Dr. Dray urges patients to avoid paralysis by analysis: "Stop overthinking it. Just put it on your face and move on." Clinical skincare does not require an elaborate multi-step regimen to be effective.

For patients using azelaic acid once daily, the most practical approach is applying it in the morning on clean, dry skin, followed by a broad-spectrum sunscreen that doubles as a moisturizer. Tretinoin is reserved for the nighttime routine, followed by a dedicated moisturizer if desired. Dr. Dray notes that many prescription tretinoin cream vehicles are sufficiently emollient on their own, meaning many users do not need an additional night cream.

If a patient is directed to use azelaic acid twice daily, both actives can be layered at night. In this scenario, order of application is largely arbitrary: azelaic acid can be applied before or after tretinoin depending on personal preference. Because the patient is already applying two medicated creams or gels layered on top of each other, the skin is often adequately moisturized without adding a separate night cream.

Finally, Dr. Dray cautions against diluting these targeted treatments with complex multi-serum regimens: "What about my serums? What about this y'all?" She reminds viewers that prescription topicals are tested in clinical trials as standalone interventions, not stacked underneath ten cosmetic serums. Layering excessive products creates diminishing returns, risks vehicle incompatibility, and increases barrier irritation.

[09:21](https://www.youtube.com/watch?v=MYiOWPf354A&t=561s) The Trap of Overcomplication and the "Cookbook Approach"

When managing conditions like rosacea, acne, and hyperpigmentation, the governing rule is simple: "fewer products, fewer problems." Piling on serums and treatments in pursuit of fading dark marks or banishing breakouts exponentially increases the risk of barrier irritation, which directly sabotages pigment clearance and worsens acne flares. Dr. Dray warns that if you find yourself constantly stressing over what to apply next, you have already overcomplicated your routine. In fact, if social media is triggering that anxiety, she suggests deleting apps like TikTok and Instagram altogether.

Dr. Dray points out that the social media skincare space creates false pressure to adopt maximalist routines: "You don't get a gold medal in skincare because you have the most TikTok algorithmic routine that gets the most clicks, the most likes, the most hype on social media." Managing skin conditions is medical care, not baking, and it cannot follow a rigid "cookbook approach." In baking, failing to follow a recipe to a tee might cause bread to sink or end up with a texture like chewing gum; clinical dermatology, however, requires nuance, patience, and individual personalization. Layering dozens of products to compete with internet trends will not earn anyone a "collagen medal of honor."

- Excessive product layering triggers irritation, which worsens both active acne and post-inflammatory hyperpigmentation. - Skincare requires tailoring to personal tolerance, not following internet algorithms.

[11:04](https://www.youtube.com/watch?v=MYiOWPf354A&t=664s) Applying the Framework to Other Retinoids

The logic behind combining azelaic acid with tretinoin extends to the entire retinoid family. Patients using other prescription topical retinoids—such as adapalene, tazarotene, or trifarotene—follow the exact same principles of skin tolerance, frequency, and barrier preservation.

The concept also applies to over-the-counter cosmetic vitamin A derivatives, including retinol and retinaldehyde. Regardless of whether an individual is applying a high-strength prescription medication or a gentle cosmetic formulation, the key consideration is how active vitamin A interacts with the skin barrier when paired alongside azelaic acid.

[11:28](https://www.youtube.com/watch?v=MYiOWPf354A&t=688s) Target Concerns: Acne Plus Dark Marks, Rosacea, and Photoaging

The case for combining a topical retinoid with azelaic acid becomes particularly compelling for individuals dealing with acne paired with post-inflammatory hyperpigmentation. In this scenario, azelaic acid works synergistically with the retinoid: both ingredients tackle acne through distinct mechanisms, while azelaic acid provides targeted pigment-modulating benefits to fade dark marks left in the wake of breakouts.

For rosacea, the calculation shifts. Azelaic acid is an established, FDA-approved, first-line therapy for rosacea, whereas topical retinoids are not standard, even if anecdotal and clinical experience indicates they may help some patients. Because rosacea skin is inherently hyper-reactive, prone to flushing, and easily sensitized by drying topicals, a conservative approach is crucial. Clinical evidence supports that once-daily azelaic acid can be just as effective as twice-daily application for rosacea, making once-daily application an ideal starting frequency to avoid flare-ups.

When it comes to photoaging, topical retinoids are the gold standard, while azelaic acid does not carry the same robust anti-aging evidence base. Nevertheless, azelaic acid's anti-inflammatory properties and gentle resurfacing can smooth rough skin texture and improve overall tone. Even so, Dr. Dray cautions against adopting an "everything but the kitchen sink" mindset in an attempt to make skin "go back in time," as overloading actives inevitably provokes the barrier damage and inflammation one is attempting to treat.

