Compare Aziderm Cream (Azelaic Acid) with Alternatives for Acne and Rosacea

When you're dealing with stubborn acne or red, irritated skin from rosacea, finding the right treatment can feel like a constant trial-and-error cycle. Aziderm Cream, which contains 20% azelaic acid, is a popular prescription option in the UK - but it’s not the only one. Many people wonder: is it the best choice? Are there cheaper, gentler, or more effective alternatives? The truth is, azelaic acid works well for many, but it doesn’t work for everyone. And the alternatives? Some are just as effective. Others offer different benefits. Let’s cut through the noise and compare Aziderm Cream with the most common alternatives you’ll actually see on pharmacy shelves or prescribed by dermatologists.

What Aziderm Cream Actually Does

Aziderm Cream is a topical treatment with 20% azelaic acid. It’s not a steroid. It’s not an antibiotic. It’s a naturally occurring acid found in grains like barley and wheat. In a lab, it fights bacteria that cause acne, reduces inflammation, and slows down excess skin cell production - which helps unclog pores and fade post-acne dark spots. It’s also one of the few treatments safe to use during pregnancy, which is why doctors often recommend it for women who can’t take retinoids or oral antibiotics.

Real-world results? In clinical trials, about 60-70% of people with mild to moderate acne saw noticeable improvement after 12 weeks of twice-daily use. For rosacea, it reduces redness and bumps in roughly 50-60% of users. But here’s the catch: it takes time. You won’t see changes in a week. Most people need 6 to 8 weeks to feel a difference. And if your skin is sensitive, you might get stinging, dryness, or peeling at first.

Alternative 1: Finacea Gel (Azelaic Acid 15%)

Finacea Gel is the most direct alternative to Aziderm. It also contains azelaic acid - but at 15%, not 20%. That might sound weaker, but it’s actually the formulation that’s been FDA-approved for rosacea in the US and widely used in Europe. The gel base is lighter than Aziderm’s cream, so it’s less likely to clog pores or feel greasy on oily skin.

Studies show Finacea reduces inflammatory lesions (pimples and bumps) by about 50% after 12 weeks - very close to Aziderm’s results. The big difference? Finacea is often prescribed for rosacea specifically, while Aziderm is more commonly used for acne. If your main issue is persistent redness and visible blood vessels, Finacea might be the better fit. It’s also slightly less irritating for sensitive skin, though it still causes mild burning in about 1 in 5 users.

Alternative 2: Differin Gel (Adapalene 0.1%)

If you’re looking for something that works faster than azelaic acid, Differin Gel is a strong contender. It’s a retinoid - the same class as tretinoin - but available over the counter in the UK. Adapalene unclogs pores, reduces inflammation, and prevents new breakouts by regulating skin cell turnover. It’s often the first-line treatment for mild to moderate acne in dermatology clinics.

Compared to Aziderm, Differin works quicker. Many people see results in 4 to 6 weeks, not 8 to 12. It’s also more effective at preventing blackheads and whiteheads. But here’s the downside: it can be harsh. Dryness, flaking, and redness are common in the first few weeks. People with rosacea often can’t tolerate it. If your skin is already sensitive or reactive, Differin might make things worse before they get better.

Alternative 3: Metronidazole Cream or Gel (0.75% or 1%)

Metronidazole is an antibiotic you apply directly to the skin. It’s a go-to for rosacea, especially when redness and bumps are the main problems. Unlike azelaic acid, it doesn’t treat acne or fade dark spots. But for rosacea alone, it’s just as effective as Aziderm - and often cheaper.

A 2023 review in the British Journal of Dermatology found metronidazole reduced rosacea lesions by 55-65% over 12 weeks. It’s gentler than azelaic acid for most people, with fewer reports of stinging or peeling. The downside? It doesn’t help with acne. If you’re dealing with both acne and rosacea, you’d need to use it alongside another treatment. Also, long-term use can sometimes lead to mild resistance, so it’s not ideal for continuous daily use over years.

Alternative 4: Benzoyl Peroxide (5% or 10%)

Benzoyl peroxide is the OG acne fighter. It kills acne bacteria, reduces oil, and sloughs off dead skin. You can buy it over the counter in washes, gels, and spot treatments. It works fast - sometimes in under a week. And it’s dirt cheap compared to prescription creams.

