Shereene IdrissBoard Certified Derm, Founder and Chief Nerd

Azelaic Acid + Tretinoin: How to Use Them Together from a Dermatologist

9 Sept 2026 · 2 min

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1:47

In this video dermatologist Shereene Idriss explains how to combine azelaic acid and tretinoin for treating acne, hyperpigmentation, and post‑inflammatory redness. She emphasizes that azelaic acid is a non‑exfoliating, gentler ingredient that can be used both morning and night, making it an ideal starter for newcomers. After the skin tolerates azelaic acid, she advises introducing a retinoid (tretinoin) slowly—starting with a tiny amount 1–2 nights per week and always at night—because consistency matters more than strength. Idriss discusses the choice between prescription‑strength tretinoin and over‑the‑counter (OTC) options, noting that many people cannot tolerate the higher potency and that an OTC product used more frequently often yields better results. She warns to stop any product if burning or irritation persists, and invites viewers to ask questions or request product recommendations.

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Azelaic acid and tret are a great combination, and I've been prescribing them together for years, especially when it comes to acne and pigmentation, but also redness, because azelaic acid has that tiny added benefit of helping to minimize the look of post-inflammatory redness, which will eventually become hyperpigmentation. Despite the scary word acid, azelaic acid is not an exfoliating acid like glycolic acid or salicylic acid, so worry not, You will not be blowing up your face. But if you are new to Tret and azelaic acid, I would start with azelaic acid because it is the gentler of the 2 options. And the little tingling or an itch at first is completely normal. But if that burning sensation or irritation continues— Drop it like it's hot. And when and only when you know your skin is comfortable with azelaic acid, that's when you can bring in the big guns. Hello, retinoid. The key is to start with a tiny amount, 1 to 2 nights a week, depending on what your skin can tolerate. Because at the end of the day, it's all about consistency over intensity. At night, because retinoids are exclusively a nighttime companion and not of the day. But azelaic acid can be used around the clock, both morning and evenings. So now you're probably wondering though, which type of retinoid? Do we want a prescription Tret or is over-the-counter okay? Get your pens and papers out because I need you to listen up. Fact is, not everyone can tolerate a prescription Tret. Prescription strength doesn't necessarily mean better results, especially not with retinoids, because in this category it's about consistency that matters more than strength. And I personally would much rather you use something that is over-the-counter more nights a week than not versus a prescription that you can only tolerate 1 or 2 nights every few weeks and in the process have your face blow off. So if you have any questions about azelaic acid and tretinoin, let me know below. But if you want some recommendations for my favorite over-the-counter products, comment combo below.