[13:16](https://www.youtube.com/watch?v=MYiOWPf354A&t=796s) Managing Irritation: The One-Ingredient-at-a-Time Rule

Rather than worrying about which product to layer first, the fundamental rule is simple: do not assume you need both ingredients in the first place. Skincare beginners who are naive to both retinoids and azelaic acid should always introduce only one active ingredient at a time and stick with it consistently.

```mermaid flowchart TD accTitle: Staged Introduction of Skincare Actives accDescr: Decision flow for introducing azelaic acid or retinoids one at a time over a three-month evaluation period. subgraph Step1["Phase 1: Single Active"] A["Start with One Active (Azelaic Acid or Retinoid)"] --> B["Test Tolerance (e.g., Once Daily for 2 Weeks)"] B --> C["Adjust Frequency (Maintain Daily or Alternate)"] end subgraph Step2["Phase 2: Evaluation"] C --> D["Stay Consistent for 3 Months"] D --> E{"Are Results Satisfactory?"} end subgraph Step3["Phase 3: Outcome"] E -->|"Yes"| F["Maintain Simple Routine (Avoid Extra Products)"] E -->|"Plateau / Need More"| G["Consult Dermatologist to Layer Second Active"] end ```

For instance, someone prescribed azelaic acid might start by applying it once daily for the first couple of weeks to assess tolerability. If the skin handles it well, they can attempt bumping up to twice daily; if that triggers excessive dryness or peeling, they can safely scale back to once daily. Giving an active three full months allows the skin cycle time to respond. Many individuals find that a single well-tolerated active resolves their concerns entirely, making an additional active ingredient completely superfluous. Only if progress plateaus after establishing tolerance should they consult their dermatologist about cautiously layering in a retinoid (or vice versa).

- Begin with a single ingredient to establish baseline tolerance before layering. - Give a new active a consistent 3-month trial period before declaring it insufficient. - Scale back frequency immediately if peeling, stinging, or redness occurs.

[15:53](https://www.youtube.com/watch?v=MYiOWPf354A&t=953s) The Bottom Line and Evidence-Based Pairings

Ultimately, azelaic acid paired with a topical retinoid (or cosmetic retinol/retinaldehyde) is an effective, evidence-backed combination—especially for those managing acne alongside stubborn hyperpigmentation. However, it is not an obligatory routine for everyone. For some, the combination adds unnecessary irritation; for others, it is simply redundant. Rosacea patients can also utilize the pair, but must remain extra vigilant and conservative to prevent flushing and barrier breakdown.

For viewers seeking an accessible, science-backed anti-aging pairing available at the drugstore without high costs or social media fluff, Dr. Dray highlights the combination of topical retinoids with AmLactin lotion (ammonium lactate), directing viewers to an end-screen video for a full breakdown. She wraps up the discussion by reminding viewers to like, subscribe, and wear daily sunscreen.

## Notable quotes > [00:37](https://www.youtube.com/watch?v=MYiOWPf354A&t=37s) two for one — Dr. Dray

> [07:51](https://www.youtube.com/watch?v=MYiOWPf354A&t=471s) Stop overthinking it. Just put it on your face and move on. — Dr. Dray

> [07:51](https://www.youtube.com/watch?v=MYiOWPf354A&t=471s) What about my serums? What about this y'all? — Dr. Dray

> [09:21](https://www.youtube.com/watch?v=MYiOWPf354A&t=561s) fewer products, fewer problems — Dr. Dray

> [09:21](https://www.youtube.com/watch?v=MYiOWPf354A&t=561s) You don't get a gold medal in skincare because you have the most TikTok algorithmic routine that gets the most clicks, the most likes, the most hype on social media. — Dr. Dray

> [09:21](https://www.youtube.com/watch?v=MYiOWPf354A&t=561s) cookbook approach — Dr. Dray

> [09:21](https://www.youtube.com/watch?v=MYiOWPf354A&t=561s) collagen medal of honor — Dr. Dray

> [11:28](https://www.youtube.com/watch?v=MYiOWPf354A&t=688s) everything but the kitchen sink — Dr. Dray

> [11:28](https://www.youtube.com/watch?v=MYiOWPf354A&t=688s) go back in time — Dr. Dray

## Mentioned Dr. Dray, American Academy of Dermatology (AAD), Cutibacterium acnes, Demodex, AmLactin, TikTok, Instagram, YouTube, Amazon

## Video description Can you use azelaic acid with tretinoin or another topical retinoid? Dermatologist Dr. Dray explains how these two skincare ingredients can work together for acne, rosacea, post-inflammatory hyperpigmentation, and other common skin concerns.

Azelaic acid has anti-inflammatory, antimicrobial, and pigment-modulating properties, making it useful for acne, rosacea, and dark marks left behind after breakouts. Tretinoin and other topical retinoids work differently by helping normalize skin cell turnover, prevent clogged pores, treat acne, and improve signs of photoaging.

Dr. Dray explains why combining azelaic acid and tretinoin can be particularly useful for people dealing with acne and hyperpigmentation, how to introduce both ingredients without unnecessarily irritating the skin, and whether azelaic acid really needs to be used twice a day.

