Is azelaic acid good for hair loss?

Azelaic acid, a natural ingredient often used in skin care, is now being considered a possible treatment for hair loss. Some research suggests that it might help with male pattern baldness, especially in women, where its effects could be similar to those of minoxidil 2% [1]. This article will answer the following questions: Is azelaic acid good for hair loss?

What is azelaic acid?

Azelaic acid is a natural substance in grains like barley, wheat, and rye. It helps improve skin health and treats conditions such as acne, rosacea, and melasma [2].

It works well because it has strong anti-inflammatory and antibacterial properties. These properties can reduce acne by targeting hair follicles—the areas where the spots of acne start. It is also an effective anti-keratolytic, which helps its effectiveness against comedones [3].

Because it benefits hair follicles, azelaic acid is also being studied as a treatment for hair loss. It might be even more effective when combined with other substances like Minoxidil [4] or vitamin B6 [5].

How dose azelaic acid improve hair growth?

A study in 2020 showed that azelaic acid alone can help promote hair growth. It does this by boosting certain genes (Gli1 and Gli2) and increasing an enzyme (catalase) in the hair follicle area  [4].

When azelaic acid is used together with minoxidil, it also raises the level of a protein called Shh in the hair follicles. This combination works better for hair growth than minoxidil alone  [4].

Azelaic acid activates hair growth genes

In simple terms, activating genes like Gli1, Gli2, and the Shh protein helps push hair follicles from a resting phase into a growth phase. This process is similar to what other research has shown about triggering hair growth  [4].

Azelaic acid protects the hair follicles

Additionally, azelaic acid seems to protect the hair follicle cells from damage caused by UVB light. It also helps reduce inflammation and stress on the scalp. All these effects together suggest that azelaic acid, especially when combined with minoxidil, can be a promising way to promote hair growth and protect hair follicles  [4].

Azelaic acid regulates hair growth signals

In conclusion, the findings indicate that azelaic acid helps regulate important growth signals in the hair follicles. When used with minoxidil, it may improve hair growth by boosting these signals and protecting the hair-producing cells  [4].

Azelaic acid inhibits DHT

Older research suggested that both zinc and azelaic acid can inhibit the enzyme 5-alpha reductase, which is responsible for converting testosterone into the more potent dihydrotestosterone [6].

The mechanism of male pattern baldness

To help us understand this older research, which suggests the that azelaic acid behaves as a 5-alpha-reductase inhibitor, let’s briefly go over how hair is lost in androgenetic alopecia.

Although the exact cause of male pattern baldness is still being studied, experts agree that it’s multifactorial. This is a posh way of saying that male pattern baldness is due to a number of factors such as genetics, hormones (called androgens), and certain enzymes.

DHT and hair miniaturisation

One key enzyme, 5-alpha-reductase, is found in everyone. This enzyme changes testosterone (a male hormone) into dihydrotestosterone (DHT), another male hormone.

DHT then attaches to receptors in your hair follicles, causing them to shrink and eventually stop producing hair [7].

People with pattern baldness are more sensitive to DHT or may have higher levels or a more active form of 5-alpha-reductase, leading to more DHT and increased hair loss.

Azelaic acid may help improve hair growth by affecting this process, potentially reducing the impact of DHT on your hair follicles.

Older studies suggest that azelaic acid can block 5-alpha-reductase, the enzyme that turns testosterone into DHT. With less DHT, hair follicles are less likely to shrink, which can help reduce hair loss from pattern balding.

What does the research say about azelaic acid and hair loss?

Scientists have tested whether azelaic acid can help with hair growth. Here’s what they found:

• For people with alopecia areata, azelaic acid worked about as well as anthralin, a common treatment [8].
• In women with pattern hair loss, azelaic acid showed results similar to minoxidil 2% [1].
• In men with pattern baldness, using minoxidil 5% alone was about the same as combining it with azelaic acid [8].
• In animal studies, a mix of azelaic acid and vitamin B6 made hair grow faster. It produced longer, thicker hair than saline, propylene glycol, azelaic acid alone, or vitamin B6 alone [5].
• For people with patchy alopecia areata, azelaic acid helped improve symptoms in about 20% of cases [10].

Potential side effects of azelaic acid

The most common side effect when using azelaic acid on your scalp is mild itching—similar to what some people experience with minoxidil [1]. However, other potential side effects include:

Common side effects:

• Burning, stinging, or tingling sensations on the skin
• Dryness, itching, peeling, or mild redness

Uncommon side effects:

• Skin blistering, crusting, or flaking
• Scaling, intense redness, or soreness

Side effects with unknown frequency:

• Hoarseness
• Fever
• Joint swelling, pain, or stiffness
• Blurred vision
• Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
• Swelling, pain, or redness in the eyes
• Rapid heartbeat
• Difficulty breathing or swallowing
• Chest tightness

Rare side effects:

• Changes in skin colour in the area being treated

If you experience any of these symptoms, please get in touch with your doctor right away.

How to use azelaic acid for hair growth

If you want to try azelaic acid for hair loss, you can buy a combination of hair loss solutions from medicalmojo.co.uk. These compounded medicines often contain:

• A 5-alpha-reductase inhibitor, such as finasteride or dutasteride,
• Minoxidil or caffeine, and
• Azelaic acid

If you don’t find the combination you are looking for, please email us at info@medicalmojo.co.uk or call 023 81575 111.

As a compounding pharmacy, we can create bespoke formulations for you.

Spray hair loss liquid

The usual dose is 1ml or six sprays applied to the scalp daily. Some prescribers recommend a twice-daily dosage. However, we recommend starting with a once-daily application and monitoring the side effects.