But it’s not a direct substitute for Aziderm. Benzoyl peroxide doesn’t reduce redness or fade pigmentation like azelaic acid does. It’s also more likely to bleach towels, pillowcases, and clothing. For people with sensitive skin or rosacea, it’s often too drying and irritating. If you have acne with lots of blackheads and oily skin, benzoyl peroxide is a great tool. But if your skin is red, flaky, or reactive, stick with azelaic acid or metronidazole.

Alternative 5: Natural Options - Niacinamide and Tea Tree Oil

If you prefer non-prescription, plant-based options, niacinamide (vitamin B3) and tea tree oil are popular. Niacinamide reduces inflammation, regulates oil, and helps fade dark spots - similar to azelaic acid, but milder. Studies show 4% niacinamide applied twice daily can reduce acne lesions by 40-50% over 8 weeks.

Tea tree oil has antibacterial properties. A 2022 trial found 5% tea tree oil gel was as effective as 5% benzoyl peroxide for reducing acne, but with far less irritation. The catch? It’s not as reliable. Results vary wildly depending on the product quality. Also, tea tree oil can cause allergic reactions in some people. Neither niacinamide nor tea tree oil is approved as a medical treatment for rosacea, though some users report less redness.

Which One Should You Choose?

There’s no single best option - it depends on your skin type, your main concern, and your tolerance for side effects.

• Choose Aziderm Cream if you have acne with dark spots, or rosacea with bumps, and you want something proven, pregnancy-safe, and multi-functional.
• Choose Finacea if your main issue is rosacea redness and you prefer a lighter texture.
• Choose Differin if you want faster results on acne and your skin can handle retinoids.
• Choose Metronidazole if you have rosacea-only and want something gentle and affordable.
• Choose Benzoyl Peroxide if you have oily, non-sensitive skin with lots of blackheads and you want a budget option.
• Try Niacinamide if you want a gentle, non-prescription option for mild acne or redness.

Many dermatologists in Nottingham and beyond actually combine treatments. For example: use metronidazole in the morning for redness, and azelaic acid at night to target bumps and pigmentation. Or layer niacinamide under azelaic acid to reduce irritation. Don’t assume you have to pick just one.

Common Mistakes People Make

People often think switching creams will solve everything. But the real issue is how they use them.

• Applying too much: A pea-sized amount for the whole face is enough. More doesn’t mean faster results - it just means more irritation.
• Not using sunscreen: Azelaic acid and retinoids make skin more sensitive to the sun. If you’re not wearing SPF 30+ daily, you’ll undo the progress and risk more dark spots.
• Stopping too soon: Most people give up after 3 weeks because they don’t see instant results. These treatments take time. Stick with it for at least 8 weeks before deciding if it works.
• Using too many actives at once: Layering azelaic acid with retinoids, acids, and scrubs? That’s a recipe for a red, flaky mess. Start slow. One active at a time.

What to Do If Nothing Works

If you’ve tried Aziderm, Finacea, Differin, and metronidazole - and nothing gives you lasting results - it might be time to consider oral treatments. Low-dose antibiotics like doxycycline are often prescribed for moderate to severe rosacea. For stubborn acne, isotretinoin (Roaccutane) is the gold standard - but it requires strict monitoring.

Also, consider seeing a dermatologist if you haven’t already. Sometimes what looks like acne or rosacea is actually perioral dermatitis, fungal acne, or eczema. A skin biopsy or patch test can rule out other causes. Don’t keep cycling through creams if your skin isn’t improving.

Frequently Asked Questions

Next Steps

If you’re starting azelaic acid for the first time, begin slowly. Use it every other night for the first week. Then move to nightly if your skin tolerates it. Always apply it to clean, dry skin. Wait 15 minutes before applying moisturiser. And never skip sunscreen - even on cloudy days.

Keep a simple skin diary: note what you’re using, when you apply it, and how your skin looks each morning. After 6 weeks, review your progress. If you’re not seeing improvement, talk to your GP or dermatologist. Don’t just keep trying stronger products. Sometimes the problem isn’t the cream - it’s the routine, the triggers, or something deeper.