So, Just How does Metrogel work ?

Written by on March 20, 2007 in Metrogel 1%, What Causes Rosacea? with 17 Comments

I have mentioned a few times in the past that the way that metrogel helps rosacea is unknown. This statement deserves some clarification. Actually the way that metronidazole works is well known. This is despite the official prescribing information for Metrogel 1% listing the Pharmacodynamics as “the mechanisms by which metronidazole acts are unknown”.

How the effect of metrogel leads to a benefit in rosacea, well, that is something worth exploring some more later on.

You may wonder why there is so much emphasis on the metronidazole based products ? As much as metrogel and its friends metrocream, metrolotion, rozex, noritate (and indeed generic metrogel, also from fougera) are not a panacea for rosacea, they do represent the single most proven treatment specifically for rosacea. Thus newly diagnosed rosacea sufferers are quite likely to leave their doctor’s surgery with a script for metro-something. All the studies show that in many cases metrogel does indeed work. Further, other studies clearly show that combining metrogel with antibiotics results in better clearance.

How Does it Work?

So back to `how does it work ?’  Well my one sentence summary is “metronidazole breaks down into a substance that kills the DNA of the cells of some particular bacteria and protozoa”.

Thanks to Dan for sending me the following links ;

From DrugBank: Metronidazole

Pharmacology: Metronidazole, a synthetic antibacterial and antiprotozoal agent of the nitroimidazole class, is used against protozoa such as Trichomonas vaginalis, amebiasis, and giardiasis. Metronidazole is extremely effective against anaerobic bacterial infections and is also used to treat Crohn’s disease, antibiotic-associated diarrhea, and rosacea.

Mechanism of Action: Unionized metronidazole is selective for anaerobic bacteria due to their ability to intracellularly reduce metronidazole to its active form. This reduced metronidazole then disrupts DNA’s helical structure, inhibiting bacterial nucleic acid synthesis and resulting in bacterial cell death.

From Antibiotics that Inhibit Nucleic Acid Synthesis

Figure 11-8. Structure of metronidazole and its mechanism of action. Metronidazole enters an aerobic bacterium where, via the electron transport protein ferrodoxin, it is reduced. The drug then binds to DNA, and DNA breakage occurs.

(An anaerobic organism is any organism that does not require oxygen for growth. Protozoa are a particular type of single cell organisms.)

This naturally leads to the followup question – if eliminating the substances that metronidazole (and for the purposes of this argument, lets include systemic antibiotics as well) is active against leads to relief from some rosacea symptoms, what does that say about the possible cause of rosacea ? Now, that is a question that there isn’t much agreement about and something worth talking about some more, later.

How Long Does Metrogel Take to Work?

According to the Metrogel 1% Prescribing Information the results were recorded after 10 weeks of use of Metrogel.

So you can expect to have to wait several weeks before you will see improvement in your papules and pustules. From personal experience, changes can be seen in as little as 3 weeks, but for me the improvement was indeed gradual.

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

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17 Reader Comments

  1. william helton says:

    i use metro gel 1% ; and 100mg doxycycline twice daily as prescribed by my doctor . i also ,have problems with sebaceous hyperplasia i used to take orecea but above combination seems to work better. i forgot to mention 56yrs.old

  2. heather says:

    ive been using this gel 0.75% twice a day and its getting worse ive been using it for two weeks and im getting worse bumps and spots but im gonna keep going fingers crossed

  3. All the best Heather,

    It can take 3-4 weeks to see a difference with metronidazole 0.75%. Some people might find the overall formulation too harsh for their sensitive skin, so keep an eye out for a negative reaction that might suggest this treatment is not for you.


  4. Rosa says:

    I’m convinced topical Metronidazole works by disrupting Demodex Folliculorum (hair follicle mites).

  5. Rosa says:

    Furthermore, topical Metronidazole will NOT work by disrupting Demodex Brevis (oil gland mites) because it can not penetrate down in to the sebaceous glands that they dwell in.

    Demodex Folliculorum (hair follicle mites)
    Treatment = topical Metronidazole

    Demodex Brevis (old gland mites)
    Treatment = systemic Accutane

    Treatment for the infections (pimples) caused by the mites dragging and burrowing bacteria commonly found on human skin can be helped by antibiotics. Antibiotics for Rosacea or Acne is just curing the symptom, NOT the cause of the problem. MITES!

