Does topical metronidazole work for rosacea?
Dr. Fernandez explains how topical metronidazole can transform rosacea treatment by calming redness, reducing inflammation, and restoring your skin’s natural balance.
Table of Content:
What is metronidazole? |
Is metronidazole effective? |
Best dose and formulation |
Can you buy it OTC? |
Getting a prescription |
Price of metronidazole |
Strengths and formulations |
Benefits of metronidazole |
How to use it |
Dermatologist tips |
Potential side-effects |
Precautions |
FAQs about metronidazole

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What is topical metronidazole?
Topical metronidazole is an antibiotic commonly used to treat rosacea in addition to other skin conditions. It works by reducing inflammation and stopping the growth of bacteria or parasites that may contribute to the condition. It is available in different strengths and formulations.1
What is metronidazole used for?
- Rosacea: The primary and most common use of topical metronidazole is to treat rosacea, a chronic skin condition characterized by redness, flushing, visible blood vessels, and sometimes acne-like pustules. It helps reduce redness and inflammation while controlling the formation of bumps and pimples associated with the condition.
- Perioral dermatitis: Occasionally prescribed to manage perioral dermatitis, a rash that occurs around the mouth and sometimes the eyes or nose, though this is an off-label use.
- Bacterial vaginosis (BV): Common vaginal infection caused by an imbalance of the normal vaginal bacteria.
- Wound healing (off-label): In some cases, topical metronidazole is used for wound care, especially for wounds or ulcers that may have an odor caused by anaerobic bacteria.
- Other skin infections (off-label): May be used for certain bacterial or parasitic skin infections, depending on a healthcare provider’s judgment.2
Is metronidazole effective for rosacea?
Studies show that topical metronidazole is a well-established treatment for rosacea3 4. It works by reducing inflammation and calming the skin, which helps alleviate redness, swelling, and inflammatory lesions like papules and pustules. Dr. Carolina Fernandez, board-certified dermatologist, says that while it may not significantly improve the flushing or visible blood vessels often associated with rosacea, it is particularly effective for managing the inflammatory component of the condition. Consistent use, as prescribed by your dermatologist, typically shows noticeable improvement within a few weeks to months.
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What is the best dose and formulation of metronidazole for rosacea?
Dr. Fernandez says that the choice between metronidazole cream or gel for rosacea depends on your skin type and specific needs. The gel is typically better for oily or acne-prone skin due to its lightweight, non-greasy texture. In contrast, the cream is more suitable for dry or sensitive skin, as it provides additional hydration and is less likely to cause dryness.
Metronidazole is commonly available in 0.75% and 1% concentrations. Both are effective, but the 1% formulation may deliver slightly better results when used once daily. The 0.75% concentration is usually applied twice daily and works well for many individuals. Your dermatologist can recommend the ideal formulation and concentration based on your skin type and the severity of your rosacea.
Can I buy metronidazole cream for rosacea without a prescription?
Metronidazole gels or creams are not available over the counter (OTC) in the United States; they require a prescription from a healthcare provider. It is a topical antibiotic commonly used to treat conditions such as rosacea, certain bacterial skin infections, and bacterial vaginosis.
How to get a rosacea prescription for metronidazole?
To get a prescription for metronidazole for rosacea through Miiskin, start by taking clear photos of the affected areas along with a description of your symptoms. Request a virtual consultation with a board-certified dermatologist, who will review your case, provide a diagnosis, and may prescribe metronidazole gel or cream if appropriate. The prescription can be sent to your preferred pharmacy for pickup or delivery. Use the app to track your progress and follow up with the dermatologist as needed for any adjustments to your treatment plan.
Can you buy topical metronidazole online?
Once you obtain a metronidazole prescription via Miiskin you can buy it at an online or local pharmacy.
Is there a generic topical metronidazole for rosacea?
Yes! Dr. Fernandez says that topical metronidazole is widely available in both generic and brand-name formulations. Common brand names include MetroGel, MetroCream, MetroLotion, Noritate, and Rosadan.
What is the price of topical metronidazole?
