A small real‑world study found that using a 15% azelaic acid gel on the face significantly cuts down the red bumps and pimples of moderate rosacea, and the improvement sticks around even after you stop using it. The gel works by lowering the skin’s over‑production of the LL‑37 peptide that drives inflammation. This makes azelaic acid a practical, over‑the‑counter option for anyone looking to manage rosacea without prescription meds.

Approximately 16 million Americans have rosacea, an inflammatory cutaneous disorder with central facial erythema, papules, pustules, telangiectasia, flushing, and swelling being among the more commonly recognized features. Overexpression of cathelicidin peptide LL-37 has been implicated in the pathophysiology of rosacea. Azelaic acid has been found to inhibit the pathologic expression of cathelicidin, as well as the hyperactive protease activity that cleaves cathelicidin into LL-37. Given these findings, a small prospective, open-label, interventional trial was undertaken to assess the effects of azelaic acid 15% gel on inflammatory lesions of papulopustular rosacea in a real-world setting. Use of azelaic acid was associated with a significant reduction in inflammatory lesions, which persisted beyond the active treatment phase. Overall, azelaic acid 15% gel is an appropriate initial topical therapy for the treatment of moderate facial rosacea.