Metronidazole is a prescription drug that is available in several formulations. As an oral treatment it is known as flagyl. Topical metronidazole is available as noritate, metrogel, rozex, metrogel 1%, metrolotion and metrocream.
What is metronidazole ? well scientifically it is a white to pale yellow crystalline powder. Metronidazole is a member of the imidazole class of anti-bacterial agents and is classified as an antiprotozoal and anti-bacterial agent.
When taken orally, metronidazole is known as flagyl. Flagyl is used for a wide variety of infections including those in the adbomen, bones, joints, nervous system, respiratory tract, skin, as well as vaginal and intestinal infections.
A bit of history
Curatek Pharmaceuticals developed and submitted the New Drug Application for Metrogel in 1988. Since its introduction by Curatek, MetroGel has become the most widely prescribed therapy in the United States for rosacea. In 1993 Curatek Pharmaceuticals sold metrogel to Galderma Laboratories.
Curatek, continued to market MetroGel-Vaginal (metronidazole vaginal gel, 0.75 percent) for bacterial vaginosis. MetroGel-Vaginal was introduced in the U.S. in 1992.
How does metrogel work ? well amazingly after all these products have been marketed and many studies done, the mechanisms by which metronidazole acts in reducing inflammatory lesions of rosacea are unknown.
Dermik markets a 1%, once a day formulation of metronidzole called Noritate.
Metrogel was responsible for generating sales of about $75 million in 2004.
The patent on the branded product by Galderma expires on June 6, 2006. Fougera is poised to make generic metrogel available, having had tentative approval to produce a generic metrogel.
In July of 2005 Galderma announced that 1 percent metrogel had gained FDA approval. This 1% metrogel features a combination of niacinamide, betadex and propylene glycol. The vehicle is a water-based formulation and contains no alcohol.
Some of the more interesting published papers on rosacea and metrogel, and other metronidazole treatments include ;
Topical Metronidazole Maintains Remissions of Rosacea
Topical metronidazole therapy for rosacea.
The efficacy of topical metronidazole in the treatment of ocular rosacea.
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32 comments ↓
My skin looks like so red, itchy and with pimples.
The doctor said I am suffering from Roseca and the treatment will be for 6-8 weeks.
I have medicine of :
Doxycline (twice a day)
Flagyl (4 times a day)
Rozex tropical gel (night use)
Cetaphil moisturing cream (morning use)
Did anyone try that before ?
Hi Winnie,
What you describe is a normal well-know treatment regime for rosacea. It is quite common to be prescribed antibiotics and rozex/metrogel together. Many people find this form of treatment quite successful, so we are hoping that you do too.
davidp.
Is metrogel-vaginal the same stuff as the topical used for rosacea? It’s much cheaper
Jamey,
Metrogel as a treatment for rosacea was discovered accidentally when Metrogel Vaginal was used and a benefit was seen. I would think that it is quite safe to apply it to your facial skin.
davidp.
I used rozex gel and minocycline together for a long time last year. Since then I only use Rozex and am glad to say the complaints are reduced to something I can live with. Is it safe to stop using the gel? Anyone who has experience with that. And is it ok to use Rozex lets say, permanently?
Regards,
Martijn
Hi and thanks for this website. I have just been dianosed with Rosacea and am very upset. I just thought I had really dry skin! When I was told it will never go away, I was distraught. I had spent about 20 years on antibiotics to make acne scars fade away and it worked. Now I have to deal with this, I am quite overwhelmed. So, thank you again for this website, I don’t feel so alone and ugly anymore. My first treatment is the Rozex gel, but am finding it makes my skin even worse at times? Has anyone else found that?
Hi Skye, unfortunately rozex can cause a reaction in some users, especially those with sensitive skin. For those who can tolerate it, it can work reasonably well. Good luck with working out the best way to use it, or not at all.
Hi Digital Davo, thank you for responding. I will read some more info that is on your site and then I shall discuss other options with my dermatologist.