Generic versions of topical metronidazole are widely available and are typically more affordable than their brand-name counterparts. For example, a 60-gram tube of generic metronidazole 1% gel can cost around $35 with a discount card, whereas the brand-name MetroGel may be priced significantly higher, averaging approximately $500 for the same quantity.
More about topical metronidazole for rosacea
Strengths and formulations of topical metronidazole for rosacea
- 0.75% gel
- 0.75% lotion
- 0.75% cream
- 1% cream
- 1% gel
Benefits of topical metronidazole for rosacea
Dr. Fernandez says that there are several benefits of using metronidazole for rosacea:
- Reduces redness and inflammation: Metronidazole helps diminish the persistent redness (erythema) and inflammation associated with rosacea by modulating inflammatory processes in the skin.5
- Treats papules and pustules: It is particularly effective at reducing the bumps (papules) and pus-filled lesions (pustules) characteristic of inflammatory rosacea.6
- Gentle on sensitive skin: Metronidazole is well-tolerated by most individuals with rosacea, even those with sensitive skin. It’s available in formulations that minimize irritation, such as creams, gels, and lotions.
- Dual action:The medication offers both anti-inflammatory and antimicrobial properties, helping to address potential microbial factors that may worsen rosacea.
- Proven safety for long-term use: Metronidazole is safe for extended use, which is important for managing a chronic condition like rosacea. Long-term use can help maintain symptom control and reduce flare-ups.
- Minimal side effects: Topical metronidazole has fewer side effects, such as dryness or mild irritation, which are manageable with proper skincare.
- Affordable: Getting a generic formulation is quite affordable compared to other rosacea treatments.
How to use topical metronidazole for rosacea?
Cleanse your skin
- Wash your face gently with a mild, non-irritating cleanser.
- Avoid using harsh scrubs or soaps that can worsen rosacea symptoms.
- Pat your skin dry with a clean, soft towel—don’t rub.
Apply a moisturizer
- Use a non-comedogenic, fragrance-free moisturizer suitable for sensitive skin.
- Apply it after cleansing and before the medication to prevent dryness.
Apply a thin layer of the medication
- Squeeze a small amount of metronidazole cream, gel, or lotion onto your fingertips.
- Spread a thin layer over the affected areas of your face, avoiding your eyes, mouth, and nostrils.
Follow the recommended frequency
- Use the medication as prescribed, typically once or twice daily.
- Apply it at the same time(s) each day for consistency.
Let it absorb
- Allow the medication to fully absorb before applying other skincare products or makeup.
Dermatologist tips for using metronidazole for rosacea
- Use sunscreen daily: Protect your skin from UV exposure, which can trigger rosacea. Choose a gentle, broad-spectrum sunscreen with SPF 30 or higher, and apply it after the medication.
- Be consistent: It may take 4–8 weeks to see noticeable improvement, so stick with the treatment plan. Do not stop using the medication unless advised by your healthcare provider.
- Monitor for side effects: Common side effects include mild skin irritation, dryness, or redness. If you experience severe irritation or allergic reactions, stop using the medication and contact your healthcare provider.
- Avoid triggers: Spicy foods, alcohol, extreme temperatures, and stress, can worsen rosacea.
- Have a proper skin care routine in place: Ask your dermatologist to recommend additional products or treatments.
- Follow up with your dermatologist: If your rosacea doesn’t improve after several weeks or gets worse, consult your healthcare provider for reassessment.
Potential side-effects of topical metronidazole for rosacea
Dr. Fernandez says that while topical metronidazole is generally well-tolerated, like any medication, it can cause side effects. Common and less common side effects include:
Common side effects
- Skin irritation: Redness, dryness, itching, or burning at the application site.
- Mild stinging sensation: Especially when applied to sensitive or irritated skin, which is why you should suspend application if your skin is irritated or damaged.
Less common side effects
- Skin rash or hives: Indicating a possible allergic reaction.
- Peeling or scaling of the skin: In some cases, prolonged use may cause dryness or flakiness.
- Watery or irritated eyes: If the medication accidentally comes into contact with the eyes.
