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Is Azelex Cream or Finacea Gel Better for Your Skin?

Azelex (azelaic acid) 20% cream and Finacea (azelaic acid) 15% gel are both FDA-approved azelaic acid treatments, but they serve different purposes and contain different concentrations. Azelex is specifically indicated for mild to moderate inflammatory acne vulgaris, while Finacea is approved for treating inflammatory papules and pustules of mild to moderate rosacea. The main differences lie in their concentration, formulation, and approved uses, making one more suitable than the other depending on your specific skin condition.

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In This Article

What Is the Main Difference Between Azelex and Finacea?

The primary difference is that Azelex contains 20% azelaic acid in a cream base for treating acne, while Finacea contains 15% azelaic acid in a gel formulation specifically for rosacea. Despite Azelex having a higher concentration, the different vehicles and intended uses make them each optimal for their respective conditions.

Azelex uses a cream vehicle that provides more moisturizing properties, making it suitable for acne-prone skin that may be dry or irritated from other treatments. The 20% concentration delivers stronger antibacterial and anti-inflammatory effects needed to combat acne-causing bacteria and reduce inflammatory lesions.

Finacea’s gel formulation is lighter and less occlusive, which works well for rosacea patients whose skin tends to be sensitive to heavier formulations. The 15% concentration provides effective anti-inflammatory benefits for rosacea while minimizing the risk of irritation that sensitive rosacea skin might experience with higher concentrations.

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Which Azelaic Acid Formulation Works Better for Acne?

Azelex 20% cream is specifically FDA-approved and clinically proven for mild to moderate inflammatory acne vulgaris, making it the better choice for acne treatment. Clinical studies supporting its approval demonstrated significant reduction in both inflammatory and non-inflammatory acne lesions compared to vehicle control.

The higher 20% concentration in Azelex provides stronger antimicrobial activity against Cutibacterium acnes, the bacteria that contribute to acne development. It also offers more potent anti-keratinizing effects, helping to prevent the formation of comedones by normalizing skin cell turnover in hair follicles.

While Finacea can sometimes be used off-label for acne, it lacks the FDA indication for this use and may not provide the same level of effectiveness due to its lower concentration and different formulation approach.

Which Treatment Is More Effective for Rosacea?

Finacea 15% gel is the superior choice for rosacea, as it is specifically FDA-approved for treating inflammatory papules and pustules of mild to moderate rosacea in adults. Clinical trials showed that Finacea achieved approximately 50 to 58% reduction in papules and pustules compared to 38 to 40% with vehicle control.

The gel formulation is particularly well-suited for rosacea patients because it is less likely to cause occlusion or trap heat, which can trigger rosacea flares. The 15% concentration provides effective anti-inflammatory benefits while being gentler on the sensitive, reactive skin typical of rosacea patients.

Some studies have even shown azelaic acid 20% cream to be more effective than metronidazole 0.75% cream for rosacea, with higher patient satisfaction rates. However, this was in research settings, and Finacea remains the only FDA-approved azelaic acid specifically indicated for rosacea treatment.

How Do the Side Effects Compare Between Azelex and Finacea?

Both medications share similar side effect profiles since they contain the same active ingredient, but Azelex may cause slightly more irritation due to its higher concentration. The most common side effects for both include burning, stinging, and tingling at the application site, typically occurring in the first few weeks of treatment.

Azelex users may experience:

  • Burning or stinging (reported in approximately 29% of patients)
  • Pruritus or itching (approximately 11% of patients)
  • Erythema or redness (approximately 4% of patients)
  • Dryness and peeling (approximately 4% of patients)

Finacea typically causes:

  • Burning or stinging (reported in approximately 29% of patients)
  • Pruritus (approximately 11% of patients)
  • Scaling and dryness (approximately 8% of patients)
  • Erythema (approximately 4% of patients)

The gel formulation of Finacea may be better tolerated by those with sensitive skin, while the cream base of Azelex might be preferable for those with dry skin who need additional moisturizing properties.

Can You Use These Medications for Conditions Other Than Their Approved Uses?