May I please ask another question?? I also have the tiny white cysts that can go with this condition. Do you or anyone else have that? What can I expect?? Just wanting a truthful answer from someone who is suffering and not the usual medical mumbo jumbo. I am sure you understand.
Thank you very much.
Hi Skye.
Sounds like you mean the pustules that are common for rosacea sufferers. When my rosacea was at its worst, yes I had those white/clear fluid filled pustules that looked a little bit like acne. I don’t have a photo of one as such, but there is a general idea of the papules and redness here ;
http://rosacea-support.org/photos-of-red-nose-papules-pustules-acne-like-rosacea
These are just one more symptom from the inflammation that comes with rosacea. As you reduce the inflammation you will find that the papules and pustules do go away.
As for an alternative to rozex, you might try rozex cream or noritate if you can get it. It is not guaranteed to work if rozex doesn’t, but it at least gives you an option. If there isn’t irritation, stick at it for at least 4 weeks to see if you are going to see a benefit.
davidp.
Thank you Davo!
hi, after many years ( 12 infact ) of being told by my then doctor that i had psoriasis of the face and it just getting worst as the years went on ,i changed doctors and she told me she thought i may have ROSACEA. The thing is i have the redness and burning feeling of Rosacea but the scaleing of the scin as of Psoriasis ( is this what happens with Rosacea ? ) . My doctor put me on Oxytetracycline which were fantastic but i am now trying for a baby so i stopped taken them and the Rosacea has come back worst stan ever so she has put me on ROZEX. The question is i have been using it for only 4 days but i seem to of had a headache ever since and my skin has gone really dry and what looks like Psoriasis has gone worst to. so any ideas would be a great help
Hi Tracy,
The Metrogel PI says “Pregnancy: Teratogenic Effects: Pregnancy Category B. There are no adequate and well-controlled studies with the use of METROGEL® (metronidazole gel), 1% in pregnant women.
Metronidazole crosses the placental barrier and enters the fetal circulation rapidly. No fetotoxicity was observed after oral administration of metronidazole in rats or mice at 200 and 20 times, respectively, the expected clinical dose. However, oral metronidazole has shown carcinogenic activity in rodents. Because animal reproduction studies are not always predictive of human response, METROGEL® (metronidazole gel), 1% should be used during pregnancy only if clearly needed” - so you may want to discuss this with your doctor.
As far as headaches are concerned, about 2.2% of the trialists reported this as a side effect.
all the best,
davidp.
When Galderma came out with its 1% metrogel in 2006, my doctor switched me to it. I’d been pustule-free for years. Suddenly the pustules were back in force, like boring relatives at Thanksgiving.
To give them credit, a pharmacist at Galderma was very helpful when I contacted them. They recommended I go back to the .75 formula but didn’t say why. When I did, the pustules vanished again. I wonder which of the additional ingredients was the culprit for me? (thanks Davo for the clues above). Anyone have a similar experience?
Hey everyone who has this awful rosacea, I know how you all feel. I use the rozex gel which works really well for me, when my skin gets really dry which would be the only side affect from it I use QV moisturiser for sensitive skin, this works too. I have narrowed it down what flares my rosacea and that is tomato based sauces, and red wine, my two favourite loves of life. I once went on this low GI diet and for the first 4 days we had this soup to eat which was full of tomato base of tins of tomatoes well within a few days one side of my face was completely red and the other side was starting, my eyes were really irritated and swollen. That’s how I found out. Everynow and then it just flares up and sometimes I endulge in a glass of red which I regret for the next week. Hope that helps some of you out there, really check your diet.
Good luck
Trish
hi everyone, this question is for the ladies (sorry all you men ) . I find that around my monthly cycle my Rosacea gets twice as worse also when i was pregnant 4yrs ago the Rosacea fanished completely, so iam wondering whether it might be a hormonal inbalance.
has anyone had the same experiance?
Hello to Davo, Tracey, Trish and Robin.
Thank you for participating in this site. Your info is very valuable to the rest of us and makes me feel more ‘normal’ if you know what I mean. Well, I am talking to my Dermatologist this week and will try to get more answers.
