How the Two Active Ingredients Work
Azelaic Acid — Dicarboxylic Acid
Azelaic acid is a non-phenolic, saturated dicarboxylic acid with nine carbons, naturally produced by the yeast Malassezia. On skin it has several documented actions: it is antibacterial, anti-keratinizing, antimelanogenic, antioxidant, and anti-inflammatory. Its antibacterial effect comes from inhibiting microbial intracellular enzymes, and it acts mainly against gram-positive organisms such as Cutibacterium acnes, while its pigment-lightening effect comes from inhibiting the enzyme tyrosinase. It is FDA-approved in commercial products for papulopustular rosacea and also shows benefit in acne vulgaris and melasma. Sage Journals + 3
Miconazole — Antifungal
Miconazole is an azole antifungal. It blocks the fungal cell's ability to make ergosterol, a key membrane building block, which targets yeasts such as Malassezia and Candida that can contribute to seborrheic dermatitis, fungal (Malassezia) folliculitis, and related conditions.
Why They Are Combined
Some skin presentations involve both inflammation and a fungal (yeast) component. Pairing azelaic acid with a dedicated antifungal lets a prescriber address both in one cream. Because commercial azelaic acid products do not contain an antifungal, compounding is how this specific combination — and a custom strength — is made.
About the Base
XemaTop™ is the topical cream base used to carry the actives. Its suitability for a given patient's skin type should be confirmed with the prescriber.
Clinical Context
Azelaic acid is well studied in dermatology, with established anti-inflammatory, antibacterial, and antimelanogenic actions across rosacea, acne, and pigmentation disorders. Miconazole is added when a prescriber suspects or is treating a fungal component. Ingredient choice, strength, and use remain the prescriber's clinical decision.
Quality and Compliance
Mixwell Compounding Pharmacy prepares this cream in our purpose-built, USP <795>-compliant lab to the prescriber's exact instructions, dispensed only with a valid prescription. Mixwell is a non-sterile pharmacy and does not prepare sterile products or injectables. Commercial azelaic acid products exist; this compounded combination is intended for cases where a prescriber wants a custom strength or a combination not commercially available. Compounded medications are not reviewed or approved by the FDA. Nothing here promises a specific result, and compounded preparations are not presented as superior to commercially available products.
References
- Feng X, Shang J, Gu Z, Gong J, Chen Y, Liu Y. Azelaic Acid: Mechanisms of Action and Clinical Applications. Clin Cosmet Investig Dermatol. 2024;17. doi:10.2147/CCID.S485237. PMID: 39464747.
- Nazzaro-Porro M, Passi S. Identification of tyrosinase inhibitors in cultures of Pityrosporum. J Invest Dermatol. 1978;71(3):205–208. doi:10.1111/1523-1747.ep12547184.
- Professional Compounding Centers of America (PCCA). Formulation science and compounding resources. https://www.pccarx.com/Blog/