Metronidazole

If you experience inflammatory acne-like symptoms from rosacea or perioral dermatitis, metronidazole may be just what the doctor ordered. It’s a powerful antibacterial and anti-inflammatory medication that treats these skin conditions. That said, it’s not without some potential side effects. 

Here we’ll explain what metronidazole is, its benefits, how to use it, and what its potential side effects are. We’ll also include some ingredients that work well with metronidazole and how to get it, if it’s right for you.  

What is metronidazole?

Metronidazole is an FDA-approved drug used to treat bacterial and protozoal infections, including bone and joint infections, gynecological infections, and skin infections.¹ Metronidazole belongs to a class of medications called nitroimidazole antimicrobials—they work by stopping bacterial growth.² When it comes to skincare, specifically, metronidazole uses include the treatment of acne-like lesions that are commonly associated with rosacea and perioral dermatitis. 

Metronidazole comes in a variety of forms including immediate- and slow-release pills and topical creams, gels, and lotions—depending on the condition.

What does metronidazole treat?

When it comes to rosacea, metronidazole can effectively treat inflammatory acne-like lesions (papules and pustules), a potential symptom of rosacea.³

The anti-inflammatory properties of this medication also make it effective in treating perioral dermatitis, an inflammatory skin condition that manifests as a rash around the mouth (perioral).⁴ Symptoms include small pink bumps or spots with an acne-like appearance. Perioral dermatitis is another condition that’s not fully understood, but its causes have been attributed to steroid use, hormones, and oral contraceptive pills. Yeast and bacteria naturally found on your skin may also contribute to perioral dermatitis.⁵  

What are the benefits of metronidazole?

Indications for metronidazole include skin conditions that have an inflammatory component, including rosacea and perioral dermatitis. Metronidazole gel, cream, or lotion is typically applied once or twice daily. It’s important to use as directed to recognize the benefits of metronidazole. It helps to:

• Reduce swelling and redness that results from some skin conditions

• Ease inflammation from acne-type lesions in rosacea

• Treat perioral dermatitis by reducing inflammation of the rash-like symptoms

What are the side effects of metronidazole?

Metronidazole gel side effects are usually not serious, but you should consult your medical or dermatology provider if you have questions or experience side effects that don’t go away or worsen. 

Here are some of the potential side effects of metronidazole gel or cream:⁶,⁷

• Contact dermatitis is one of the potential side effects of using gel or cream. Burning and stinging can occur in addition to redness (erythema), skin irritation, and itching (pruritus). 

• Eye irritation and tearing can occur if metronidazole gel gets into the eyes. Use care when applying topical gel close to the eyes, and be sure to wash your hands after application. That way, you'll prevent yourself from accidentally touching your eyes while still having metronidazole gel on your fingers. 

• A metallic taste in your mouth may occur. The use of metronidazole gel has been associated with a metallic taste.  

Should you experience any of these side effects, you may be directed to use the medication less frequently or to discontinue use. Should you experience allergic reactions, upper respiratory tract infections, or headaches that don’t go away, contact your healthcare provider. 

Limited studies have been conducted on the safety of topical metronidazole use during pregnancy or nursing. If you become pregnant or are breastfeeding, consult your doctor before using this medication.⁸

Other ingredients that work well with metronidazole

Metronidazole works perfectly well on its own and when used as directed. But it also works well with other ingredients. Here are some topicals to add to your skincare routine that is generally safe to use with metronidazole: 

• Azelaic acid reduces erythema, papules, and pustules related to rosacea.⁹   

• Zinc pyrithione is an antifungal and antibacterial agent used to treat many skin conditions, including seborrheic dermatitis and fungal acne.

• Niacinamide is a form of vitamin B3. It has anti-inflammatory and antioxidant properties, improves hydration, fades hyperpigmentation, and evens skin tone.¹⁰

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

1. Weir, C.B. & Le, J.K. Metronidazole. StatPearls. (2022 Jun 30).

2. MedlinePlus. Metronidazole Topical. (n.d.).

3. McClellan, K.J. and Noble, S. Topical metronidazole. A review of its use in rosacea.American Journal of Clinical Dermatology. (May-June 2000).

4. Veien, N.K., et al. Topical metronidazole in the treatment of perioral dermatitis.Journal of the American Academy of Dermatology. (February 1991).

5. Tolaymat, L. and Hall, M.R. Perioral dermatitis.StatPearls. (2022, May 27).

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

7. Amneal Pharmaceuticals of New York LLC.METRONIDAZOLE - metronidazole gel. DailyMed. Ibid.

8. Amneal Pharmaceuticals of New York LLC.METRONIDAZOLE - metronidazole gel. DailyMed. Ibid.

9. Dall’Oglio, F., et al. A novel azelaic acid formulation for the topical treatment of inflammatory rosacea: A multicenter, prospective clinical trial.Journal of Cosmetic Dermatology. (2021 May 1).

10. Vlase, L., et al. Mechanistic basis and clinical evidence for the applications of nicotinamide (niacinamide) to control skin aging and pigmentation. Antioxidants. (August 2021).

Kristen Jokela is a certified Family Nurse Practitioner at Curology. She obtained her Master of Science in Nursing at the University of South Florida in Tampa, FL.

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Written by

Curology Team

Medically reviewed by

Kristen Jokela, NP-C