A Review of Curology (PocketDerm) & Why I'm an Azelaic Acid Fangirl

I had a hard time choosing the title of this post, not because I couldn't think of anything, but because I thought of so many horrible puns that I struggled to resist, such as: "AHA, BHA, now BAE?" (Har. Har.) Or "S&M in your skincare: how to abuse your pores and enjoy it", or "Is that a tube of Azelaic acid or are you just happy to see me: a review of Pocketderm" and so on.

The two Azelaic acid creams I've tried.  What's that wheat doing there?!  You'll see later.

Against all odds, I've managed to restrain myself and focus on the relative seriousness of this post, but it's difficult because my pupils have dilated from a day's worth of reading on the wonders of Azelaic acid and I'm sort of flopping around in a fangirling frenzy.

In this Post:

• My First Experience with an Azelaic Acid Cream
• My Experience with Curology PocketDerm's Service
• My Review of the PocketDerm Product
• Where it fits in my Asian skincare routine
• Why Azelaic Acid is so Exciting (Warning: Nerdiness)

Update: PocketDerm has changed it's name to Curology, and added more ingredients and flexibility to their formulations.  Carry on!

I've placed the "Serenade to Azelaic Acid" at the very end, as this post is quite long and those who aren't interested in 1. ridin' nerdy, 2. curling up with a cup of tea in a comfy chair to read the whole thing can skip out early.

My First Experience with an Azelaic Acid Cream

I'm no stranger to chemical exfoliants, which is pretty entertaining for me to say because I used to be terrified of them.  I use both BHA and AHA daily-use chemical exfoliants regularly, and have even branched out to stronger versions that are labelled a 'peel' but were weak enough for regular use.  You can read more about my routine (and the spreadsheet I use to track my stash and testing schedule) here: My Routine & Spreadsheet.

Actives photo from my Updated Multi-Step Korean Skincare Routine Summer 2015: Sheet Masks Galore post.

After a cursory read on the benefits of Azelaic acid + an overseas friend's offer to unload an extra tube she had, I decided to take the plunge and give it a shot, because my current acid routine wasn't working (enough) for me.  I was using BHA twice a day in a battle to keep the clogs in my skin at a standstill, which required me to 1. minimize all other irritants, and 2. use AHA only very rarely to avoid overexfoliating my skin.

I'd also tried western BHAs, including Stridex (red box) and MUAC's 3% BHA 'peel' but frankly their effect vs irritation ratio on my skin wasn't good.  (Menthol.  Why does Menthol have to be in everything?!)  I complained to said friend that I needed a "super-powered BHA" that I could just use a few times a week like AHAs and thus I learned of Azelaic acid.  She sent me this:

Uniapharm Acne-Derm cream: feel your pores tremble.

She warned me that the cream, which she had gotten herself (or from relatives) in Poland, was effective but a bit harsh, and she wasn't kidding.  Here's the deets on the cream, from my Updated Multi-Step Korean Skincare Routine Summer 2015: Sheet Masks Galore post:

Uniapharm Acne-Derm: Polish, azelaic acid cream chemical exfoliant 

PM routine: I use this 3 times a week, because it's like bringing my pores to a bar brawl ... after 10 shots of tequila.    

I purchased this from a friend in the UK; she had an extra tube and offered to send it my way.  This is my first azelaic acid product, and it's intense.  So intense.  Repurchase?  I'll let you know in 6 months when it's finished beating my misbehaving skin into submission. 

Where to get it: Honestly I have no idea.  Where does one find Polish OTC pharmacy goods?!

As you can see, I wimped out far short of the 6 months; I loved the effects that Azelaic acid had on my skin but it had all the tenderness of a berserking moose defending its territory.  I wanted Azelaic acid in a kinder, more gentle form, and I wanted it easily available.  Sadly, Azelaic acid is not readily sourced over the counter, but it's something you can get from a Dermatologist.  I get misdirected questions that need to be addressed to a Dermatologist all the time, but I've never been to one myself. 