The video also explores the evidence for once-daily vs. twice-daily azelaic acid for papulopustular rosacea, why once-daily treatment may be a reasonable option for some people, and how individual skin tolerance should guide your skincare routine.

Dr. Dray also discusses using azelaic acid with adapalene, tazarotene, or trifarotene, whether retinoids can be used with rosacea, and why adding more active ingredients does not necessarily mean better results.

In this video:

• Can you use azelaic acid with tretinoin? • How azelaic acid works for acne and hyperpigmentation • How tretinoin works for acne and photoaging • Why azelaic acid and retinoids can complement each other • Does azelaic acid need to be used twice a day? • Once-daily vs. twice-daily azelaic acid for rosacea • Azelaic acid for post-inflammatory hyperpigmentation • Using azelaic acid with adapalene, tazarotene, and trifarotene • Can you use tretinoin if you have rosacea? • Azelaic acid and tretinoin for anti-aging • How to reduce irritation from combining active ingredients • Why more skincare actives are not always better • How to build a simple azelaic acid and retinoid routine

Timestamps

0:00 Introduction 0:37 What Does Azelaic Acid Do? 2:17 What Does Tretinoin Do? 3:22 Why Combine Azelaic Acid and Tretinoin? 4:13 Do You Need Azelaic Acid Twice a Day? 7:07 When Would You Use It Twice a Day? 7:51 How to Combine Azelaic Acid With a Retinoid 11:04 What If You Use Adapalene or Tazarotene? 11:28 Acne Plus Dark Marks 11:59 What About Rosacea? 12:39 What About Photoaging? 13:16 The Biggest Issue: Irritation 15:53 My Bottom Line

The key takeaway is that twice-daily azelaic acid is not automatically better than once-daily treatment. Prescription azelaic acid 15% gel is labeled for twice-daily use for rosacea, but clinical research has found comparable improvement with once-daily application for papulopustular rosacea. The ideal frequency depends on the specific product, condition being treated, tolerability, and consistency.

For many people, a simple routine of azelaic acid in the morning, tretinoin at night, moisturizer, and daily sunscreen can be an effective approach. The goal is not to use the maximum number of skincare actives, but to find a routine that provides benefits without excessive irritation.

#AzelaicAcid #Tretinoin #AzelaicAcidAndTretinoin #Retinoids #Acne #Hyperpigmentation #Rosacea #PostInflammatoryHyperpigmentation #Skincare #Dermatologist #DrDray #AntiAgingSkincare #Retinol #AcneTreatment #skincareroutine

FTC: This video is not sponsored. Links are commissionable, meaning I may earn commission from purchases made through links.

💜Shop my Amazon store https://o.bttn.io/0BwiPWFIZLG 💜Follow me on liketoknowit https://www.liketoknow.it/drdrayzday 💜Social media Instagram @drdrayzday Pinterest https://www.pinterest.com/drdrayzday/ Facebook @DrDrayzDay Twitter: @drdrayzday Tiktok: @drdrayzday

Disclaimer: This video is not intended to provide diagnosis, treatment or medical advice. Content provided on this Youtube channel is for informational purposes only. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options. Information on this Youtube channel should not be considered as a substitute for advice from a healthcare professional. The statements made about specific products throughout this video are not to diagnose, treat, cure or prevent disease.

[Source](https://www.youtube.com/watch?v=MYiOWPf354A)

中文简报

壬二酸与维A酸：两者可以联合使用吗？| 皮肤科医生 Dr. Dray 详细阐述了壬二酸与 tretinoin 如何通过不同且互补的生物学途径发挥作用，使其成为针对痤疮及炎症后色素沉着的强效临床组合。在谈及使用频率时，她指出临床数据表明，每日使用一次壬二酸可达到与每日两次相当的疗效，同时大幅减少灼痛感和屏障刺激，尤其是对玫瑰痤疮患者而言。她破除了关于玫瑰痤疮患者使用维A酸类药物的误区，同时强调活性成分的联合使用应保持谨慎，切忌盲目叠加产品。最后，她建议采用精简的护肤方案——例如晨间使用壬二酸配合防晒霜，晚间使用维A酸类药物——并建议患者在引入另一种活性成分前，先适应一种成分数月。联合使用壬二酸和 tretinoin 可通过互补且非冗余的途径改善痤疮与炎症后色素沉着：维A酸类使表皮细胞更新恢复正常，而壬二酸则具有抗菌作用并能抑制酪氨酸酶。 (3:22) 针对丘疹脓疱型玫瑰痤疮的临床试验数据表明，每日一次使用壬二酸在减少炎性皮损方面与标准的每日两次用药效果相当，同时能将副作用和处方补充费用减半。 (4:13) 外用维A酸类药物对玫瑰痤疮并非绝对禁忌；它们有助于促进真皮结缔组织重塑，并减少滋生炎性蠕形螨的面部角质细胞。 (5:58) 追求极致的多重精华叠加方案会加剧皮肤屏障刺激，进而引发炎症级联反应，反而加重活动性痤疮爆发和炎症后色素沉着，破坏治疗效果。 (9:21)

Reading summary

Dermatologist Dr. Dray explains that pairing tretinoin with azelaic acid provides an effective, evidence-backed strategy for managing acne and post-inflammatory hyperpigmentation through distinct cellular pathways. However, she emphasizes that combining both actives is not universally necessary and requires a staged, barrier-conscious approach tailored to individual skin tolerance. Complementary Mechanisms for Acne and Hyperpigmentation (3:22) Tretinoin and azelaic acid address cutaneous disease through non-redundant physiological pathways, aligning with American Academy of Dermatology guidelines that favor multi-modal treatment strategies. Tretinoin, a prescription topical retinoid, alters gene expression to normalize epidermal turnover and desquamation, clearing follicular plugging and dispersing concentrated melanin deposits. Concurrently, azelaic acid functions as a dicarboxylic acid offering antimicrobial action against Cutibacterium acnes, downregulating inflammatory cascades, and directly inhibiting tyrosinase—the rate-limiting enzyme required for melanin synthesis. When combined, the two