Metrogel, Metrolotion, Metrocream, Noritate, once or twice per day – all the same same !!

Despite quite a lot of activity in the marketing and development of the metronidazole based rosacea treatments (lotion, cream, gel, generic equivalents, metrogel 1%, once per day, twice per day) this research suggests that the formulation and treatment frequency make little difference to the treatment outcome.

So if you can tolerate one of the available formulations of metronidazole, there is likely marginal benefit from changing to another.

Also if you can obtain a cheaper generic form of metronidazole, then you probably won’t notice a difference to the full priced original.

Should I Use Metrogel Once or Twice per day?

Finally, this research seems to answer the question – should I use metrogel once or twice a day ? The answer being that it doesn’t seem to make any real difference.

This is all good news for rosacea sufferers.

Now, lets see the companies that sell metrogel and friends invest in innovative products and not just pointless derivatives.

Metronidazole in the treatment of rosacea: do formulation, dosing, and concentration matter?

Yoo J, Reid DC, Kimball AB., Clinical Unit for Research Trials in Skin, Harvard Medical School, Boston, MA 02114, USA, J Drugs Dermatol. 2006 Apr;5(4):317-9

BACKGROUND: Topical metronidazole is commonly used in the management of rosacea. No consensus on the optimal formulation, concentration, or dosing regimen exists.

PURPOSE: To assess the relative efficacy of metronidazole cream, gel, and lotion at concentrations of 0.75% and 1%, in dosing regimens of once and twice daily.

METHODS: A meta-analysis of published metronidazole efficacy rates was performed.

RESULTS: In non-weighted analysis, the mean efficacy was 28.2% (95% confidence interval [CI], 22.0%-34.4%) for the cream, 38.4% (95% CI, 18.4%-58.4%) for the gel, and 35% for the lotion. Confidence intervals for QD versus BID dosing and 0.75% versus 1% concentrations also overlapped. In weighted analysis, the mean reduction was 31.3% for the cream, 22.1% for the gel, and 35% for the lotion.

CONCLUSIONS: Metronidazole cream, gel, and lotion vehicles have similar efficacies. There were no substantial differences between concentrations of 0.75% and 1%, or between once daily and twice daily regimens.

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

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13 Reader Comments

  1. Stephanie says:

    Please answer me on my e-mail though you may include my question in the website if you wish. I will get the answer more quickly via e-mail.

    Is metrocream helpful to seborrheaic dermatitis of rosacia? Can it irritate the seborrhea? My doctor prescribed a steroid for my seborrhea related to rosacia. It clears it up completely but if I stop it, the seborrhea returns. I would rather use metrocream for which I have now gotten a prescription. It may be a better long term treatment for all of the rosacia related problems. I have some pimples occasionally but do not have lasting redness. I used to flush but no longer do.

    Thanks,
    Stephanie

  2. David Pascoe says:

    Hi Stephanie,

    Here is one study that found that metrogel also works for seborrheic dermatitis.

    You are right that steroids are not a viable long term treatment for rosacea.

    Have you tried any of the antifungal treatments like ketoconazole to treat your seborrheic dermatitis ?

    hope this helps,
    davidp.

  3. aziza zaater says:

    I used Noritate while I was in USA. Now I live in Qatar, I searched most pharmacies for any metronidazol cream, they can’t find it. 2 tears ago I was able to find Dumazol in Qatar.

    Can you supply a name of the product in this region?
    thanks

  4. M Wood says:

    I thought I noticed a significant difference b/n metrogel and metrolotion, with the lotion being more helpful.

    Seems to make sense that different people will have different efficacy based on delivery.

    I can’t seem to find it now though.

  5. Janice says:

    Hi

    I have suffered from Rosacea for about 2 years and managed it quite well (with metrogel and lycene) and haven’t had an outbreak for at least 5mths. I have tooth infection and the dentist gave me metronidazole tablets to clear it up and I have had now got the most severe outbreak I ever had (swelling of my face particularly around the nose and very red and itchy). We also have very cold weather here at the moment. Could it all be co-incidence?

    Thanks for anyone’s help

  6. David Pascoe says:

    Comment via email;

    Janice,

    I have also taken the medication that your dentist prescribed for you and it did not affect my rosacia. I do think that cold weather is a problem because mine was under control with nortate cream mixed with ketocnizole for several months. I thank those who made suggestions via the site. However, when the cold strikes, I get a spot or two of either rosacia or seborrhea or some mix. My doctor says it rosacia. When this happens, I use a little of the mild steroid foam that my doctor prescribed when this first broke out. It gets it under control in a couple of days.

    Hope this helps.
    Stephanie

  7. HELLO, MY DOCTER JUST PRESCRIBED ME (FOUGERA) METRONIDAZOLE 0.75% TOPICAL CREAM. PLUS DOXYCYCLINE HYCLATE 100MG CAPSULES, THAT I TAKE TWICE A DAY FOR MY ROSACEA. I STARTED TAKING THIS YESTERDAY AND THIS MORNING MY NOSE AND CHEEKS ARE REDDER, IS THIS NORMAL? AND HOW LONG WILL IT STAY SO RED. IT DOES FEEL A LITTLE DRY. THANK YOU FOR LISSONING. LINDA

  8. Alexia says:

    Hi, hope you can help. I recently got diagnosed with Rosacea (type with pustules). My doctor prescribed Rosex Metronidazole 00.75% gel. After a week of using 2 x daily I got welts, more bumps with broken capilliaries… I got some on my lips and they also swelled up with welts, etc. I think the condition was made worse. My doctor then prescribed benzoyl peroxide. Will this really help in the long run? Could I use a metronidazole cream rather then a gel, or is it likely to cause the same sort of reaction? What alternative topical treatment could I use?
    Thank you.

  9. Pakiso says:

    Hi! I have had rosacea for the past 3 years although i was formally diagnosed a year ago. My doctor prescribed metronidazol gel and doxycylcine. I’m struggling to find metronidazol gel over here but the doxycycline helps a lot. My question is: can metronidazole tablets help in any way with my rosacea? I will appreciate any information.

  10. David Pascoe says:

    Hello Pakiso,

    You wouldn’t normally take oral antibiotics and oral metronidazole (flagyl) together they do the same thing. There are potentially more side effects when taking Flagyl so be sure to check with your doctor.

    davidp.

  11. Pakiso says:

    Thanks for the information David. I will talk to my doctor. I guess my primary question was whether or not metronidazole tablets help in treating rosacea. Thanks again for the info.

  12. Janice says:

    Hi,

    Following on from David’s comment. I took Metronidazol as prescribed by my dentist for a tooth infection and my faced swelled up and took 4 days to calm down, leaving me with a much worse attack of rosacea than previously experienced.

    Hope that helps
    JH

  13. grace t. says:

    i have been recently diagnosed with rosacea. my god. this is no joke. its so hard to live with the bumps, itchiness and red.. i cant eat anything , so scared to eat even just a piece of bread.i lost 10 lbs in 2 weeks.now all i eat is salad, cucumber.i using metrolotion and ovace. i think,m eladil makes it worst? i think its not helping me as it should be.can i also combined the herbal meds with doxycyline? pls help.. i miss so many days at work.thnk u all.

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