Can you use azelaic acid with clindamycin?

Yes

Yes, you can use azelaic acid with clindamycin: a trial found a gel containing both cleared more acne than either one alone, so apply clindamycin first, let it dry for a minute or two, then azelaic acid, or simply use them at opposite ends of the day.1 2 3

Evidence strength: Strong

How we grade evidence

The chemistry

These two attack acne by different routes. Clindamycin is a prescription topical antibiotic that reduces acne bacteria and inflammation. Azelaic acid is a dicarboxylic acid that also has antibacterial action, calms inflammation and slows excess pigment, which helps with the dark marks acne leaves behind (Sauer 2023). In a multicentre, randomized, double-blind trial, 150 people with mild to moderate facial acne used 5% azelaic acid, 2% clindamycin or a gel combining the two for 12 weeks. The combination cut the acne severity index by about 64%, compared with about 48% for clindamycin and 32% for azelaic acid alone. Side effects were reported by 22% of the combination group, a rate that was not significantly different from the single ingredients (Pazoki-Toroudi 2011). That study used a compounded gel, so it shows the two are compatible on skin, not that any particular store product matches it.

Chemistry

Compatible. They were tested in one gel without loss of effect.

Irritation

Low to moderate. Azelaic acid often tingles in the first weeks.

Order and wait

Clindamycin first on dry skin, a minute or two to dry, then azelaic acid.

Common mistakes

The most common error is relying on clindamycin by itself for months. The American Academy of Dermatology guideline recommends pairing topical antibiotics with benzoyl peroxide to limit resistance, and azelaic acid does not replace that role (Reynolds 2024). Ask your prescriber where benzoyl peroxide fits. Another mistake is stopping azelaic acid in week one because of itching or tingling. That sensation often settles as skin adjusts. Finally, people judge the routine too early. The trial measured results at 12 weeks, so give the pair about three months before deciding.

Your routine

Morning

Gentle cleanser
Azelaic acid, thin layer
Moisturizer
Sunscreen SPF 30+

Evening

Gentle cleanser
Clindamycin as prescribed
Benzoyl peroxide if your prescriber added it
Moisturizer

Go slower if

Clindamycin is prescription-only. If you are pregnant or breastfeeding, ask your doctor which acne treatments suit you. Stop and call your prescriber if you get severe burning, swelling, or diarrhea while using clindamycin.

Evidence strength

Strong for compatibility and benefit, from one randomized, double-blind trial of a 5% azelaic acid and 2% clindamycin gel (Pazoki-Toroudi 2011). Prescription azelaic acid strengths are higher than the 5% tested, and we found no trial of those stronger products combined with clindamycin.

Products with azelaic acid

The Ordinary Azelaic Acid Suspension 10%

Picked for azelaic acid

10% azelaic acid in a smooth, silicone-based cream suspension.

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FAQ

Does clindamycin go before or after azelaic acid?

No study has tested the order. Clindamycin usually comes as a thin lotion, gel or solution, so apply it first and put the azelaic acid cream or gel on once it has dried. Using azelaic acid in the morning and clindamycin at night avoids the question entirely.

How long should I wait between them?

A minute or two, until the first layer no longer feels wet. No longer interval has been studied, and the trial put both in the same gel (Pazoki-Toroudi 2011).

Can I use azelaic acid instead of benzoyl peroxide with clindamycin?

Not as a swap your doctor hasn't approved. The AAD guideline pairs antibiotics with benzoyl peroxide specifically to limit resistance (Reynolds 2024).

Will azelaic acid help the dark marks too?

It may. Azelaic acid is also used for post-inflammatory hyperpigmentation (Sauer 2023).

Your skin