I am going ask about the hormonal imbalance Tracy…When I find out anything, I will post it here.
Trish, I am really glad the rozex gel is working for you and that you have been able to hunt down some causes of aggravation of the condition. If you have any other info, no matter how trivial you may think it may be, please write it here!
Thanks for your informative yet light-hearted message Robin. Very interesting. As Davo pointed out to me, the sensitivity range of our skin has a big bearing. Unfortunately I have had major probs with the rozex gel….but like I said before, I am talking with my Doc this week and will get back to you all with whatever I find out!!
Bye for now,
Skye.
Hi Everyone,
I was diagnosed with Rosacea about 15 years ago. My doctor sent me to a dermatologist who prescribed a course of tetracycline and Rosasol (metronidazole with SFP 15 sunscreen in it). It works beautifully. My skin cleared up quickly and I use it to this day. She also told me to track the times it was worse. I found that I definitely have a real spike in occurances about three days before my period and is pretty bad for about a week regardless of what I do, so hormones must have an effect. I use Oil of Olay Classic as a moisturizer and use a gentle oatmeal scrub about once a week to keep the flaking skin to a minimum. I wear a broad-brimmed hat in the summer and extra sunscreen. A couple of the sunscreens that I tried made the rosacea worse. I am not really happy with the one I have now. Come the summery weather, I will start looking and testing again. It can get pretty expensive trying different sunscreens! If anyone has one that works well, let us know!
Hi Tracy and Terry.
I probably have had Rosacea since being in my thirties. I always flushed easily and thought I just had ‘highly coloured’ skin. (I had never heard of Rosacea back then).
Over the past year and half or so my skin became more ‘ruddier’ and blotchy with lots of broken capillaries staring to show over the nose and cheeks. Again I thought this was down to ageing, (I’m now 45). It wasn’t until I finally started breaking out in the red spots, which trurned out to be P&P’s, that I finally went to the doctor. I found this phase quite distressing as I could count on one hand how many spots I have had on my face throughout my entire life.
The doctor told me that my age and approach to menopause was the likely cause of the worsening of the condition as Rosacea can get more progressive with the perimenopause and menopausal periods of your life.
Incidently, when I look back, when my condition started to worsen it co-incided with me stopping taking hormonal based contraception and I have had problems with irregular bleeding and stuff over the past year.
I have looked around other forums on the internet and have read several postings by women who had a worsening of flare ups around ‘the time of the month’ and some have reported that this stopped when they took oral contraception.
So I too beleive that, with women anyway, hormonal imbalances can play a big role in the ups and downs in the severity of this condition.
I have been on a high dose oral antibiotic for 3 months which has left me 100% P&P free, at the moment anyway. I have now been given Metrogel with the advice just to keep it on standby and use as a ’spot-on’ type treatment if I start to have breakouts again, as it is a strong drug and unnecessary use should be avoided.
I have read about many of the side effects of Metrogel, including worsening the condition, irritation and dryness, that I am happy enough to only use it if needed, as my skin is in a reasonable state at the moment, (red but reasonable LOL). If anyone has any thoughts or experiences on this approach, I would be interested in listening to them.
I have been using Rosex cream twice a day, morning and night for some months now and have noticed a huge, massive improvment in the appearance of my nose. I never get papules and pustule flare ups any more, which is a god send… however it is still always a little bit red, and so feel the problem is only half solved?
I am planning on getting a referral from my GP to see a dermatologist soon but can anyone else advise what i could do/take on top of the rosex cream to beat the redness?
I use sensitive dermalogica products as it is, and always wear a sensitive sun screen… my diet is pretty good and I am doing yoga to help with stress etc.
Feel like I am almost there with beating this problem.. but not quite!!
Hi Davo, Trish, Tracey, Robin and everyone.
Sorry it has taken me so long to follow-up on my previous message, but my computer died and I have now got a new one up and running.
