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Azelaic Acid for Hair Growth: Can It Treat Hair Loss Conditions?
Dr Peter Barron (GMC)
Medically reviewed by
Dr Peter Barron (GMC)
Updated on November 10, 2024

Azelaic acid for hair growth is gaining interest in the world of research. This natural compound is known for its use in skin health serums and treatments, but there’s some promising research on its role as a treatment for hair loss.

Azelaic acid for hair growth may improve symptoms of androgenetic alopecia (pattern baldness). One study suggests its effects on female pattern hair loss may be similar to those of Minoxidil 2% [1], a proven treatment for this condition. In this article, we’ll explore: 

  • What azelaic acid is and how it can improve hair growth
  • The latest research on azelaic acid for hair 
  • Potential side effects
  • How to use it to treat hair loss
Table of Contents

What is azelaic acid?

Azelaic acid is a natural compound found in grains, such as barley, wheat and rye. It can improve skin health and is used in treatments for skin conditions like acne, rosacea, and melasma [2].

Azelaic acid has strong anti-inflammatory and antibacterial properties [3], which can improve acne symptoms by targeting hair follicles (where acne often develops) [3]. Azelaic acid’s impact on hair follicle health has led to interest in its potential as a hair growth treatment.  

It may be more effective as a hair growth treatment when combined with other substances, such as Minoxidil [4] or vitamin B6 [5]. 

How can azelaic acid improve hair growth? 

To understand how azelaic acid may improve androgenetic alopecia (AGA), you must first understand how this condition works. Although the exact cause of pattern baldness needs further research, most researchers agree AGA is caused by a combination of genetics, hormones called androgens, and enzymes.

An enzyme called 5-alpha-reductase is present in nearly everyone’s bodies. This enzyme converts testosterone (male sex hormone) to dihydrotestosterone (DHT) (another male sex hormone).

DHT binds to androgen receptors in your hair follicles, which makes them shrink and stop producing hair [6]. When hair follicles shrink, they eventually stop producing hair altogether, leading to hair loss. In people with AGA, hair follicles are more sensitive to the effects of DHT. Alternatively, they may have higher levels of 5-alpha-reductase or a more active version, and, therefore, produce more DHT.

DHT impact on hair

So, how does this relate to azelaic acid? Older research (from 1988) suggests azelaic acid is a 5a-reductase inhibitor [7], and this theory has been carried into modern research [4]. This means it may stop the action of the enzyme that converts testosterone into DHT, stopping hair follicles from shrinking and, therefore, reducing hair loss from AGA. 

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

Scientists have tested this theory to see whether azelaic acid delivers real-life results for hair growth. Here’s what researchers found. 

  • For people with alopecia areata, azelaic acid may have similar outcomes to anthralin [8] (a commonly prescribed medication for alopecia areata). 
  • Azelaic acid demonstrated similar results to Minoxidil 2% in women with female pattern hair loss [1].
  • There was no significant difference between results when using Minoxidil 5% and combining it with azelaic acid for male pattern baldness [9].
  • Animal research found combining azelaic acid with vitamin B6 promoted faster hair growth and led to longer, thicker hair follicles compared with saline, propylene glycol, azelaic acid alone, and vitamin B6 alone [5]. 
  • In people with patchy alopecia areata, azelaic acid may help improve symptoms in around 20% of cases [10].
  • A small 2012 study [10] included 31 participants with patchy alopecia areata, who hadn’t received treatment in the past month. They applied either 20% azelaic acid or 0.5% anthralin cream for 12 weeks, then had an 8-week break with no treatment. Around 53% of people in the azelaic acid group and 56% in the anthralin group experienced full regrowth by the end of the study. Researchers indicated this may suggest azelaic acid is as effective as anthralin, but larger studies are needed to confirm this. 
  • A 2023 study [1] explored the effects of azelaic acid vs minoxidil on female pattern hair loss. 26 women with mild pattern hair loss used either 5% azelaic acid or 2% topical minoxidil on their scalp, twice a day for six months. Both treatments significantly improved hair density and thickness, and there were no noticeable or reported differences between the two treatments. 
  • A 2015 study [9] included 46 patients with male pattern baldness. For six months, half used 5% minoxidil alone on their scalp, while the other half used a combination of 5% minoxidil, 1.5% azelaic acid, and 0.01% tretinoin. Both groups showed a significant increase in hair number and thickness after six months, but there were no significant differences between the two groups.
  • A 2008 study [5] explored the effects of azelaic acid and vitamin B6 on mice. Five groups of mice were treated with either saline, propylene glycol, azelaic acid, vitamin B6, or a combination of azelaic acid and vitamin B6. The combination of azelaic acid and vitamin B6 led to faster hair growth, longer and thicker hair follicles, and an increased number of basal cells in the skin. It also increased levels of IGF-1 (a growth-promoting factor) in the skin of mice while lowering TGF-β1 (a factor that can inhibit growth).
Side effects of azelaic acid for hair growth

