Was prescribed a half-dozen different medicines for acne treatment in my teens and early 20s. Some did not work at all, others worked well but only for a short time. Azelex was like a miracle because it started working within the first two weeks, and has kept working for over 14 years. It did initially redden my skin and cause pretty harsh burning, but that lasted less than six months and has never returned since my body adapted to the medicine. Applying twice a day is annoying, and there are no generics available so the prescription is expensive. Those are my only complaints. This medication has definitely changed my life for the better.
From 
Skin Problems and Treatments Resources
Health Solutions From Our Sponsors
Medical Editor: John P. Cunha, DO, FACOEP
TERRIBLE. After struggling with acne, my dermatologist prescribed me Azelex 20%, and advised that i apply it twice a day and to mix it with moisturizer because it tends to dry out skin. After 3 days, it completely ruined my skin. Even after using *so much* moisturizer, it would burn my face and itch. After 2 days i figured i should keep giving it a chance. However on the 3rd day my face was just completely ruined. i woke up and my face was unbelievably DRY. my face formed wrinkles and i looked like an elder. Not to mention, my skin was peeling everywhere. It left dark patches of hyperpigmentation around my mouth, nose, and forehead. I was left with my face in a worse condition than when i started using Azelex. i don't know what to do know, i think it left me with a chemical burn or something of the sort. Now i'm left using homemade remedies to try to salvage all that i can.
Related Reading: acne | azelex | itch