After I spoke to my dermatologist, I was not exactly jumping with joy, but realized I must accept this condition, it is not going away. So, all the symptoms, reactions etc all appear to stem from internal heat in varying sources. Exercise, stimulating foods, the sun, anxiety in all of its forms, periods, all produce an internal heat that sets off our rosacea. As you would have previously read from all the great info Dave has provided, it seems to be a mystery why we get it in the first place, but it must be lurking there within us from the very beginning and at some point, it just decides to show up. Mine is sort of under control at the moment, but my skin just doesn’t like that rozex gel unfortunately. So, if it works for you, that is super. I wish everyone the very best and I look forward to frequenting this page again!
WoW! I found an interesting website. I have Rosacea and have been annoyed by it for many years. It’s embarrassing and it has destroyed a lot of my face. I’m trying MetroGel at the moment to see if it has any effect. I believe that certain foods, stress, and hormones have a definate effect. Also, I’ve noticed that when I’m getting dehydrated, it really gets it going. So, I’m trying to drink half of my weight in ounces every day to see if that will help. I’m 45. Nice to read your posts.
Dorthea
Hi Dorthea, I am sorry about your condition, but am really glad you found this site, it has helped me a lot. Very interesting observation about dehydration, I am now going to watch out for it. Thank you, you are not alone.
Hi! My Dr. just prescrobed MetroGel for my Rosacea this past Monday but after just 3 days, I am noticing no differance at all. I was just wondering how long before it starts to make a noticeable differance?
Hi Hal,
It usually takes about 30 days for you to notice anything after a new skin regimen. My derm told me I would notice a decrease in redness in about 3 months with MetroGel- can’t wait! I too was just given a Rx for 1% MetroGel & picked it up today. I’ve been reading all these posts which is nice to know we all feel each other’s pain. Has anyone out there been on MetroGel for a while & if so, how do you like it?
Hi Everyone,
In response to Hal, I have been on Metrogel for over 15 years. Never heard of rosacea when I was diagnosed in 1993! My doctor sent me to a dermatologist, who nodded and said, “Yup, classic Rosacea.” With oral antibiotics and the Metrogel, it took about 2 weeks before I saw any improvement.
Funny that Allibear’s derm said that Metrogel was strong. My derm says just the opposite, that it is mild and okay to use it twice a day, every day when I’m having flare ups and then once a day to keep it in check.
It was interesting to note from Dorthea that dehydration caused a worsening of symtoms. I will also keep an eye on that - never thought of it. Thanks.
I have also found that any of the anti-aging ingredients in moisturizers really burn my skin (I am 55) Tried a whole bunch of them but with disasterous results, so I just stick to my Oil of Olay Classic. Whatever works best for each of us, eh?!
Terry
Is this metrogel useful for bacterial vaginosis?
And is it one of the natural cures for that disease??
I went to dermatologist, had cysts white pimples on face irritated skin and a rash, burning sensation, also flet burning sensation on head and body not shingles.
Queen of returns. He put me on desonide for face 0.05%, triamcinlone acetonide 0.1% or use fliocinonide 0.05% none did not work.
I tried la roache posay thermal water, rosaliac cleanser and I am trying rosalia cream, I do not know if it will work with makeup.
Sorry so long, so far so good. But my skin is still red and get very irritated with these products. I have stopped using them but what about metrogel and a cleanser. Skin is very dehydrated and dry and red.
Should I call dermmatologist back or make another appointment. Been there 5 times no answers to problen, he said try cetaphil, aquanil or cerave which does not agree.
Marcia
sorry so long this has been going on for 4 months, 50 yrs old, very frustrated.
Hi
Ive jus been prescribed Metrogel does it cause any nasty side effects like upset tummy- nausea anything like that??
Hi Marcia Montal, sorry to hear you have our problem, but don’t lose hope. I am so glad you found this site…
First, I had the same symptoms as you in the beginning and after being told it would increase dramatically, I can tell you it has not. Everyone is different.
Second, you can read from my previous postings above that I was put onto Rozex Gel with 7.5mg of metronidazole. My skins reaction was horrible, it went dry, like plastic, redder than ever etc. I stopped it. I have very sensitive skin, so that is no real surprise.
