Metronidazole (topical)

Also known as: MetroGel/MetroCream/MetroLotion (brands), nitroimidazole

Dermatology

In plain English

Topical metronidazole is a long-standing prescription treatment for the bumps and redness of rosacea. It calms inflammation on the face when applied once or twice daily. It is well tolerated and is one of the first-line options for rosacea.

The science

Metronidazole's benefit in rosacea is attributed mainly to anti-inflammatory and antioxidant activity (dampening neutrophil-generated reactive oxygen species) rather than antibacterial action. The Cochrane review of rosacea found topical metronidazole more effective than placebo for papulopustular rosacea (moderate-quality evidence), establishing it as a mainstay, with topical ivermectin and azelaic acid supported by higher-quality evidence.

References

• van Zuuren EJ et al., Cochrane Database Syst Rev 2015 (interventions for rosacea)
• van Zuuren EJ et al., Interventions for rosacea (summary), JAMA 2015