From the Guidelines
Azelaic acid is the preferred treatment for rosacea due to its broader benefits, including reducing inflammation, killing bacteria, normalizing keratinization, and reducing hyperpigmentation, as compared to metronidazole 1.
Key Differences Between Metrogel and Azelaic Acid
- MetroGel (metronidazole) is typically prescribed as a 0.75% or 1% gel applied once or twice daily and works primarily through anti-inflammatory and antimicrobial properties, making it particularly effective for papulopustular rosacea with red bumps and pus-filled lesions 1.
- Azelaic acid, available in 15-20% formulations applied twice daily, offers a more comprehensive approach to treating rosacea by addressing multiple pathways, including inflammation, bacterial colonization, and hyperpigmentation 1.
Efficacy and Safety
- Studies have shown that azelaic acid 15% gel is effective in reducing inflammatory lesions and improving symptoms of rosacea, with a significant number of patients achieving marked improvement or complete remission 1.
- Metronidazole has also been shown to be effective in reducing inflammatory lesions, but its efficacy may be more limited compared to azelaic acid, especially in patients with post-inflammatory hyperpigmentation 1.
- Both treatments have similar side effect profiles, with skin irritation, dryness, and temporary stinging or burning being common complaints 1.
Treatment Recommendations
- For patients with mild to moderate rosacea, azelaic acid 15% gel may be a better initial treatment option due to its broader benefits and potential for improved outcomes 1.
- For patients with severe or resistant rosacea, combination therapy using both metronidazole and azelaic acid may be recommended by dermatologists for enhanced efficacy 1.
- Treatment duration for both medications typically spans 8-12 weeks before evaluating effectiveness, with maintenance therapy often necessary afterward 1.
From the Research
Comparison of Metrogel and Azelaic Acid for Rosacea
- Metrogel, which contains metronidazole, and azelaic acid are two commonly used topical treatments for rosacea 2, 3, 4, 5, 6.
- Both metronidazole and azelaic acid have been shown to be effective in reducing the symptoms of rosacea, including inflammatory lesions and erythema 2, 3, 4, 5, 6.
Efficacy of Metrogel and Azelaic Acid
- A study comparing the efficacy of azelaic acid 20% cream, metronidazole 0.75% cream, and permethrin 5% cream found that azelaic acid was significantly more effective in reducing inflammatory lesions than the other two creams 6.
- Another study found that azelaic acid 15% gel was effective in reducing the number of inflammatory lesions and erythema in patients with mild-to-moderate papulopustular rosacea 4.
Safety and Side Effects
- Both metronidazole and azelaic acid have been shown to be safe and well-tolerated, with mild and transient side effects such as itching, burning sensation, and scaling 3, 4, 6.
- A study found that patients who used azelaic acid 20% cream were more satisfied than those who used metronidazole 0.75% cream or permethrin 5% cream 6.
Treatment Recommendations
- The choice of treatment for rosacea depends on the severity and subtype of the disease, as well as the patient's individual needs and preferences 2, 5.
- Topical metronidazole and azelaic acid are commonly recommended for the treatment of mild-to-moderate rosacea, while oral antibiotics such as doxycycline may be used for more severe cases 2, 5.