ingredients demonstrate clinical synergy. Tretinoin accelerates the shedding of existing pigment pools while azelaic acid curbs active inflammatory triggers and shuts down new pigment production. This concurrent activity is especially valuable for acne lesions that leave stubborn post-inflammatory hyperpigmentation, producing faster and more comprehensive clearance than monotherapy. Evidence for Flexible Azelaic Acid Dosing (4:13) Although prescription azelaic acid formulations (such as 15% gel) are officially labeled for twice-daily use, Dr. Dray notes that a rigid two-times-a-day schedule is not mandatory for therapeutic efficacy. A 12-week clinical trial evaluating papulopustular rosacea found that once-daily azelaic acid was clinically comparable to twice-daily application in reducing inflammatory papules and pustules. Importantly, once-daily dosing substantially reduced common adverse effects, including burning, stinging, erythema, and dryness—side effects to which sensitive barriers are particularly prone. It also cuts product consumption and refill expenses in half. While comparative evidence for acne and hyperpigmentation is less definitive, real-world experience demonstrates that many patients sustain satisfactory clinical improvement using azelaic acid only once per day. Cautious Retinoid Application in Rosacea Management (5:58) Dr. Dray challenges the common assumption that patients with rosacea must avoid topical retinoids altogether. While azelaic acid is an established, FDA-approved first-line intervention for papulopustular rosacea, retinoids can also provide therapeutic value by remodeling dermal connective tissue, stabilizing tissue reactivity, and offering anti-inflammatory benefits. Additionally, retinoid-induced cellular desquamation removes excess surface corneocytes, reducing hospitable microenvironments for Demodex mites associated with rosacea flares. Nevertheless, because rosacea involves a fragile, hyper-reactive epidermal barrier, retinoids must be approached with caution. Whether using prescription tretinoin or over-the-counter options like retinol or retinaldehyde, patients must monitor closely for signs of barrier irritation, as aggressive retinization can aggravate underlying erythema and flushing. Routine Design and Staged Introduction Protocols (7:51) Dr. Dray warns against complex multi-serum regimens popularized on social media, emphasizing that layering excessive products increases vehicle incompatibility and barrier irritation, which ultimately exacerbates breakouts and hyperpigmentation. A standard split routine places azelaic acid in the morning under a broad-spectrum sunscreen and tretinoin in the evening. If azelaic acid is prescribed twice daily, both medications can be layered at night in any sequence, as the formulation bases typically provide sufficient hydration without an additional moisturizer. This framework applies equally to other topical retinoids, including adapalene, tazarotene, and trifarotene. To prevent unnecessary irritation, beginners should follow a single-ingredient introduction rule. Patients should start with one active, test tolerance over a couple of weeks, and maintain consistent use for a full three-month cycle to allow skin turnover to manifest results. Only if progress plateaus should they consult a dermatologist about introducing a second active, scaling back frequency immediately if erythema, peeling, or stinging arises. Dr. Dray concludes that while combining azelaic acid with topical retinoids is scientifically sound and therapeutically complementary, patients must avoid trend-driven overcomplication. Many individuals achieve complete resolution of their skin concerns using a single well-tolerated active, and routine design should prioritize barrier preservation over maximalist product layering.

Source quotes

[0:37] Dr. Dray: two for one [7:51] Dr. Dray: Stop overthinking it. Just put it on your face and move on. [7:51] Dr. Dray: What about my serums? What about this y'all? [9:21] Dr. Dray: fewer products, fewer problems [9:21] Dr. Dray: You don't get a gold medal in skincare because you have the most TikTok algorithmic routine that gets the most clicks, the most likes, the most hype on social media. [9:21] Dr. Dray: cookbook approach [9:21] Dr. Dray: collagen medal of honor [11:28] Dr. Dray: everything but the kitchen sink [11:28] Dr. Dray: go back in time

Original transcript

