Journal of Clinical and Investigative Dermatology
Research Article
Expert Perspectives on Clinical Practices and Treatment Preferences for Azelaic Acid and Combination Therapy in Various Dermatological Conditions in the Indian Setting
Manjula S* and Krishna Kumar M
Department of Medical Services, Micro Labs Limited, Bangalore, Karnataka, India
*Address for Correspondence:Dr Manjula S, Department of Medical Services, Micro Labs Limited,
Bangalore. Telephone no: (080) 22370451 E-mail Id: drmanjulas@gmail.com
Submission:13 November, 2025
Accepted: 08 December, 2025
Published:10 December, 2025
Copyright: © 2025 Manjula S, et al. This is an open access article
distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Keywords: Azelaic Acid; Glycolic Acid; Acne Vulgaris; Melasma; Post-
Inflammatory Hyperpigmentation; Combination Therapy
Abstract
Objective:To assess clinicians’ perspectives on the management
of melasma, acne vulgaris, and post-inflammatory hyperpigmentation
(PIH) in Indian settings, with a focus on the use of azelaic acid and its
combination with glycolic acid in various dermatological conditions.
Methods:This cross-sectional study was conducted using a 23- item questionnaire to gather perspectives from dermatologists across Indian settings. The survey focused on clinical experiences, physician preferences, and observations regarding the use of both monotherapy and combination therapy in managing pigmentary disorders and acne. Responses were analyzed using descriptive statistical methods.
Results:Among the 556 participants, approximately 48% indicated that a 10% concentration of azelaic acid is most commonly recommended in routine clinical practice. Around 62% of clinicians reported that acne associated with pigmentation is the primary indication for azelaic acid use. More than half (54.32%) of respondents recommended an optimal treatment duration of 6-8 weeks when using a combination of azelaic acid and glycolic acid for acne management. Nearly 55% rated the azelaic acid + glycolic acid combination as effective for treating post-acne pigmentation. A majority (70%) favored combining azelaic acid with oral antibiotics for mild to moderate papulopustular acne. About 58% noted that azelaic acid + glycolic acid therapy occasionally required the use of a moisturizer. Most respondents (75.18%) emphasized that dose escalation of azelaic acid in acne management should depend on individual skin sensitivity. Additionally, around 44% reported that, among newer formulations, azelaic acid face wash was the most recommended option.
Conclusion:This study highlights that dermatologists commonly prefer 10% azelaic acid cream for acne with pigmentation. A combination of azelaic acid and glycolic acid used for 6-8 weeks has shown excellent perceived efficacy in improving post-acne hyperpigmentation. Treatment decisions based on an individual’s skin sensitivity, with face wash formulations, gained popularity, and short term contact therapy was recommended initially.
Methods:This cross-sectional study was conducted using a 23- item questionnaire to gather perspectives from dermatologists across Indian settings. The survey focused on clinical experiences, physician preferences, and observations regarding the use of both monotherapy and combination therapy in managing pigmentary disorders and acne. Responses were analyzed using descriptive statistical methods.
Results:Among the 556 participants, approximately 48% indicated that a 10% concentration of azelaic acid is most commonly recommended in routine clinical practice. Around 62% of clinicians reported that acne associated with pigmentation is the primary indication for azelaic acid use. More than half (54.32%) of respondents recommended an optimal treatment duration of 6-8 weeks when using a combination of azelaic acid and glycolic acid for acne management. Nearly 55% rated the azelaic acid + glycolic acid combination as effective for treating post-acne pigmentation. A majority (70%) favored combining azelaic acid with oral antibiotics for mild to moderate papulopustular acne. About 58% noted that azelaic acid + glycolic acid therapy occasionally required the use of a moisturizer. Most respondents (75.18%) emphasized that dose escalation of azelaic acid in acne management should depend on individual skin sensitivity. Additionally, around 44% reported that, among newer formulations, azelaic acid face wash was the most recommended option.
Conclusion:This study highlights that dermatologists commonly prefer 10% azelaic acid cream for acne with pigmentation. A combination of azelaic acid and glycolic acid used for 6-8 weeks has shown excellent perceived efficacy in improving post-acne hyperpigmentation. Treatment decisions based on an individual’s skin sensitivity, with face wash formulations, gained popularity, and short term contact therapy was recommended initially.