If you experience rosacea, you may be familiar with the acne-like bumps on your face that can develop during a flare-up. Sometimes, these bumps can be helped with a topical antibiotic. 

One such antibiotic that your doctor may prescribe is metronidazole. Topical metronidazole is an antibiotic used to treat inflammatory lesions from rosacea. Although the cause of rosacea isn’t fully understood, metronidazole likely works through anti-bacterial and anti-inflammatory effects. It helps with both redness and acne-like lesions from rosacea., But metronidazole isn’t right for everyone. When your medical provider prescribes medication, they consider other existing conditions or circumstances that may indicate the antibiotic shouldn’t be used in the case at hand—these are called contraindications or precautions. In this article,  we’ll share metronidazole contraindications, precautions, side effects, and how the antibiotic works to relieve symptoms of rosacea.¹,²

Rosacea and metronidazole

Rosacea often causes the face to break out in acne-like bumps. Metronidazole is an antibacterial agent that’s FDA-approved for the topical treatment of inflammatory lesions of rosacea.³ Topical metronidazole—applied to the skin in a gel, cream, or lotion—can help reduce inflammatory lesions of rosacea and redness, and is generally well-tolerated by users.⁴

But rosacea isn’t the only condition metronidazole may help with. 

At Curology, our dermatology providers may also recommend metronidazole for help with improving the symptoms of periorificial dermatitis, a skin condition characterized by groups of red, itchy, and tender papules on the face (around the eyes, nose, or mouth).⁵ Oral metronidazole—which is ingested rather than applied to the skin—is used to treat bacterial infections in the body, such as those in the stomach, liver, and joints.⁶ We’re all about skincare, so our team only prescribes topical metronidazole. 

How do I use metronidazole properly?

First things first: When using prescription medication, always apply it according to the prescribing provider’s instructions. Here are general instructions for applying topical metronidazole for the treatment of rosacea,⁷ but if your prescriber gives you different instructions, follow those instead. Generally speaking, here’s what to do:

1. Wash your hands to avoid transferring dirt and bacteria from your hands to your face.

2. Rinse the affected area with water or wash it with a gentle cleanser.

3. Allow the area to dry completely.

4. Apply a thin layer of metronidazole to the affected area and rub it in gently.

Avoid applying the product near your eyes, as it can cause a stinging sensation. If some of the gel or cream gets in your eye, wash it out immediately with cold water.

If you’re concerned about the success of the treatment, we recommend you talk with your medical provider.

Possible metronidazole side effects 

Like any medication, metronidazole may come with unwanted side effects. If you experience side effects while using this medication, contact your doctor right away. While there are numerous potential side effects of metronidazole use, here are a few examples:⁸,⁹

• Contact dermatitis (burning, itching, dryness, stinging)

• Eye irritation

• Nausea

• A metallic taste in your mouth 

Who shouldn’t use topical metronidazole?

Before prescribing medication, medical providers consider patient history and other existing conditions or circumstances that might indicate that the medication isn’t a good fit. If you’re considering topical metronidazole for treating rosacea or periorificial dermatitis, we’ve gathered a (non-exhaustive) list of conditions to let your prescribing provider know about. Metronidazole is contraindicated in patients:

• With a history of hypersensitivity to metronidazole.

Metronidazole should be used with caution in patients:

• With an abnormal blood condition. Examples include anemia, hemophilia, and blood cancers such as leukemia and lymphoma.

If you check any of these boxes, be sure to mention this information to the healthcare provider prescribing metronidazole, whether that’s a Curology dermatology provider or another medical provider. Concerned about metronidazole use in pregnancy? This antibiotic is generally safe to use while pregnant—but always check with your medical provider.

Where Curology comes in

Curology was founded by dermatologists whose mission is to create accessible skincare products for the treatment of acne, rosacea, and signs of aging. We help take the guesswork out of your skincare routine—licensed dermatology providers work with you to examine your skin, assess your skincare goals, and provide custom treatment options. 

Signing up is easy. Just answer a few questions about your skin and snap a few selfies to help us get to know your skin. If Curology is right for you, we’ll pair you with one of our in-house licensed dermatology providers, who will review your skin goals and design a personalized prescription formula with ingredients like niacinamide, ivermectin, azelaic acid, and metronidazole. Regarding metronidazole, specifically, if they decide it may help achieve your skincare goals, they’ll determine the right metronidazole dosage for your unique skin.

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Your first month’s on us!* Just pay $4.95 (plus tax) to cover shipping and handling and your personalized Curology formula and other recommended products will arrive at your door. 

P.S. We did the homework so you don’t have to:

1. https://www.aad.org/public/diseases/rosacea/treatment/acne-like

2. https://dermnetnz.org/topics/metronidazole

3.  Connor B. Weir; Jacqueline K. Le. Metronidazole.StatPearls. (2022, June 30).

4.  McClellan, K. J., and Noble, S.Topical metronidazole. A review of its use in rosacea. National Library of Medicine. (2000, June).

5. Kammler, H. J., et al.Perioral Dermatitis Medication. Medscape. (2020, November 13).

6. Weir, C. B., Le, J. K.Metronidazole. National Library of Medicine. (2022, June 30).

7. N  Galderma Laboratories, L.P. Metrogel®. (n.d.).

8. Cosette Pharmaceuticals, Inc.METRONIDAZOLE - metronidazole cream. DailyMed. (n.d.).

9. Amneal Pharmaceuticals of New York LLC.METRONIDAZOLE - metronidazole gel. DailyMed. (n.d.).

* Subject to consultation. Subscription is required. Trial is 30 days. Results may vary.

Written by

Curology Team

Medically reviewed by

Nicole Hangsterfer, PA-C