[0:00] Well, hey guys. Welcome back. If you're [0:01] new here, I'm Dr. Dre. I'm a [0:03] boardcertified dermatologist. Many of [0:05] you are using a topical retinoid like [0:07] tininoan, and you may have come across [0:10] posts online or just be wondering in [0:12] general, does it make sense to pair this [0:14] with azelleic acid? Cuz I heard that [0:17] they can be really good together. We're [0:19] going to get into all those questions in [0:20] today's video. I'm going to clarify some [0:22] things about how to use these two things [0:24] together or either alone. How often do [0:27] you need to use them in order to see the [0:29] kind of results that maybe you are [0:30] looking for? And hopefully to help [0:32] clarify any points that might have been [0:35] confusing and stuff you've come across [0:36] online. What does azelleic acid have to [0:39] offer? Azelleic acid is something known [0:41] as a dicaroxyic acid. It has [0:44] anti-inflammatory effects, antimicrobial [0:46] effects, and pigment modulating [0:49] properties. It's actually used as a [0:52] prescription treatment for acne, for [0:54] rosacea, and for melasma. So, widely [0:57] differing conditions all seem to get [1:00] some benefit from a little azelleic acid [1:02] on there. For acne, it can help reduce [1:04] inflammation, reduce the burden of acne [1:06] causing bacteria known as cutie [1:08] bacterium, acnes, and can even gently [1:10] exfoliate the skin to help reduce pore [1:13] clogging. One of the biggest advantages [1:14] of azelleic acid is when it comes to [1:18] helping to clear up unwanted [1:20] hyperpigmentation. This makes it really [1:22] good for treating acne because acne and [1:24] deeper skin tones tends to heal with [1:26] stubborn hyperpigmentation. So you're [1:28] getting a treatment for the acne and for [1:31] preventing or clearing up any unwanted [1:34] pigmentation from the acne. So you can [1:36] see you kind of get a two for one there. [1:38] Azelleic acid works for pigmentation by [1:41] inhibiting tyrrosinase which is the [1:43] enzyme that the cells in your skin that [1:45] make skin color melanocytes use to make [1:47] that pigment melanin and so it can help [1:50] basically in reducing excess [1:51] pigmentation and it also is [1:53] anti-inflammatory. The inflammation is a [1:56] big driver actually in increases in [1:58] pigment production. Okay, hence the [2:01] postinflammatory hyperpigmentation. And [2:03] the American Academy of Dermatology in [2:06] their guidelines includes azelleic acid [2:08] as a recommended topical acne treatment. [2:11] So it is commonly used for acne with the [2:14] added benefit of the anti-pigmentation [2:16] effects as well. What does tininoan do? [2:19] Tininoan is a topical retinoid. [2:21] Retinoids work by influencing gene [2:23] expression in cells of the skin. They [2:25] help to normalize the way your skin and [2:28] your epidermis turns over, ultimately [2:30] reducing pore clogging, smoothing the [2:32] skin surface. For acne, in other words, [2:34] they help to improve abnormal follicular [2:37] plugging. So, it's great for blackheads [2:39] and white heads. Retinoids are also [2:41] useful as acne maintenance treatments, [2:43] meaning once the acne is cleared, if you [2:45] continue them, they help maintain [2:47] clearance, keep it from coming back [2:49] because they have these [2:50] anti-inflammatory effects as well. And [2:52] then many of you pursue topical [2:54] retinoids such as tininoan for the [2:57] anti-aging benefits. Topical retinoids [2:59] can improve collagen production in the [3:01] skin, diminishing wrinkles. They have [3:03] again those anti-inflammatory effects. [3:05] They also help to target age spots, [3:08] hyperpigmentation related to cumulative [3:10] lifetime sun exposure and rough skin [3:12] texture. In other words, tininoan and [3:15] azelleic acid, they're not redundant. [3:17] They don't do the same things. They [3:19] offer some different benefits that are [3:22] complimentary, which is one of the [3:23] reasons why many people get a lot of [3:25] benefit out of not using one, but rather [3:28] both. When combining treatments, it's [3:30] generally preferable to combine [3:32] treatments that have complimentary [3:34] mechanisms of action. The AD acne [3:36] guidelines speak to this in recommending [3:38] combinations of acne treatments that [3:40] address different mechanisms. Tininoan [3:43] helps reduce pore clogging and reduces [3:45] inflammation. Azelleic acid is [3:47] antimicrobial. reduces inflammation. So [3:50] you start to hit a couple of different [3:52] angles with this combination approach. [3:54] And then as far as dark spots, tininoan [3:56] can help hasten the clearance of those [3:58] dark spots. It can help suppress [3:59] upregulation of pigment producing [4:01] pathways. Azelleic acid inhibits [4:04] tyrosinase. So you can see how we're [4:06] starting to get a couple of different [4:07] mechanisms here converging onto one [4:10] issue to well help with those dark [4:12] marks. Now here's a common question I [4:14] get. Do you need to use azelleic acid [4:16] twice a day? Maybe your dermatologist [4:18] told you to use it that way or somebody [4:20] on the internet said, "Oh, use it twice [4:22] a day." Prescription azelleic acid twice [4:24] daily use is the standard labeled [4:26] regimen and what is often recommended. [4:29] But that doesn't necessarily mean that [4:30] everyone must use it twice a day in [4:33] order to get any effects or that you [4:35] cannot get the same degree of effects [4:37] only using it once a day. There's [4:39] actually a small clinical trial that [4:41] demonstrates that for papulopuscular [4:43] rosacea. Once a day use of azelleic acid [4:47] yields comparable results to twice a day [4:50] use, it tends to be less drying and [4:52] irritating. And