While both medications are sometimes used off-label for various skin conditions, this should only be done under medical supervision. Azelaic acid has shown promise in treating post-inflammatory hyperpigmentation, melasma, and keratosis pilaris, but these uses are not FDA-approved for either formulation.

Some dermatologists may prescribe Azelex off-label for rosacea in patients who need a stronger concentration or prefer a cream formulation. Similarly, Finacea might be used off-label for very mild acne in patients with sensitive skin who cannot tolerate stronger acne medications.

However, using these medications outside their approved indications means there is less clinical data supporting their effectiveness for those conditions. Always discuss off-label use with your dermatologist to ensure it is appropriate for your specific situation.

How Do You Apply Azelex and Finacea Correctly?

Both medications are applied twice daily, but the application techniques differ slightly due to their different formulations. For optimal results, both should be applied to clean, dry skin and allowed to absorb before applying other products.

For Azelex cream:

  • Wash and thoroughly dry the affected areas.
  • Apply a thin layer of cream and gently massage until absorbed.
  • Use twice daily, morning and evening.
  • Wait at least 20 minutes before applying makeup or other products.

For Finacea gel:

  • Cleanse the affected areas with a mild cleanser and pat dry.
  • Apply a thin layer of gel and gently rub in until absorbed.
  • Use twice daily, morning and evening.
  • Allow the gel to dry completely before applying cosmetics or sunscreen.

Both medications may cause initial irritation that typically decreases with continued use. If severe irritation occurs, temporarily reduce application frequency to once daily until tolerance improves.

Which Medication Costs More and Are There Affordable Options?

Both Azelex and Finacea are brand-name prescription medications that can cost between $500 and $600 per tube without insurance coverage. The exact price can vary depending on pharmacy location, tube size, and current manufacturer pricing.

Generic versions of Finacea (azelaic acid 15% gel) are available in the US and may cost 50% to 80% less than the brand-name. Azelex does not currently have a generic available in the US, but is available from one of Universal Drugstore’s international partners.

This can be particularly helpful for patients without insurance coverage for dermatology medications or those with high copays for brand-name prescriptions.

When comparing costs, consider that treatment duration typically lasts several months, so the total cost of therapy should factor into your decision-making process along with clinical effectiveness.

How Long Does It Take to See Results With Each Treatment?

Both Azelex and Finacea typically require 4 to 8 weeks of consistent twice-daily use before noticeable improvement occurs, with full benefits often taking 12 weeks or longer. The timeline is similar for both medications despite their different concentrations and formulations.

For acne treatment with Azelex, patients may notice:

  • Reduced skin oiliness within 2 to 4 weeks.
  • Decreased inflammatory lesions by 6 to 8 weeks.
  • Improvement in post-inflammatory hyperpigmentation by 8 to 12 weeks.

For rosacea treatment with Finacea, typical progression includes:

  • Reduced burning and stinging sensations within 2 to 4 weeks.
  • Decreased papules and pustules by 4 to 8 weeks.
  • Overall improvement in skin texture and appearance by 8 to 12 weeks.

It is important to continue treatment even if initial irritation occurs, as this typically subsides within the first few weeks. Stopping treatment too early may prevent you from experiencing the full benefits of azelaic acid therapy.

Should You Choose Azelex or Finacea Based on Your Skin Type?

The choice between Azelex and Finacea should be based primarily on your diagnosed skin condition rather than skin type alone, but formulation preferences can play a supporting role in the decision. Your dermatologist will consider both your condition and skin characteristics when making recommendations.

Azelex cream may be preferable for:

  • Patients with acne and dry or normal skin.
  • Those who prefer a more moisturizing formulation.
  • Patients who have experienced excessive drying from other acne treatments.
  • Those with acne in areas that tend to be drier, such as the cheeks.

Finacea gel may be better suited for:

  • Patients with rosacea and oily or combination skin.
  • Those who prefer lightweight, fast-absorbing formulations.
  • Patients whose skin is easily irritated by occlusive creams.
  • Those who wear makeup regularly and need a non-greasy base.

Remember that the active ingredient and its proven efficacy for your specific condition should be the primary consideration. Formulation preferences are secondary to choosing the medication that is clinically indicated for your diagnosed skin condition.

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