  6. Rosa says:

    These mites become UN-commensal parasites when they reach large numbers.

    Many things can lead to large numbers (otherwise known as an infestation – weaken immune system due to illness, stress, age, poor diet, etc.

  7. Jason says:

    WHEN IS THIS GOING TO START WORKING??? Ugh, I’m suicidal because I look like a monster. I just can’t take this hell anymore! People staring at me, actually GAWKING at me. Is this what my life is going to be like? It’s not worth it!

  8. Cleve says:

    Jason, Jason, I know it looks bad, because I have it too and yes indeed it looks bad. and i hate it too, but life is still sweet and there is always tomorrow, another day and this too will pass. It will.

    Do you have a doctor who can give you antibiotics? That works. I don’t have a doctor or insurance. I just have to bear it. Some day’s it stings and burns when I am outside in the sun. So I tend to stay inside and away from people.

    I hope you are feeling better and know we are all suffering together.

  9. Emily says:

    Jason I know how you feel. My life has been consumed with my skin. constantly trying to anticipate conditions that cause it to flair up bad. I cant hardly leave the house on the winter i step into the cold ots instamt wind burn. Trying a billion different face washes just to end up completly broke out feeling like you washed your face with acid when it says sensotive skin everywhere! Your not alone, don’t give up hope. People are constantly questioning about it and im sure they think im some kinda strung out meth addict or something I know it can really start to get to you. It will get better just remember it DOES get worse before it gets better. I have finally got a handle on mine with a strict routine that can’t be broken wash face in the morning with triderma tone with witch hazel apply metro gel stuff .75% repeat at bedtime. Good luck and God Bless hopefully by now your seeing great results -Em

  10. momovich says:

    To Jason and many others: I am here because I have Rosacea. I wanted to share, however, an observation that may encourage you. Today, things look bad. Today, you feel unattractive. Today, you feel hopeless. When I was in college, I had a sweet friend who had a skin disorder that created huge, red, slimy patches all over his body. This was not just the face, this was all over his face AND body…crusty, bloody, yellow, oozing sores. ALL OVER! I recently saw a photo of this same man (many years later). His skin is clear. He has apparently been married, had twins, and is successful in business. I do not know any details. I just want to encourage you that you WILL get past this, you WILL have a life, you WILL have relationships, you WILL have success. If my friend, in college, was able to treat his horrible, and presumably incurable condition to the extent that it no longer consumed him, so that he could lead a “normal” life, then SO WILL YOU.

  11. devi says:

    why is Metronidazole cream 0.75% cost me $117.98

    • Evie Fishkin says:

      The pharmacist said the cost of it was $500, but my co-pay only $35. That was a lot of money down the tube cause soon as I put it on I broke out with red spots all over my face. Not using it again! I purchased another few creams one over the counter and one on line that is helping. My first breakout was horrible. My Derm- said it was rosacea. After a few weeks starting to calm down except for being very itchy.

      It is expensive because it is sold by pharmacy and it doesn’t work and they don’t know why it works. Bad stuff.

    • It is 20$ a tub in mexico, and you don’t need a doc;s script to buy it…or maybe trying looking into Canada drugs they run cheaper too , more like 60$ I believe …

  12. Julia says:

    Hello to all rosacea suffers. Metronidazole can be purchased through Canada at a much more reasonable price and you do not need a prescription for this. Something is very wrong with the health care system in the US. Please look at other options. My insurance would not cover it either because it would have cost over $300.00 dollars. I have purchased this from Canada and it works very well. Shame on the US and their health care system.

  13. Jennifer Y says:

    I am newly dx with rosacea, and I picked up my $207 tube of metrogel. Per my dermatologist, I should use cleansers like dove sensitive, or Cetaphil. Problem is my skin is very dry. Surprisingly since using dove sensitive, it’s make my rosacea worse, plus my face feels so stiff and dry, after moisturizer. I’ve used St Ives green tea scrub, and it actually calms the redness temporarily. I just can’t find the right skin care system to use. Any suggestions? A friend recommended the Clinique redness kit, but it’s a bit pricey.

  14. Sandra says:

    This may not be less expensive, but it’s recommended by a dermatologist who focuses on rosacea:

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