of course, it's going to [4:53] be cheaper. If you have to put something [4:55] on once a day, it's going to last you a [4:58] lot longer. You're not going to have to [4:59] refill the prescription as often as if [5:02] you're applying it twice a day. After 12 [5:04] weeks, once daily treatment was found to [5:06] be as effective as twice daily treatment [5:08] for reducing inflammatory lesions of [5:10] papulopuscular rosacea cuz as lic acid [5:13] in this group, it can cause stinging, [5:15] irritation, dryness. And this is a group [5:17] of people who are very sensitive to [5:19] those types of side effects. So it's [5:21] really really important maybe to [5:23] consider that if you have papular [5:24] postural rosacea, but not exactly clear [5:27] with regards to the other conditions we [5:29] mentioned here, acne or [5:30] hyperpigmentation. Do you need to use it [5:32] twice a day? I mean, that's how it's [5:34] prescribed and recommended. But, I mean, [5:36] there are people out there who use it [5:37] once a day, either because they never [5:39] realize they should be using it twice a [5:41] day. The derm didn't tell them, they [5:43] didn't read the, you know, dosing [5:45] frequency on the prescription or they [5:47] just, you know, maybe they were told to [5:48] use it once a day. People do things [5:49] differently and they still get results. [5:52] So, uh, it all boils down to you, the [5:54] individual. It's not always that black [5:56] and white. But a note about tininoan [5:58] plus azelleic acid for rosacea and why I [6:01] also wanted to bring up that once a day [6:03] versus twice a day frequency. It's this [6:06] popular myth that if you have rosacea [6:08] you can never use a topical retinoid [6:11] like tininoan. And that's actually not [6:12] true. There's even some evidence to [6:14] suggest that topical retinoids can end [6:16] up being helpful for rosacea due their [6:19] dermal remodeling effects. And they also [6:21] of course have some anti-inflammatory [6:23] properties which could be beneficial for [6:24] rosacea. They may help cut down on just [6:27] dry dead skin on the surface that [6:30] ultimately facilitates more of those [6:31] little demadeex face mites which play a [6:34] role in papulopusular rosacea for sure. [6:36] And there's even some evidence that the [6:38] cosmetics retinol and retinaldahhide can [6:40] help normalize the epidermal [6:42] proliferation and downregulate [6:44] inflammatory pathways which potentially [6:46] can be quite helpful for clearing the [6:49] papules and pestules of rosacea. Rosacea [6:52] prone skin is fragile. prone to [6:54] blushing, flushing, sensitivity. Because [6:56] of that, those patients are also more [6:59] likely to develop irritation from [7:00] retinoid, go through a rough [7:02] retinization process. So, it's not [7:04] necessarily going to be right for [7:05] everyone, but it's also not off the [7:07] table for everyone either. When should [7:08] you be using azelleic acid? Twice a day, [7:10] then? Well, if you're using a product [7:12] that is intended for acne or [7:13] hyperpigmentation, you've been advised [7:15] to use it twice a day. Use it twice a [7:17] day. If you have papulopus rosacea, you [7:19] can't hack using it twice a day. It's [7:21] too drying. It's too irritating. do know [7:23] that the once a day frequency was shown [7:24] to be as effective for reducing the [7:27] papulo puscular rosacea but less drying [7:29] and irritating and of course cheaper so [7:31] it might be a good option for you that's [7:33] not to say that if you have acne you [7:34] have hyperpigmentation you can never [7:36] just use azelleic acid once a day but I [7:39] would generally follow the advice of the [7:41] prescriber as far as the frequency and [7:44] maybe reassess at a later time point if [7:46] you can go down in frequency for cost uh [7:48] reasons you know that may be an option [7:50] for you how to combine both of these [7:52] ingredients. It's pretty [7:54] straightforward. You don't have to [7:55] overthink it. A lot of people get really [7:57] hung up on layering the two. And I mean, [8:00] honestly, I I tell people, stop [8:02] overthinking it. Just put it on your [8:04] face and move on. Um in the morning [8:06] though you would probably apply your [8:08] azelleic acid to clean bare skin [8:10] followed by your sunscreen which duels [8:12] as a moisturizer and then at night you [8:15] can apply your tininoan or um topical [8:18] retinoid or retinol and follow with a [8:20] moisturizer if you feel you need to. Um [8:22] some tininoan vehicles the cream is [8:26] moisturizing enough for a lot of people. [8:27] So that alone may may cut it. This is [8:29] two separate active ingredients. One [8:31] you're using in the morning and one [8:32] you're using at night. Alternatively, if [8:34] you want to or have been advised to use [8:36] your azelleic acid twice a day, apply [8:39] azelleic acid also at night and then [8:42] apply tininoan or apply tininoan first [8:44] and then azelleic acid and then decide [8:46] if you need a moisturizer. Remember, [8:48] you're using