Hair loss foam

The usual dose is 1ml, which is equivalent to two sprays. Again, we recommend starting with the once-daily application and monitoring your response to the side effects.

FREE hair loss consultations

Remember that when you order from medicalmojo.co.uk, you are entitled to a FREE hair loss consultation. To learn more, please get in touch with us or call 023 81575 111.

Other hair loss treatments

Azelaic acid is just one of many options for boosting hair growth in people with pattern baldness. Other common ingredients we use to make the hair loss solutions, foams and capsules include:

• Minoxidil,
• Finasteride,
• Dutasteride,
• Caffeine,
• Coenzyme Q10,
• Melatonin,
• Biotin,
• L-carnitine,
• Azelaic acid,
• Sildenafil,
• L-arginine

In addition to our compounding services, we also work with several PRP/i-PRF clinics. These involve using small samples of your own blood that have been centrifuged and re-injected into your scalp. The enriched platelets contain growth factors, which have been proven to promote hair growth [11].

If you are interested in having PRP, please contact one of our partners:

Rock Health Clinic

Second Floor, Herbal Quarters on, Art Quarter, 14-15 Allison St, Birmingham B5 5TH

Mobile: 07835 900966

Website: https://rockhealth.co.uk/

You can watch my experience of having i-PRF here:

Dynamic Regenerative Medicine

Medical Consulting Rooms, 38 Harborne Rd, Birmingham B15 3EB

Phone: 01564 330773

Website: https://www.dynamicregenmedicine.co.uk/

Well, they say a picture tells 1000 words, so we will let this one do the talking.

Still not convinced? Well, let’s dive down into the science.

idant properties [3] and can provide UV protection [3].

Safety of finasteride and dutasteride

The Medicines and Healthcare products Regulatory Agency (MHRA) is introducing a patient alert card for men taking finasteride to raise awareness about possible psychiatric and sexual side effects, including depression, suicidal thoughts, and sexual dysfunction.

Patients are advised to read the medicine leaflet and seek medical advice immediately if they notice mood changes or sexual health issues.

If you are concerned about the safety of using finasteride for male pattern baldness please contact us and one our prescribers will go over the risks and benefits.

At Medical Mojo we can reduce the risks associated with finasteride by compounding it as a topical solution. This means there is less systemic absorption and hence fewer side effects.

To learn more, read our blog: How to reduce the side effects of finasteride

Disclaimer: This information is for educational purposes only and is not a replacement for professional medical advice.

References:

1. Thanomkitti, K., Pruksaeakanan, C., Subchookul, C., Charoenpipatsin, N., Triwongwaranat, D., Varothai, S., Thuangtong, R. and Chumnumrat, T., 2023. Efficacy and Safety of Topical 5% Azelaic Acid Solution Versus 2% Minoxidil Solution in the Treatment of Female Pattern Hair Loss. Siriraj Medical Journal, 75(12), pp.887-893.
2. Searle, T., Ali, F.R. and Al-Niaimi, F., 2022. The versatility of azelaic acid in dermatology. Journal of Dermatological Treatment, 33(2), pp.722-732.
3. Sieber, M.A. and Hegel, J.K.E., 2013. Azelaic acid: properties and mode of action. Skin pharmacology and physiology, 27(Suppl. 1), pp.9-17.
4. Amirfakhryan E, Davarnia B, Jeddi F, Najafzadeh N. Azelaic acid stimulates catalase activation and promotes hair growth through upregulation of Gli1 and Gli2 mRNA and Shh protein. Avicenna J Phytomed. 2020 Sep-Oct;10(5):460-471.
5. Yoon, S.H., Park, D.H. and Sin, J.I., 2008. A Study for Verification of Hair Growth Effect of Azelaic Acid and Vitamin B 6. Archives of Plastic Surgery, 35(5), pp.507-513.
6. Stamatiadis, D., Bulteau?Portois, M.C. and Mowszowicz, I., 1988. Inhibition of 5??reductase activity in human skin by zinc and azelaic acid. British Journal of Dermatology, 119(5), pp.627-632.
7. Kaufman, K.D., 2002. Androgens and alopecia. Molecular and cellular endocrinology, 198(1-2), pp.89-95.Sasmaz, S., Arican, O. Comparison of Azelaic Acid and Anthralin for the Therapy of Patchy Alopecia Areata. Am J Clin Dermatol 6, 403–406 (2005).
8. Gugle, A.S., Jadhav, V.M., Kote, R., Deshmukh, M.D. and Dalvi, A.V., 2015. Comparative study of efficacy of topical minoxidil 5% and combination of topical minoxidil 5%, topical azelaic acid 1.5% and topical tretinoin 0.01% on the basis of dermoscopic analysis in androgenetic alopecia. MVP Journal of Medical Sciences, pp.90-99.
9. Salih, M.I. and Qurtas, D.S., 2022. The Efficacy of Azelaic Acid 20% Cream in the Treatment of Scalp Alopecia Areata. Iraqi Journal of Pharmacy, 19(1), pp.23-33.
10. Rodrigues, B.L., Montalvão, S.A., Cancela, R.B., Silva, F.A., Urban, A., Huber, S.C., Júnior, J.L.R., Lana, J.F.S. and Annichinno-Bizzacchi, J.M., 2019. Treatment of male pattern alopecia with platelet-rich plasma: a double-blind controlled study with analysis of platelet number and growth factor levels. Journal of the American Academy of Dermatology, 80(3), pp.694-700.

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