The authors agree in pointing to an Arabic origin for this surname. E. Rossoni indicates that the southern clusters derive from nicknames, affectionate or augmentative forms of the Arabic term zahr, meaning "flower", and adds that the surname also exists as a variant of the Sardinian Atzara. V. Blunda specifies the etymon as az zahrah and suggests that it may have functioned as a nickname applied to a female ancestor for her beauty or delicacy, or as a reference to a flowery place. G. P. Holmes agrees with that etymology and notes that the surname is also present among Jewish communities.

G. Rohlfs proposes an alternative etymology of Greek-Byzantine origin: he derives it from the Greek psaràs ("fisherman"), a form that survives in Greece as Psaràs and that in the Greek-speaking dialect of the Bova area, in the province of Reggio Calabria, takes the form azzari meaning "fish". This variant is documented in Bova Marina and in Sicily.

As for the distribution, Rossoni notes that the surname is typical of Sicily, with areas of concentration in the provinces of Ragusa and Syracuse. The derived forms present their own distributions: Azzarelli appears in the Genoa area, in the Perugia area —including Foligno, Spello and Assisi— and in Sicily; Azzaro is peculiar to southern Sicily; Azzarone is specific to the Foggia area.