now two moisturizing [8:50] vehicles on top of each other. So, [8:52] probably moisturized. Okay, you probably [8:54] don't need to use another moisturizer. [8:56] Maybe you do. Everyone's skin is [8:58] different. But that's generally how I [8:59] would use these things. What about my [9:01] serums? What about this y'all? These [9:04] topicals are not tested and recommended [9:07] clinically alongside these complex skin [9:11] care routines to know at what point do [9:13] you start getting diminishing returns [9:15] from layering too many different types [9:17] of products. So, generally speaking, [9:20] especially when we're talking about [9:21] rosacea, fewer products, fewer problems. [9:23] If we're talking about [9:24] hyperpigmentation, the more products you [9:26] start chasing after, the greater the [9:28] likelihood of irritation, which is going [9:30] to sabotage your pigment fading journey. [9:32] And acne does not favor excessive [9:35] irritation. So, keep it really simple. [9:38] If you find yourself whating too much, [9:40] chances are you've over complicated it. [9:42] And that over complication is probably [9:44] going to trigger irritation. Just keep [9:46] it as simple as possible. And if you [9:48] need to delete your Tik Tok app, your [9:50] Instagram app in order to not get [9:52] overwhelmed, by all means, cuz there's a [9:55] lot out there as far as routines and [9:57] people weighing in on all the stuff they [9:59] do. And it can make you feel like, oh, I [10:01] should be doing that when, you know, [10:04] here's the thing. Um, you don't get a [10:06] gold medal in skincare because you have [10:09] the most Tik Tok algorithmic routine [10:12] that gets the most clicks, the most [10:13] likes, the most hype on social media [10:16] because acne, rosacea, [10:18] hyperpigmentation, these are all very [10:20] different skin conditions, patients, [10:23] needs, their responses, the risks, the [10:27] benefits, they all differ. Okay, we acne [10:30] treatment, rosacea treatment, medical [10:33] treatment is not something that can [10:36] follow a cookbook approach. It's not [10:38] like baking where you need to follow [10:41] this recipe to a tea. Otherwise, your [10:43] bread's going to sink, okay? It's not [10:45] going to rise properly. It's going to [10:47] taste like chewing gum if you don't do [10:49] it right. This is a lot more nuanced. It [10:52] has to be tailored to the patient, um, [10:55] not to the algorithm. You don't need to [10:56] compete with the Joneses for layering [10:58] the most anti-aging stuff on your face. [11:01] Um, you're not going to get a a collagen [11:03] medal of honor. This concept is not [11:05] limited to tininoan. So, the other [11:07] topical retinoids fit in here in the [11:09] same way. If you're instead of using [11:11] tininoan, you're using adapylene. [11:12] Instead of using tininoan, you're using [11:14] tazeritine. Instead of using tininoan, [11:16] you're using triferitine. You're using [11:17] retinol, retinaldahhide. Those are [11:19] cosmetics. I mean it it all fits in here [11:22] with regards to the use of a topical [11:24] form of active vitamin A, whichever it [11:26] be, whether it be medication or [11:28] cosmetic. If you have acne plus [11:30] hyperpigmentation, then the combo of a [11:33] topical retinoid and azelleic acid are a [11:36] lot more compelling. Okay? Because here [11:38] you have a situation where you're going [11:39] to use an ingredient that can complement [11:42] one ingredient not just for the acne [11:44] treatment, but also for the [11:46] hyperpigmentation. That's a really [11:48] compelling story right there. And so [11:50] that's that's a situation where I think [11:52] you have a lot more reason to to push [11:55] forward with considering that. But [11:57] again, it doesn't follow a cookbook if [11:59] this plus that. Rosacea is another one [12:01] where aelic acid is an established [12:04] treatment for rosacea. Topical retinoids [12:06] are not. I mentioned, you know, there's [12:07] reason to believe that they can help. [12:09] There's even some clinical experience [12:12] suggesting, yeah, it definitely can [12:14] help. But the azelic acid is going to be [12:16] the more logical go-to here. It can be [12:20] drying and irritating. And we do have [12:22] evidence in people with rosacea that [12:24] using it just once a day can still be [12:26] effective as opposed to the twice daily [12:28] frequency. So in other words, it all [12:30] boils down to how reactive your rosacea [12:32] is to topicals. If you're real [12:34] sensitive, you get dry, irritated, it [12:36] leads to more flushing. You've got to be [12:38] a lot more a lot more conservative. What [12:40] about photoagging? A lot of people use [12:42] topical retinoids for photoagging. Um, [12:44] you know, topical azelleic acid isn't [12:46] necessarily uh evidence-based per se for [12:49] photoagging, for anti-aging, but it is [12:52] anti-inflammatory. It can smooth rough [12:54] skin texture somewhat. So, it may be [12:57] beneficial to you. It also may be [12:59] beneficial if you've got um, you