Metrogel also works for Seborrheic Dermatitis

Written by on May 13, 2008 in Metrogel 1%, seborrheic dermatitis with 5 Comments

This paper found that 0.75% metrogel worked just as well as ketoconazole 2% cream in treating SD. The study found that both were able to offer significant improvement with similar side effects.

The authors suggest that because there is so little evidence of anti fungal activity of metronidazole, it is difficult to speculate that this is the reason for its efficacy in treating SD.

Patients with rosacea were excluded from this study, so there is a good finding here that even if you only suspect that you have seborrheic dermatitis, metrogel is a good opening treatment option.


Metronidazole 0.75% gel vs. ketoconazole 2% cream in the treatment of facial seborrheic dermatitis: a randomized, double-blind study, D Seckin, O Gurbuz, O Akin, JEADV, Volume 21 Issue 3 Page 345-350, March 2007.

Background: Recently, two placebo-controlled studies have shown that topical metronidazole was effective in the treatment of seborrheic dermatitis.

Objective: To compare the efficacy and safety of metronidazole 0.75% gel with that of ketoconazole 2% cream in the treatment of facial seborrheic dermatitis.

Methods: A total of 60 consecutive patients with facial seborrheic dermatitis were included. Patients were randomized into two groups. One group used ketoconazole 2% cream with metronidazole gel as vehicle; the other group used metronidazole 0.75% gel with ketoconazole cream as vehicle for a 4-week treatment period. Main outcome measures were change in clinical severity scores, patients’ and investigator’s global evaluation of improvement and frequency of side-effects.

Results: All the assessments were made by an investigator who was unaware of which group the patients were allocated to. Mean percentage decrease in clinical severity scores from baseline to last available visit was 63.4% (95% CI 57.7–69) and 54.4% (95% CI 47.9–61) in the ketoconazole- and metronidazoletreated patients, respectively (P = 0.31). Eighty-two per cent of patients in the ketoconazole group vs. 79% of patients in the metronidazole group rated their global improvement as significant or moderate (P > 0.05). No statistically significant difference in the frequency of side-effects was detected between the two groups. The results of this study need to be confirmed in further studies involving large numbers of patients.

Our data demonstrated that metronidazole 0.75% gel had a comparable efficacy and safety profile with that of ketoconazole 2% cream in the treatment of facial seborrheic dermatitis.

Discussion: (From full paper)

This prospective, double-blind, randomized study has compared the efficacy of metronidazole 0.75% gel with ketoconazole 2% cream in the treatment of facial seborrheic dermatitis. Our results indicate that both ketoconazole cream and metronidazole gel were effective and safe in the treatment of seborrheic dermatitis.

Metronidazole has been used effectively and safely in the treatment of rosacea for a long time. It is supposed that its efficacy in rosacea is down to its anti-inflammatory properties, such as inhibition of free radical generation and oxidative tissue damage. This anti-inflammatory activity may be a contributing factor to its efficacy in seborrheic dermatitis, which is likewise an inflammatory skin condition


Coexistent rosacea was an exclusion criterion in our study as it would be a confounding factor in determination of clinical improvement. However, seborrheic dermatitis and rosacea may occur concomitantly and we think that such patients, especially in pre-rosacea stage, are not uncommon.

Therefore, it may be wise to take advantage of metronidazole’s effectiveness in both diseases and recommend topical metronidazole for these patients.

Both ketoconazole and metronidazole are widely used topical agents, with a low frequency of side-effects. Few of our patients in both treatment groups experienced side-effects, and these were mild to moderate in severity and transient in patients who did.

In a study by Shelanski et al.  topical ketoconazole was found to cause contact sensitization more commonly than the other imidazoles.

We did not detect any difference between ketoconazole and metronidazole in terms of side-effects. However, we are aware of intolerance to topical ketoconazole in some patients in our dermatology practice. Such patients can alternatively be treated with topical metronidazole.

Our study demonstrated that metronidazole 0.75% gel is effective in the treatment of facial seborrheic dermatitis and this effect is not statistically different from that of ketoconazole 2% cream. We think that topical metronidazole can be added to the list of topical treatments in seborrheic dermatitis.

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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5 Reader Comments

  1. D says:

    I tried metro gel for my seb derm behind my ears and it drastically healed the scaling and redness down to a small area. It seemed to lose effectiveness over time, but I am very thankful for as much as it did help. Later I also tried it on other spots on my body and head without the same success.

  2. orgasmic says:

    I,ve been using metrogel for about a year and at first it was very effective but now it seems to have lost some of its effectiveness so i need to find something else.And also, Iv had some anxiety for about the same time as using the metrogel so I am wondering if this could be a side effect of the metrogel?Has anyone else had this experience?

  3. jessy says:

    recently only mine confirmed as rosecia. mine little redness over my cheeks.not any where. first i started metrogl .30 g. then i stopped using this . now again i started with benzac2.5% with tablet microdox dt. can u sugest a good remedy for complete disappearence of rosacia

  4. Larry says:

    For myself metrogel isn’t nearly strong enough to have any significant impact on my facial seb derm. On the other hand ketonocazole works pretty good. Unfortunately, if i use it regularly too much it has side effects on my rosacea. Theirs also an article here noting possible side effects of continuous long term ketonocazole use.

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