Thirdly, I managed to sooth my skin very well with - EGO QV intensive moisturizing cleanser for extremely dry skin and also EGO QV moisturizer for extremely dry skin; they come in two types, for either the face or the body, I use the body one because it is much more soothing. It helps the painful dryness and decreases the redness. I get it from the pharmacy. Perhaps it will work for you.
Fourth; I suggest you go out of your way to see another dermatologist, ask beforehand how much experience they have had with the rosacea skin condition, if not much, ask someone else. I am afraid if it really is rosacea it is not going away anytime soon. You deserve someone who will listen to you and take this condition seriously.
Fifth; I have now slowly introduced the rozex gel back onto my skin, and I mean only every third night I apply it and so far my skin is accepting it, thank goodness. Will see how it goes and will post updates about it here in the future.
Lastly; messages can be as long as you need them to be, no need to apologize. Stay tuned here to see if anyone else can offer you some advice. Take care.
I am very frustrated. I first over a year ago, started with a rash on both sides of my cheeks by my ears and behind my ears. I went to my MD he put me on a steroid cream. This made it better but not go away, I went to a dermatoligist and she took me off the steroid right away, then gave me antibiotics, cream, and dx me with rosacea acne, but ater months it did not go away, it would what I describe as yuk and yukier. I always had nice skin. So I went to another dermatoligist, he said rosacea too and put me on antibiotic and metrogel, I got the worst yeast infection, so I had to go to my gyn and get that taken care of (never had a yeast infection until this I am 47) Then I went to anotehr doctor after 1 year of not going away she stated to stop everything. She stated it was not Rosacea because it was not the classic flushing/red, it was on the sides of my face so she thought it was topical dermatitis or seborric dermatitis. To wash only with Dove on my privates, underarms and feet, and not use anything to wash my face, take off my eye makeup (only thing I use) with dove. This worked for a few works actually saw improvement, then it came back worse. Iam back to the minicycline pills and metro gel, hoping to live with yuk instead of yukier. All the pictures I see on Rosacea have the pimples and redness on the frontal part of the face, has anyone ever known of it to be on the very sides of the cheeks by the ears? Help!
I need to know how to work make-up foundation into this regime. Do I wash my face, apply toner, then metronidazole, then make-up? Thanks.
Carol, you have the order correct. After washing with a gentle cleanser (I use LaRoche Posay Toleriane or Replenix Green Tea cleanser), it’s good to use a mild, non-alcohol toner (if your skin will tolerate it - I use SkinCeuticals, which has aloe and witch hazel) because the toner helps the skin absorb active products. After the toner, apply your active product such as Metrogel or Finacea. Then I apply a light moisturizer (I use LaRoche Posay Toleriane, or Rosaliac when my skin is really dry). I also like to apply Replenix Green Tea Serum before the moisturizer…I’ve used it for many years and think it helps calm my skin. And don’t forget sunscreen! - it’s important to wear it EVERY day. It’s very difficult to find non-irritating sunscreens - I can’t tolerate chemical sunscreens so I stick with the mineral sunscreens (titanium oxide and zinc oxide) - the best I’ve found is SkinCeuticals Physical Defense; Solbar, Dermalogica, and DDF are also good. I’m 47 and developed rosacea about 15 months ago. I had to completely change my skin care products (except for the green tea serum) because what I had been using suddenly irritated my face. It’s an ongoing struggle to find the right products that will help my rosacea symptoms, not worsen them or create other problems. So many products will seem good, but have one or more ingredients that I can’t tolerate or I’m not sure about and don’t want to risk trying. And some products clearly don’t work at all, or make things worse. It’s definitely trial and error, and it can be hard to know what is causing a sudden flare-up. For me, the main triggers are stress, hot or cold temperatures, heated beverages…but sometimes I can’t figure out why I have red blotches and my face is tingling and burning. I’ve been using Metrogel and Finacea and taking Oracea, and they seem to help, but I’m not sure just how much they’re helping. I tried a prescription sulfer cleanser but it was way too harsh for me. I sure hope there are better rosacea treatments on the near horizon…they’re desperately needed.
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