Potential side effects of azelaic acid 

One study suggests the main side effect of topical azelaic acid is mild itching on the scalp [1]. The other group in this study also had an itchy scalp from Minoxidil. However, there are some more potential side effects to be aware of, including [11]:

Common side effects

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

Uncommon side effects

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

Side effects with unknown incidence

  • 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
  • Eye swelling, pain, or redness
  • Rapid heartbeat
  • Difficulty breathing or swallowing
  • Chest tightness

Rare side effects

  • Skin colour changes in the treatment area

Speak to your doctor for advice straight away if you experience any of the symptoms above. 

How to use azelaic acid for hair growth

How to use azelaic acid for hair growth

Azelaic acid is available over the counter in most pharmacies and health shops. There are also online hair growth companies that offer it as part of a subscription delivery service.  

Azelaic acid should be applied topically, meaning a few drops on your scalp once or twice a day. Massage it into your scalp, or you could try using a derma roller for hair growth to potentially increase absorption even more. 

Different concentrations are available, ranging from 5% to 20%. If you haven’t used azelaic acid before, it’s best to start with a lower concentration and gradually build up the strength of the solution over time. 

If you want to use other topical medications as well, such as Minoxidil, it’s best to discuss this with your doctor. Applying too many chemicals to the same area of skin may cause irritation. 

PRP hair treatment

Other treatments for hair growth

Azelaic acid is one of many treatments that can improve hair growth in people with androgenetic alopecia. Other treatment options include:

  • Minoxidil and Finasteride — These hair loss medications are often the first line of treatment for male pattern hair loss. Research shows that both Minoxidil [12] and Finasteride [13] improve hair growth in people with androgenetic alopecia, but Finasteride is only approved for use in men.
  • PRP hair treatment — This treatment involves taking a sample of your own blood and reinjecting a concentrated solution of platelets into your areas of hair loss. It’s been shown to boost hair growth and prevent premature hair loss [14]. 
  • Low-level laser therapy — This noninvasive treatment uses targeted lasers to stimulate hair follicles, encouraging regrowth. Research suggests it’s a safe and effective way to boost hair growth [15].
  • Hair transplantHair transplants are permanent and can give you thick, healthy hair for years to come. There are two main types: follicular unit extraction (FUE) and follicular unit transplantation (FUT). Hair transplants at the Wimpole Clinic have a 97-100% success rate. 

Treating hair loss at the Wimpole Clinic

Not sure which treatments are right for you? Book a consultation with one of our expert trichologists at the Wimpole Clinic.

These hair doctors will carry out a full assessment, including diagnostic trichology tests if needed. These may include blood tests for hair loss or a hair pull test. Once you know the reason your hair is falling out, they’ll work with you to create a comprehensive treatment plan.

Ready to get started on your hair growth journey? Find your nearest clinic location today.

Azelaic Acid for Hair Growth: Can It Treat Hair Loss Conditions?, Wimpole Clinic

FAQs

Azelaic acid can improve hair growth with minimal side effects. The main side effect reported is mild itching, but overall, azelaic acid appears to be good for your hair and its growth. 

Research suggests azelaic acid can stop the action of 5-alpha-reductase, the enzyme that converts testosterone into DHT. This prevents DHT production, so hair follicles don’t shrink and you stop losing hair. 

Azelaic acid can reduce how much DHT your scalp produces. DHT stimulates hair growth on the face [16], but it is only likely to have an effect on facial hair if applied directly to the beard area. Even if a tiny amount of azelaic acid reaches your bloodstream after scalp application, effects on facial hair are very unlikely to materialise.

There’s very little evidence for azelaic acid combined with tretinoin for hair growth. Azelaic acid is good for hair growth, but tretinoin has been researched less. Further studies are needed on these two substances combined for hair growth before any conclusions can be made, but one study found no significant differences in hair growth between 5% minoxidil alone on the scalp compared to a combination of 5% minoxidil, 1.5% azelaic acid, and 0.01% tretinoin [9]. 

Yes! Azelaic acid for hair growth is applied topically — that is, directly onto your scalp in areas of hair loss. If you experience any burning, itching, or skin redness, discontinue use immediately and speak to your doctor before using it again. 

Dr Peter Barron (GMC)
Medically reviewed by Dr Peter Barron (GMC)Updated on November 10, 2024
The Wimpole Clinic offers FUE Hair, Beard & Eyebrow Transplants & Trichology.
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