From the Guidelines
Azelaic Acid is generally preferred over Metrogel (Metronidazole) for the treatment of rosacea due to its anti-inflammatory and antibacterial properties, as well as its lower risk of irritation and dryness.
Key Differences
- Azelaic Acid has been shown to reduce redness, papules, and pustules associated with rosacea, with a 51% success rate in achieving marked improvement or complete remission 1.
- Metronidazole, on the other hand, has been found to produce a 65% decrease in inflammatory lesion counts compared to a 15% reduction for vehicle, but with a lower success rate of 37-62.5% in achieving clear, almost clear, or improved rosacea 1.
Efficacy Comparison
- A head-to-head comparison of Azelaic Acid 20% and Metronidazole 0.75% found that both treatments were effective, but Azelaic Acid had a more comprehensive effect on reducing inflammatory lesions and erythema 1.
- The global rosacea consensus (ROSco) panel recommends Azelaic Acid as a first-line treatment for mild to moderate rosacea, while Metronidazole is also considered a viable option, but with a lower preference 1.
Safety and Tolerability
- Azelaic Acid has been found to have a lower risk of irritation and dryness compared to Metronidazole, making it a more tolerable treatment option for patients with sensitive skin 1.
- Metronidazole, however, has been associated with a higher risk of adverse effects, such as skin irritation, dryness, and itching 1.
The FDA Drug Labels for metronidazole (TOP), azelaic acid (TOP) do not address this question.
From the Research
Comparison of Metrogel (Metronidazole) and Azelaic Acid for Rosacea Treatment
- Metronidazole and azelaic acid are two commonly used treatments for rosacea, with both showing efficacy in reducing inflammatory lesion counts and erythema severity 2, 3, 4, 5.
- A study comparing once-daily metronidazole 1% gel with twice-daily azelaic acid 15% gel found similar reductions in inflammatory lesion counts and high success rates in both global severity and erythema 2.
- Another study found that azelaic acid 20% cream was superior to metronidazole 0.75% cream in reducing inflammatory lesions and erythema, with a higher physician rating of global improvement and increased patient satisfaction 3.
- A randomized trial comparing 15% azelaic acid gel with 0.75% metronidazole gel found that azelaic acid gel was superior in reducing mean nominal lesion count and mean percent decrease in inflammatory lesions, with a significant therapeutic advantage in erythema severity 4.
- In terms of cumulative irritation potential, metronidazole 0.75% gel was found to be less irritating than azelaic acid 15% gel after repeated applications to healthy skin 6.
Efficacy and Safety
- Both metronidazole and azelaic acid have been shown to be effective and safe in the treatment of rosacea, with similar reductions in inflammatory lesion counts and erythema severity 2, 3, 4.
- Azelaic acid appears to have a therapeutic advantage over metronidazole in terms of reducing erythema severity and improving patient satisfaction 3, 4.
- Metronidazole has been found to be less irritating than azelaic acid after repeated applications to healthy skin 6.
Treatment Outcomes
- Studies have consistently shown that both metronidazole and azelaic acid can reduce inflammatory lesion counts and erythema severity in patients with rosacea 2, 3, 4, 5.
- Azelaic acid has been found to be effective in reducing mean inflammatory lesion count and erythema severity, with a significant therapeutic advantage over metronidazole in some studies 3, 4, 5.