Why?

They're expensive, require a referral from a regular doctor (which is expensive), you have to go through the hassle of scheduling an appointment around your schedule and theirs, and then drive there (we're a one car household), tend to treat 'acute' skin conditions (not "zomg tired of this mild acne + hyperpigmentation!") and can be be rude and dismissive/may give you crap for having a fancy skincare routine.

So what do you do?


My Experience with Curology PocketDerm's Service

Welcome to the exciting new world of teledermatology: thanks to the boom of telehealth services, you can literally consult a dermatologist online, provide photos, fork over your credit card number for a very affordable subscription (no contract), tell them about your skin and your goals, and blam!  

A package arrives in the mail with your custom-blended prescription, an instruction card, and ongoing support from licensed professionals who are confoundingly nice.   I went with the 'Acne' type, instead of the 'Aging' type, because my pores need Snesus.

My box with prescription + samples!

Are their dermatologists so nice because they are exercising one's right not to wear pants when you work from home?  I have no idea, but they're really nice.  Super nice.  To everyone, not just the (many) bloggers who use them, like Kerry from Skinandtonics, Tracy from Fanserviced-b, Beauty vs Zombies, and just recently, Jude from 50 Shades of Snail.  PocketDerm has been hovering on my radar for a long, long time as a result, but my search for a gentle-yet-effective Azelaic acid option made me pull the trigger and grab my credit card.

Plus, I specifically wanted Azelaic acid, not whatever random proprietary hoopla peddled by whichever Dermatologist my insurance was willing to pay for.  Medical professionals don't usually take too kindly to headstrong patients with Ideas about what should be in their prescriptions.  But PocketDerm was totally on board, and whipped me up blend of of Azelaic acid with Clindamycin and Niacinamide.  Niacinamide and I go way back, so I was pleased to see it here.  It could have contained Tretinoin per their Acne product page, but I suspect he took my tales of the desert into account and safely left that off the list.

Awww yeah, custom blended for my skin.

Here's another great thing about the service, which caved the last of my resistance: if you have a referral code from someone (You can use this one if you need one) you can try the service for the first month for free.  Which means trying the product immediately, before you pay anything.

After that, you pay month-to-month ($20, which is cheap as heck compared to Seeing A Dermatologist Recommended By Your Doctor) without any sort of contract, so if you suddenly decide that you're no longer into this side thing with PocketDerm, you just cancel.   Heyoo.   They also have a 90 day guarantee, apparently, in case your skin suddenly decides the honeymoon period is over a few months in- they'll refund you anything you paid.

For that $20, you get your prescription regularly delivered to you, either more or less depending on how fast you use it, the ability to tweak and change what's in it, and access to licensed (and patient) Dermatologists and customer service people who are 1. super nice (did I mention they're really nice?) and 2. respond so fast I wonder when they sleep.  They genuinely interact though, so I know they're not some Q&A response program.  Keep in mind they are only available in the U.S., and only 40 states. You can see the full list here.

You get full instructions by email and by insert, but you can ask them anything anytime you want of course.  That's really what you are paying for- a Dermatologist at your virtual beck and call.

Gotta love detailed instructions.

Having a telederm who you can fire off questions like "What do you think about how X would work for my skin?" and "Is this purging or am I just breaking out?" or "WHAT IS THIS THING FORMING ON MY FACE AM I GOING TO DIE?!" at any time of the day and get a reply back within a day or sometimes hours, is pretty amazing.   You don't have to google it.  You don't have to google it.  Think of all those people who convinced themselves they had cancer after a late-night symptom search.

So, I'm pretty pleased with the service, obviously.  What do I think of the product itself?


