Dr Deborah Lee, Dr Fox Online Pharmacy, examines how metronidazole gel works as a treatment for acne rosacea, how effective it is and how to use it
Metronidazole is often recommended first line, as a topical skin treatment for acne rosacea. The treatments for rosacea can seem confusing, and you may not know which options to choose.
In the UK, metronidazole gel is available as Metrogel 0.75, or Rosex 0.75 gel.
- But what exactly is metronidazole gel?
- How does it work?
- Does it work?
- How to use it?
Read on and find out more.
What is metronidazole?
Metronidazole is an antibiotic that has been in common medical use for decades. It belongs to a class of antibiotics called nitroimidazoles. It is used specifically to treat anaerobic bacteria – these are bacteria that can reproduce without the need for oxygen – and also, to treat protozoan infections.
The metronidazole is transported through the skin and gets inside the bacteria, where it disrupts protein synthesis by interfering with DNA replication. The bacteria die because they are unable to reproduce.
How does metronidazole gel work for rosacea?
Metronidazole gel can be applied to the skin to treat acne rosacea. No one knows exactly what causes rosacea, so it is not possible to identify a possible cure for the condition. However, in clinical trials, the use of topical metronidazole to control the symptoms, has been very effective. It is thought to have the following effects –
- Reduces skin inflammation, leading to a reduction in redness, swelling and pustules.
- Has an antioxidant effect, helping to protect the skin from oxidative stress and consequent skin damage. Oxidative stress occurs when dangerous molecules called reactive oxygen species (ROS) are produced in the skin due to inflammation.
- By reducing oxidative stress, metronidazole has an anti-ageing effect on the skin.
How effective is it?
In one 2000 review of the use of metronidazole gel for rosacea compared to a placebo, the gel was found to be significantly more effective. It was used twice a day, for 7-12 weeks. In the metronidazole gel group, the numbers of papules and pustules were reduced by 48% and 65.1% respectively.
In one of the studies included in the review, most of the benefits were apparent after only 3 weeks of using the metronidazole gel.
Furthermore, some studies have shown that topical use of metronidazole gel is as effective in reducing skin lesions as taking the antibiotic doxycycline, by mouth. In addition, in patients treated with doxycycline, after the doxycycline was discontinued, 77% stayed in remission for 6 months when continuing to use metronidazole gel, as compared to 58% who used a placebo. This was a statistically significant difference.
As metronidazole gel is applied to the skin, there is minimal skin absorption, and side effects from the use of metronidazole gel, are unlikely.
How should it be used?
The British Association of Dermatology (BAD-2021,) recommends metronidazole gel as one of the first-line treatment for rosacea, along with azelaic acid, or ivermectin.
The National Institute for Health and Care Excellence (NICE), recommends the use of metronidazole gel for mild to moderate rosacea, in patients who cannot use ivermectin, either because this is inappropriate, or perhaps because they are pregnant or breastfeeding.
What to do
- Wash your skin gently and pat it dry with a clean towel.
- Apply a thin layer of metronidazole gel to the skin and rub it in, taking care not to get any in your eyes. Rub it well into the skin.
- Apply this twice a day, morning and night.
- It may take 9 weeks or more to show any benefit, so keep going.
- Side effects can include burning, stinging and itching of the skin. If minor, these may improve with time, but if not, an alternative may need to be suggested.
- You can use makeup but with rosacea, this should be oil-free makeup, used occasionally and not too thick. Apply the gel first, let it dry and apply the makeup over the top.
- Rosacea tends to flare in sunlight. Plus, metronidazole gel can make your skin more sensitive to sunlight, so always use an effective sunscreen, at least SPF 30 for anti-UVB protection, and four out of 5 stars for anti-UVA protection. Again, apply the gel first, allow it to dry, then apply the sunscreen. It’s best to keep out of the sun, wear a wide-brimmed hat, sit in the shade, and never use a sunbed.
- Metronidazole gel can have a drying effect on the skin. Use a gentle moisturiser that’s not likely to clog your pores, for example, simple hydrating products that contain hyaluronic acid, glycerin, dimethicone, or ceramides. Choose a product that is fragrance-free to minimise applying any additives on your skin.
- Rosacea can affect your eyes. If your eyes seem dry, gritty, or you are getting sore inflamed eyelids, see your GP. You may need a referral to a Consultant Ophthalmologist.
- Always use the gel before the expiry date. Store it at room temperature – not in the fridge.
Where to get metronidazole gel?
Metronidazole gel is only available on prescription. You can obtain a prescription from your GP, Consultant Dermatologist, or from an Online Pharmacy.
Rosacea is a miserable condition that can be hard to live with and have a very negative effect on your quality of life. Knowing about your treatment options and understanding them will help you comply with the treatment and get the best result. Metronidazole gel has been proven to be effective for rosacea.
Don’t despair! What steps could you take to manage your rosacea better?
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