Paula's Choice 10% Azelaic Acid Booster Versus Dr. Sheth's Probiotics & Azelaic Acid Serum

OTC Azelaic acid is usually available in concentrations from 10-15% and anything over requires a prescription.

Here's what each tier does best:

Unlike other acids, azelaic acid will not make your skin more photosensitive/sun sensitive.

Though this ingredient is naturally occurring in grains like wheat, rye, and barley, it is usually synthetically created for cosmetics to ensure stability and effectiveness.

The safety profile of this ingredient is reassuring; the US CIR Expert Panel concluded D5 is safe as used in cosmetics and Health Canada concluded that D5 is not harmful to human health or the environment as currently used in cosmetics

There's a study that people mention about D5 in a rat study showing tumors. This study is related to long-term inhalation of high D5 levels.

Regulatory bodies have judged this study to be not applicable in topical skincare since skin absorption of D5 is very low and we're not really inhaling huge amounts of D5.

The only restriction for this ingredient is environmental. The European Chemicals Agency (ECHA) restricted D5 in wash-off cosmetics at or above 0.1% due to their persistence in water.

On a cellular level, it disrupts the cell membranes of microbes by poking holes that make the cell leak. This shuts down the chemical reactions the microbe needs to make energy so it can no longer survive.

Another perk of this ingredient is that it stays functional across a wide pH range (3-10).

You'll often see it paired with boosters like Ethylhexylglycerin; one study showed that a 1:9 ratio of Ethylhexylglycerin to Phenoxyethanol damages bacterial membranes as effectively as doubling the Phenoxyethanol concentration on its own.

Typical use concentrations range from 0.3-1% depending on the formula, and this ingredient is capped at 1% int the EU.

Safety-wise, the fear mongering does not hold up to the evidence. The EU's Scientific Committee on Consumer Safety and FDA consider it safe as a preservative at up to 1%, including for children of all ages.

Adverse systemic effects only showed up in animal studies at exposures roughly 200x higher than what people get from cosmetics. And despite its very widespread use, this ingredient is a rare sensitizer and allergic reactions are uncommon.