Rosacea, a chronic inflammatory skin condition affecting around 10% of the population, can be challenging to manage.¹ One effective treatment option that dermatologists often prescribe is topical metronidazole, an antibiotic available by prescription only. This medication is traditionally available in several vehicles such as a topical gel, cream, or lotion when used for the treatment of rosacea.²

If you’ve been diagnosed with rosacea, metronidazole may be a suitable option, but it’s important to understand the expectations with treatment. Here, we’ll take a look at how long it typically takes for metronidazole to work and provide insights on its efficacy in managing rosacea symptoms.

What is metronidazole?

Metronidazole is a versatile medication available in different forms, including oral pills for internal use and topical gels or creams for skin conditions like rosacea. It has a broad range of applications, as it can treat various infections, such as meningitis and intra-abdominal infections, in addition to rosacea.³ 

Due to it being a prescription medication and its potency as an antibiotic, metronidazole should only be used under the guidance and direction of a healthcare provider.

What causes rosacea?

Rosacea stems from a combination of factors. While the exact cause remains uncertain, research suggests several potential contributors. One possible cause is neurovascular dysregulation, which involves dysfunction in regulating blood vessels and nerves in the skin.This may lead to the characteristic redness and flushing associated with rosacea. Another factor is immune system activation, in which an immune response triggers the release of inflammatory mediators, contributing to the development of rosacea.⁴ 

Demodex mites, microscopic organisms naturally found on the skin, have also been linked to rosacea. Though their exact role is unclear, higher numbers of these mites have been observed in individuals with the condition. Genetic predisposition is also believed to play a role, as rosacea tends to run in families.⁵

While these factors contribute to rosacea’s development, the condition can vary among individuals, and the exact combination of causes may differ. Understanding these potential causes can help you manage and treat your rosacea more effectively.⁶ 

Topical metronidazole is a treatment option available to help control some symptoms of rosacea.

How does metronidazole treat rosacea?

Metronidazole treats rosacea by leveraging its potent anti-inflammatory and anti-bacterial properties. Research shows that metronidazole helps improve redness (erythema), and reduce acne-like bumps associated with rosacea.⁷ 

How long does it take for metronidazole to work? 

The time it takes for metronidazole to work in managing rosacea varies depending on the severity of your condition. Most people using this antibiotic for rosacea see noticeable improvements in about three weeks.⁸ However, it’s recommended to use the medication as prescribed by your dermatology provider for best results. 

Just like with most skin treatments, patience and consistency in following the treatment routine are also essential.

Possible side effects of metronidazole 

Metronidazole, like any medication, can have side effects. However, most study patients have tolerated topical metronidazole well, with only 2% or fewer reporting side effects such as stinging, burning, itching, or dryness.⁹ It is unlikely to experience severe side effects with topical administration due to low absorption.¹⁰ Despite this low risk, monitoring your body and skin’s response to any medication, whether prescription or over-the-counter, is important. 

If you experience any new symptoms or side effects, consult your healthcare provider immediately.¹¹

Can anyone use metronidazole?

While most people tolerate metronidazole well, its use should be based on your medical history and specific needs. A dermatology provider will assess your health history to ensure that a personalized formula with this ingredient is appropriate for you. If you have a known sensitivity to metronidazole or its components, naturally, it shouldn’t be included in your rosacea treatment.¹² It’s always important to inform your medical provider if you are pregnant, breastfeeding, or trying to become pregnant when considering new medications. 

As with any medication, consult a healthcare provider before using metronidazole to ensure it suits your specific situation.

Treating your rosacea

Taking medications as prescribed by your healthcare provider is a key part of managing rosacea. Your healthcare provider may recommend topical creams or oral medications to reduce redness, inflammation, and acne-like bumps. Following their instructions ensures you get the best results and helps keep your symptoms under control. Aside from using metronidazole and other medications, there are several steps you can take to help manage your rosacea symptoms.

Making lifestyle changes can be as important as medication. Identifying and avoiding triggers that worsen your rosacea, such as sun exposure, stress, hot weather, alcohol, and spicy foods, may make a significant difference in managing flare-ups.¹³ By being mindful of these factors, you can help prevent or reduce the occurrence of symptoms such as recurrent facial flushing.

Protecting your skin from the sun is also vital for rosacea management. Using sunscreen with a high sun protection factor (SPF) shields your skin from harmful UV rays that can trigger flare-ups. This simple step helps maintain your skin’s health and reduces the risk of worsening symptoms.¹⁴

With the right care, guidance, and lifestyle adjustments, you can help manage your rosacea, reduce redness and irritation, and enjoy healthier, happier skin. Working with your healthcare provider, you can find the best approach that suits your needs and helps you achieve your desired outcomes. Remember, managing rosacea is a journey, and with dedication and support, you can achieve improved skin and enhanced overall well-being.

Treat your rosacea with Curology

Help soothe your rosacea with a personalized prescription formula from Curology that may contain metronidazole, if right for you. 

Get your rosacea symptoms under control with Curology.

Get your rosacea symptoms under control with Curology.

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While results may take time, our licensed dermatology providers will guide you through the process, ensuring you stay on track and use the treatment as directed. Begin your personalized skincare journey with Curology and see if metronidazole is the right choice for your rosacea. Sign up now!*

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

1. Rainer, B.M., et al. Rosacea: Epidemiology, pathogenesis, and treatment. Dermatoendocrinol. (2017, October 4).

2. Weir, C.B. and Le, J.K. Metronidazole. StatPearls. (2023, June 26).

3. Weir, C.B. and Le, J.K. Metronidazole. StatPearls. Ibid.

4. Farshchian, M. and Daveluy S. Rosacea. StatPearls. (2023, August 8).

5. Farshchian, M. and Daveluy S. Rosacea. StatPearls. Ibid.

6. Farshchian, M. and Daveluy S. Rosacea. StatPearls. Ibid.

7. McClellan, K.J. and Noble, S. Topical Metronidazole. Am J Clin Dermatol. (2012, August 22).

8. McClellan, K.J. and Noble, S. Topical metronidazole. A review of its use in rosacea. Am J Clin Dermatol. (May-June 2000).

9. McClellan, K.J. and Noble, S. Topical metronidazole. A review of its use in rosacea. Am J Clin Dermatol. Ibid.

10. McClellan, K.J. and Noble, S. Topical metronidazole. A review of its use in rosacea. Am J Clin Dermatol. Ibid.

11. Weir, C.B. and Le, J.K. Metronidazole. StatPearls. Ibid.

12. Weir, C.B. and Le, J.K. Metronidazole. StatPearls. Ibid.

13. Rivero, A.L. and Whitfeld, M. An update on the treatment of rosacea. Aust Prescr. (February 2018).

14. Rivero, A.L. and Whitfeld, M. An update on the treatment of rosacea. Aust Prescr. Ibid.

Maria Borowiec is a certified Nurse Practitioner at Curology. She received her Master in Nursing from University of California, Los Angeles in Los Angeles, CA.

* Subject to consultation. Subscription is required. Results may vary.

Written by

Curology Team

Medically reviewed by

Maria Borowiec, NB-BC