My Review of the PocketDerm Product

What's in it:

My current prescription contains (per PocketDerm's intro) the following:

• 4% azelaic acid (antibacterial; reduces redness, hyperpigmentation and blocked pores) 
• 1% clindamycin (antibacterial and anti-inflammatory)
• 4% niacinamide (a form of vitamin B3 that fights inflammation and hyperpigmentation)

Clindamycin is new to me, but as I mentioned above, Niacinamide has been my bestie for many years and it's one of those ingredients that get me all excited when I see it in my products.  My primary concerns are decongesting my superclogged skin, control of the resulting mild to moderate acne, and a metric tonne of hyperpigmentation.

Here's the inactive ingredients list, courtesy of their FAQ page:

Inactive ingredients:
water, glycerin, aloe vera leaf juice, PEG-100 myristate, sweet almond seed oil, xanthan gum, methyl paraben, propyl paraben, tocopheryl acetate

Considering that my package languished in a hot metal parcel mailbox for a few hours until I got to it, leaving the cardboard warm, I'm so thrilled to see those preservatives in there.  Also, with the exception of PEG-100 myristate, which it doesn't recognize, no flags at all.

What I wanted it to do:

First off, the Azelaic acid cream I had before was 20% Azelaic acid, and it was so harsh that I could only use it max 3x a week.  Ouch.  There were some rageface emergencies that required many applications of chilled sheet masks to calm.

There's no mistaking that it worked, but I had to full-stop all my other acids and I noticed that the lack of AHA use was allowing some of my skin surface demons to reappear.  It wasn't quite the levels of The Shell (the bane of all Dehydrated Skin Types, read more here: Beginner's Korean Skincare Routine: Dehydrated Combination-Oily Skin Type) but I was getting flakes in some areas and developing closed comedones (CCs) where skin had grown over blocked pores, resulting in tiny flesh-coloured bumps.

So the Acne-derm had me in love with the pore-clearing powers of Azelaic acid but hating the beating my skin was taking.  I wanted the same effect, but in a gentler form.

Acne-derm cream at top, PocketDerm cream at bottom.

Both creams are thick but spread easily, with the Pocketderm being the easier of the two.  It comes in a pump dispenser that makes it easy to control the amount dispensed.

What it actually did:

I started using it on 7/24/2015 and it's now 9/8/2015, so a little over six weeks of use as of this review.  Considering how much acid exfoliation I am accustomed to needing, I'm impressed by how well this stepped into that gap, lack of AHA troubles notwithstanding.  I am sure if I had Tretinoin in the mix, it would have handled that, so I plan to talk to my Dermatologist (aw yeah, so casual) on their thoughts about reintroducing AHA vs adding tret to my prescription.

Within a week, I noticed a brightening effect, almost like I normally see (temporarily) with sheet mask use.  I assume this is due to the anti-inflammatory properties of my mix.  As I continued to use it, I also noticed it lessened the severity of my hormonal acne when that time of the month rolled around.  It can take months to fade hyperpigmentation, and having active acne makes it difficult to assess how well it's fading old spots when new ones are cropping up regularly.

What I definitely did notice, within a few weeks, was that the appearance of pores in my nose was vastly improved.  This is pretty huge for me, because my nose and the surrounding areas are absolutely riddled with 'grit'- a motley of blackheads and sebaceous filaments that form nasty plugs that clog up my pores.  Not only do clogs cause cause acne, but sebaceous filaments cannot be permanently removed (they'll just fill right back up again) and my poor pores are now huge and very visible from several feet away. *broken sobbing*  My pores haven't looked this small in years.

Sadly, I had to take a very brief break of a few days as the move, stress, change in water, and change in climate had my skin so irritated that it was developing redness the likes of which I had never seen before, and breaking out from irritation.  I eventually realized it was the water, and started vigilantly using my pH-adjusting toner after rinsing and patting my skin dry, and before using the cream, and it's settling back down.


