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It has several key pathophysiological features such as follicular hyperkeratosis, elevated &lt;i&gt;Propionibacterium acnes &lt;\/i&gt;proliferation, and reactive inflammation, all of which should be targeted for an optimal outcome. Azelaic acid (AzA) has profound anti-inflammatory, antioxidative effects, and is bactericidal against a range of Gram-negative and Gram-positive microorganisms as well, including antibiotic-resistant bacterial strains. In addition, AzA's antikeratinizing effects are inhibitory toward comedones. 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