Rare side effects
- Metallic taste: Though rare, it can happen if the medication is absorbed in larger quantities.
- Numbness or tingling: Reported in very rare cases, possibly linked to systemic absorption*7.
* These last two effects are much more common with the oral administration of the medication which is not used in rosacea.
Precautions when using topical metronidazole for rosacea
Dr. Fernandez says that you should avoid prolonged sun exposure on treated areas, as metronidazole can make the skin more sensitive to sunlight. Every morning apply sunscreen SPF 50 when using this product.
If severe redness, swelling, or allergic reactions occur, stop using the product and consult a healthcare provider.
Do not use topical metronidazole when pregnant unless prescribed by your doctor as it is uncertain if topical metronidazole can harm a fetus.
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Frequently asked questions about using metronidazole for rosacea
What is metronidazole topical cream used for?
Dr. Fernandez says that metronidazole topical cream is commonly used to treat rosacea, a chronic skin condition that causes redness, bumps, and inflammation. It is also prescribed for other conditions where inflammation and bacterial involvement play a role, such as perioral dermatitis. Metronidazole helps reduce redness, swelling, and the number of acne-like lesions by targeting inflammation and bacteria.
What to avoid when using metronidazole cream for rosacea?
According to Dr. Fernandez, when using metronidazole cream, avoid skincare products that contain alcohol, astringents, or harsh exfoliants, as they can irritate the skin. Sun exposure should also be minimized, as it can worsen rosacea symptoms. Additionally, avoid applying the cream near the eyes, mouth, or mucous membranes unless directed by your healthcare provider.
What is the most common side effect of metronidazole?
The most common side effect of metronidazole cream is mild skin irritation at the application site, which can include redness, dryness, stinging, or burning. These symptoms are usually temporary and subside as your skin adjusts to the medication. If irritation persists or worsens, consult your healthcare provider.
Is metronidazole cream safe for rosacea?
Dr. Fernandez says that metronidazole cream is considered safe for most people when used as directed. It is well-tolerated, with minimal systemic absorption, meaning it stays primarily on the skin rather than entering your bloodstream. Rarely, some individuals may experience allergic reactions or skin sensitivity, so it’s important to monitor for unusual side effects and follow your doctor’s instructions.
What is better than metronidazole for rosacea?
Dr. Fernandez says that ivermectin cream (Soolantra)8 or azelaic acid (Finacea)9 are two alternatives in the treatment of rosacea according to studies. For redness, treatments like brimonidine gel or laser therapy may provide faster or more targeted results. The best option depends on your specific symptoms and skin type.
What is the gold standard treatment for rosacea?
Dr. Fernandez says the gold standard treatment for rosacea typically combines topical medications like metronidazole or ivermectin with oral antibiotics such as doxycycline for moderate to severe cases. For persistent redness, laser or light-based therapies are highly effective. Treatment is individualized, based on the type and severity of symptoms.
What is the strongest antibiotic for rosacea?
Dr. Fernandez, oral doxycycline or minocycline are often considered good choices of antibiotics for rosacea because of their dual anti-inflammatory and antimicrobial properties. It is particularly effective for reducing inflammatory papules and pustules. For severe cases, low-dose, extended-release doxycycline is commonly prescribed to minimize side effects while maintaining efficacy.
Article References:
1 https://www.mayoclinic.org/drugs-supplements/metronidazole-topical-route/description/drg-20064727
2 https://www.ncbi.nlm.nih.gov/sites/books/NBK539728/
3 https://pmc.ncbi.nlm.nih.gov/articles/PMC5096126/#B10
4 https://pubmed.ncbi.nlm.nih.gov/9645635/
5 https://jamanetwork.com/journals/jamadermatology/fullarticle/189144
6 https://jamanetwork.com/journals/jamadermatology/fullarticle/189144
7 https://www.webmd.com/drugs/2/drug-75148/metronidazole-topical/details
8 https://pmc.ncbi.nlm.nih.gov/articles/PMC4665052/
9 https://jamanetwork.com/journals/jamadermatology/fullarticle/479570
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