Where it fits in my Asian skincare routine

If you've read my post on Putting your products in order, including pH dependent acids, or you'll know that I break down the Asian skincare routine into the following steps:

1. Cleansers
2. Actives
3. Hydrators
4. Occlusives
5. Treatments/Protection

Prescriptions are usually placed in the 'actives' category, and while I do use a pH-adjusting toner before I apply my PocketDerm, it's more to do with trying to rid my face of the local water before it makes it angry.  I don't like it when my skin is angry.

PORE RAGE!

There are some actives that should not be used in the same routine (i.e. both in the AM or PM, instead of alternating) but that's exactly the sort of thing you should be discussing with your newly minted Dermatologist.

(Whee!  I feel a little drunk on the power of having an actual Dermatologist to pester, without setting my wallet on fire.)

I use it in my PM routine as that's what the instructions state, but I did most of my actives in the evening already.

Right now, my prescription is my only 'active' so it slots right into that spot.  I generally give it 30 minutes of wait time before I start applying other products, although that's more from habit as the instructions only say 'several minutes'.

I usually like to do sheet masks after, because it's a nice way to soothe my skin after it's been swathed in acids.


Why Azelaic Acid is so Exciting (Warning: Nerdiness)

Azelaic acid is an interesting animal, and is neither an AHA (alpha hydroxy acid) or a BHA (beta hydroxy acid) but has some of the properties of both.  That's exciting.  Really exciting,

Both AHA and BHA can have a positive impact on acne, but here's an ultra basic summary of each:

• AHA exfoliates outer layers of skin, fading hyperpigmentation and smoothing skin texture
• BHA penetrates into pores and clears them out, preventing buildup of sebum clogs

I need all of the above; my skin has an ultra fast turnover rate (meaning it produces new layers of skin too quickly for the old ones to slough off properly) and my pores are very, very clog-prone.  That combination is a perfect storm for comedonal acne including blackheads, sebaceous filaments, and closed comedones that pebble the surface of my skin.

That means when if things do surface, they struggle to clear, resulting in post-inflammatory hyperpigmentation (PIH) that lasts for months even with treatment.  Not only that, my skin is producing new acne faster (and PIH) faster than I can fade the old marks.  Snesus take the wheel.

Wheat presence mystery solved!

According to Wikipedia, Azelaic acid can help with the following, and it's found in barley, rye, and wheat:

Azelaic acid is used to treat mild to moderate acne, both comedonal acne and inflammatory acne.[6][7] It belongs to a class of medication called dicarboxylic acids. It works by killing acne bacteria that infect skin pores. It also decreases the production of keratin, which is a natural substance that promotes the growth of acne bacteria.[8] Azelaic acid is also used as a topical gel treatment for rosacea, due to its ability to reduce inflammation.[7] It clears the bumps and swelling caused by Rosacea. [...] 

 Azelaic acid has been used for treatment of skin pigmentation including melasma and post inflammatory hyperpigmentation, particularly in those with darker skin types. It has been recommended as an alternative to hydroquinone (HQ).[10] As a tyrosinase inhibitor, azelaic acid reduces synthesis of melanin.[11]

Before I go crazy with fangirling over just this part, I'll also add that it does not cause photosensitivity.  Also, do not be alarmed at the Wikipedia 'source', we'll be looking at 'real' scientific sources later.

So not only is it an anti-inflammatory so effective as to be one of the few treatments for Rosacea, reducing inflammation and thus removing one of the barriers to healing, but it also tackles clogged pores, like a BHA, even though it does not do so by affecting sebum as BHAs do.  It kills acne bacteria to improve current acne and prevent future acne.  It fades hyperpigmentation, like an AHA, but without photosensitivity.  Unlike some forms of AHA, it can be safely used by those with deeper skin tones.

What's not to love?  Naturally, I had graze in the lush and plentiful pastures of studies available on Google Scholar, and if I get too far into it, this post will never end, but here's some tasty highlights:

From Clinical studies of 20% azelaic acid cream in the treatment of acne vulgaris. Comparison with vehicle and topical tretinoin [source: Katsambas, A., Graupe, K., & Stratigos, J. (1988). Acta dermato-venereologica. Supplementum, 143, 35-39.]