know, [13:02] some post-inflammatory [13:03] hyperpigmentation. You want to help [13:04] overall skin tone. That's another [13:06] possibility there. But don't think that [13:08] just throwing every possible beneficial [13:11] ingredient at your face is going to get [13:14] it like to to to go back in time cuz at [13:16] some point we run into this issue more [13:19] ingredients, more products, more [13:21] irritation and that's not what we want. [13:22] I wouldn't over complicate this though [13:24] with the which one first questioning [13:27] because just put it on if your face [13:29] tolerates it. Keep going. Okay. And [13:31] here's the other thing. Don't assume [13:32] that you need to use both ingredients. [13:35] Okay? just because this is popular, a [13:37] lot of content being made about this. [13:38] I'm making a video about it. I'm [13:40] highlighting the benefits here. Don't [13:42] assume you're going to benefit or need [13:43] to do this. Okay? So, here's really what [13:45] I suggest you also do. If you're naive [13:47] to any of these, you've never used a [13:48] topical retinoid, you've never used [13:50] topical azelleic acid, start with one. [13:53] Use it consistently. Okay? Say for [13:55] example, you want to start with azelleic [13:56] acid or you've been told by your [13:58] treating physician, I'm going to [14:00] prescribe you azelleic acid. Okay? Talk [14:02] to them about how frequently to use it. [14:04] Maybe you use it once a day for the [14:06] first couple of weeks. See how you do, [14:08] okay? Cuz it can be dry and irritating. [14:10] Then you gradually bump up to twice a [14:11] day. Maybe twice a day is too dry and [14:13] too irritating. You go back to once a [14:15] day and you're like, "Okay, I can ride [14:16] this out." Stay consistent with it for [14:18] just stay consistent for 3 months. Stuff [14:21] takes time in the skin. I'm telling you [14:23] this because some people out there will [14:25] be done with finding their their their [14:28] routine. Okay? At that point, you will [14:29] have found something that gets you the [14:31] results that you need. clear. Adding [14:33] something else may not be necessary. [14:35] Just increases the likelihood of [14:36] irritation. If you're seeing benefit or [14:38] you're not quite sure, but um you're [14:41] thinking you could get a little bit [14:42] better with a topical retinoid. Talk to [14:44] your derm. Talk to your derm. Uh and if [14:46] they agree, all right, well then [14:48] consider adding adding a retinoid and [14:50] kind of increase to daily use as [14:52] tolerated, but don't assume that you [14:54] have to. Or vice versa. Maybe you start [14:56] with a retinoid. You get used to that, [14:57] the retinization process. Great. my acne [15:00] is really well controlled here. Um then [15:03] maybe you don't need the the azelleic [15:04] acid. Okay, so bottom line, yeah, using [15:07] azelleic acid and a topical retinoid or [15:09] cosmetic retinol retinaldahhide can be a [15:11] great pairing. But not everyone has to [15:13] do it and not everyone is necessarily [15:15] going to benefit from it. Could be too [15:16] dry, too irritating for some folks. It [15:18] could just be superfluous for others. [15:20] But for some of you, especially key [15:22] group being those who have both acne, [15:24] hyperpigmentation prone skin, I think [15:26] it's a really logical evidence-based [15:28] pairing to to entertain. Again, doesn't [15:31] guarantee it's going to be right for [15:33] you. And folks with rosacea can use the [15:35] pairing, too. Okay? Don't let an [15:36] algorithm tell you can and can't do [15:38] certain things, but you got to be a [15:39] little bit more conservative knowing [15:41] that at baseline, you have a heightened [15:43] likelihood of irritation, sensitivity, [15:46] flushing, and blushing. All right, [15:47] y'all. Drop a comment down below. Is [15:49] this routine something that you've seen [15:51] popping up here and there you are [15:53] curious about? I get a lot of questions [15:55] about this. So, I hope today's video is [15:56] helpful to you. Now, as far as a pairing [15:59] and a routine that um can help with your [16:02] anti-aging goals, specifically stuff [16:04] that you can just get at the drugstore [16:06] in and out, stay consistent, and you're [16:08] like, "Wow, okay, there's actual data [16:10] here. There's actual science here. It's [16:12] not just fluff." That's actually going [16:13] to be, believe it or not, amlactin [16:15] lotion and your topical retinoids. And [16:17] I'm going to share with you guys on the [16:19] ends slate a video where I explain that [16:21] in detail. So check that out if that is [16:23] of interest to you. I like combinations [16:25] that are logical and evidence-based for [16:27] things. If you like that type of video, [16:29] watch that one next. But if you guys [16:30] enjoyed today's video, give it a thumbs [16:32] up, share it with your friends, and as [16:33] always, don't forget sunscreen and [16:35] subscribe. I'll talk to you guys [16:36] tomorrow. Bye. [16:53] >> [music] [16:54] >> Heat. Heat.