 In the study of comedonal acne, 20% azelaic acid cream was equally effective as 0.05% tretinoin cream in reducing the number of comedones and with respect to overall response. However, azelaic acid cream was better tolerated, causing fewer local side effects than the topical retinoid.

Anyone who has endured the massive shedding, peeling, and extreme dryness that comes with tretinoin usage can attest to the harshness of those side effects.

Here's some more heady benefits from Azelaic Acid: A Review of its Pharmacological Properties and Therapeutic Efficacy in Acne and Hyperpigmentary Skin Disorders [source: Fitton, A., & Goa, K. L. (1991). Azelaic acid. Drugs, 41(5), 780-798.]

Azelaic acid is a naturally occurring saturated dicarboxylic acid which, on topical application (usually as a 20% cream), has been shown to be effective in the treatment of comedonal acne and inflammatory (papulopustular, nodular and nodulocystic) acne,  as well as various cutaneous [hyperpigmentary] disorders characterised by hyperactive/abnormal melanocyte function, including melasma and, possibly, lentigo maligna. In addition, azelaic acid has an antiproliferative and cytotoxic effect on the human malignant melanocyte, and preliminary findings indicate that it may arrest the progression of cutaneous malignant melanoma. 

So not only does it fight both kinds of acne, and help with hyperpigmentation, there is some indication that it may even help with certain forms of skin cancer?  Astounding.  Of course this is not definitive nor would it be grounds to skip wearing a strong sunscreen to protect your tender fresh skin, but it's still an impressive icing on an already too-delicious cake.

The study synopsis elaborates on how it compares to other 'big gun' acne treatments:

In controlled studies, topical azelaic acid demonstrated comparable anti-acne efficacy to topical tretinoin, benzoyl peroxide, erythromycin and oral tetracycline, while in patients with melasma azelaic acid proved at least as effective as topical hydroquinone. On topical application azelaic acid is well tolerated, with adverse effects apparently limited to a generally mild and transient local cutaneous irritation. Thus, topical [azelaic] acid, employed either as monotherapy or in combination with other treatments, is likely to prove of value in the management of acne and several hyperpigmentary disorders, most notably melasma.

So not only can it fight acne 'comparably' to the other treatments, the irritation is comparatively mild.   The full text is behind a paywall, but the preview includes a few pages of drool-worthy information, including a explanation of how Azelaic acid targets abnormal production of melanin without affecting 'normal' skin pigmentation.  I presume this is why it's being called out as particularly suited for deeper skin tones, because it will fade hyperpigmentation due to sun damage or acne, without affecting the melanin of healthy skin.

Ok, I have to stop fangirling now or this post will never end.

Where to get it 

In some countries, Azelaic acid creams can be purchased over the counter (such as the Acne-derm from Poland, or Skinoren which is available several places overseas) but there are restrictions in the US.  That's not to say that it's not available, just that I'm not comfortable with trying to find ways to get around it.

Luckily, if you are in the US, chances are (77%) that you can give PocketDerm a whirl if you're dying to get your hands on Azelaic acid, and the one month free referral lets you give it a whirl without committing to fork over cash first.  You could also check with your medical benefits and see if Dermatology/Teledermatology is covered, provided they're willing.

And with that, we're done!  I'm going to go pet my bottle and sing it the song of my clogged-skin people.
-Cat

**Disclaimer: All products reviewed/mentioned in my blog, unless expressly stated to be press samples which were provided for honest review, are 100% purchased with my own money (as this one was, PocketDerm does not know I am a blogger nor that I would review this product); regardless of their origin, my opinions are entirely my own.  This blog contains  both affiliate and non-affiliate links, and clicking the former before you shop means that this blog will receive a small commission to assist in this blog supporting itself.  Please see my Contact Info & Disclaimer policy for more information.