Metronidazole for Acne: A Guide to Proper Usage

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Acne, or acne vulgaris, is a common skin condition that most people will experience at least in some form. Typically, it is most prevalent during puberty and adolescence but can continue for many people well into adulthood. This article highlights the advantages and disadvantages of using Metronidazole for acne.

Technically speaking, acne occurs when dead skin cells mix with the skin’s excess natural oils and become clogged by hair follicles. This mixture of skin cells, oil, and hair produces unsightly blemishes on the skin that come in the form of:

  • blackheads or whiteheads,
  • pimples,
  • oily and greasy skin,
  • and the potential of scarring.

People with many oil glands on their face, especially in what’s colloquially called the T-zone (the area of the forehead, down through the nose and cheekbones), are most at risk of developing acne. However, acne is common in other body parts, particularly the upper part of the chest, shoulders, and back.

Certain people are more genetically predisposed to developing acne, and other factors, including skin cleanliness and dietary factors, can contribute to acne developing on the skin. It does not discriminate between sexes but can be more prevalent in people without access to sunlight.

Fortunately, several acne therapies are available to remove it from the body, and they can come in many different forms. Metronidazole topical gel is one of the more effective drugs for treating acne, which we will explore more in-depth in this blog.

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Metronidazole as a potential treatment option

While several acne therapies, typically with azelaic acid as a main ingredient, are available to sufferers, Metronidazole for acne is commonly regarded as one of the more effective treatment solutions, as it is FDA-approved. It is a topical solution in a gel form that is easy to apply to targeted areas on the skin while providing excellent short-term results and the long-term prevention of excessive acne appearance.

Metronidazole for Acne

Metronidazole cream is an antimicrobial, anti-inflammatory, antibacterial gel that reduces the appearance of acne-related bumps on the skin and acne. It is effective in helping to reduce the appearance of pimples, whiteheads, and blackheads, as well as the associated swelling and redness that come with them. Metronidazole gel works by killing the bacteria in the affected area, thereby stopping any existing acne breakouts and preventing them from reoccurring for a period.

Acne and its causes

There are many causes of acne, including genetics, hormones, infection, diet, stress, and others.


For many people suffering from acne, the causes may be linked to it being a hereditary condition, with many medical experts and dermatologists suggesting that genetics are likely responsible for at least 81% of acne cases. It is also thought that more severe cases of acne are associated with certain types of syndromes, such as Apert syndrome or XYY syndrome.


The human body goes through many significant hormonal changes throughout life, particularly during menstrual and puberty, when hormonal levels fluctuate significantly. During puberty, androgens increase in the body, which causes skin follicles to become larger and essentially act as wells or deposits for the skin’s oil. This build-up can lead to acne. Because there are high levels of growth hormones in the body during puberty, this also contributes to the likelihood of acne.

When people experience a lack of androgenic hormones, acne will likely decrease, which typically comes with age. People going through pregnancy often see fluctuations in their androgen levels and will often experience acne.

Acne and other skin conditions may also be a side effect of testosterone replacement therapies and during anabolic steroid use. This is why it is common to see bodybuilders and athletes who use significant amounts of dietary supplements with skin blemishes or acne.


Bacterial infections on the skin also contribute to the development of acne, but this isn’t particularly common. Certain strains of bacteria can lead to the development of acne with moderate to high severity. Bites from the parasitic mite Demodex may lead to the development of acne, but this is uncommon.


A poor diet is often seen as a cause of acne. Diets that include foods with a high glycemic index may increase acne or its severity.

An example of foods that may contribute to acne on the skin is said to be those with a high amount of full-fat dairy milk in them. It is thought that because there is a lot of whey protein in milk, which contains hormones from cows, it contributes to fluctuations in human hormones, which links back to the appearance of acne. These studies, however, are not conclusive and tend to be linked more with people’s perception of high-fat foods like chocolate being a trigger for not only obesity but acne as well.

A lack of vitamin B12 may trigger skin outbreaks like acne or worsen existing acne.


It is said that people who experience high levels of stress in their lives are more prone to acne. While research is ongoing into the connection between stress and acne, the link remains unproven. However, it likely has more of a reference to the fluctuation in hormone levels, which can occur in times of great stress, such as with people going through premenstrual syndrome.

Read also: How Does Zoloft Cause Acne?

Common types of acne lesions

Acne, or acne vulgaris, while far from a life-threatening condition, creates an undesired appearance on people’s faces. This causes a great deal of frustration and typically appears during times of heightened stress. Still, there are several treatments and drugs available to prevent the appearance of acne, acne scarring, and rosacea.

The most common form of acne is pimples, whiteheads, and blackheads. All these skin conditions are formed due to excess oil build-up in enlarged pores, often located next to hair follicles. These microscopic events occur most often on the face (especially in the T zone area), the upper chest, shoulders, neck, and back.

Pimples often appear like a small pus eruption on the skin with a white or slightly yellowed top segment with a reddened base. While a whitehead will have a similar appearance, it typically does not have that erupted look on the skin and looks more like a minimal white discoloration.

While common on most people’s faces, they are also not as visible to the naked eye as pimples. Blackheads take on the appearance as their name suggests because they are a build-up of air pollutants such as dirt and grime that then become clogged within enlarged pores. Again, they are often not as easily visible on the face from a distance.

Comedones (blackheads and whiteheads) are similar because they are both examples of clogged hair follicles on the skin. Keratin, skin debris, combines with the skin’s natural oil to block hair follicles from coming from the skin. This clogging inflames the skin, leading to whiteheads, blackheads, or pustules forming, commonly called pimples. All these fall under the umbrella term of acne.

Acne Therapies and Treatments

There are several acne therapies available to people. While these may come in prescription form, such as topical gels containing azelaic acid or orally ingested pills, acne can also be prevented with a few lifestyle changes, generally linked with better hygiene practices and lowering stress.

Severe or widespread acne may require consultation with a dermatologist or doctor, who will prescribe a drug treatment; however, if the acne only appears after specific events or times of heightened stress, medical intervention may not be necessary. If someone is prone to acne due to workplace conditions or after extensive physical exertion, for example, practicing good hygiene may be a far more practical option than seeking drug treatments.

What is Metronidazole?

Metronidazole is an antibiotic used to treat several bacterial infections around the body, internally and externally, but it’s particularly effective in preventing and treating acne. It is not available over the counter and must be prescribed by a doctor or a healthcare professional.

Medical conditions Metronidazole is commonly used for

As an antibiotic, Metronidazole can treat bacterial infections in the stomach, liver, brain, spine, lungs, heart, bloodstream, vagina, and joints. It is also used to treat trichomoniasis, a sexually transmitted disease caused by a parasite.

Metronidazole for Acne

Metronidazole is an effective acne gel applied directly on an affected skin area.

It reduces inflammation and helps control acne-related bacteria.

Metronidazole is known for being an antimicrobial, anti-inflammatory, and antibacterial product that has FDA approval. It effectively reduces inflammation on the skin due to acne and kills related bacteria in affected areas.

Using Metronidazole as prescribed by a healthcare provider

Always use metronidazole as directed by your healthcare provider. It should only be applied topically and never under the skin or internally, especially in the vaginal area. While overdosing is extremely rare, consult your local poison help hotline if it is accidentally ingested.

Effectiveness of Metronidazole for acne

When applied according to its instructions and in combination with the advice of a healthcare professional, Metronidazole is effective in treating rosacea and other acne-related skin conditions.

Proper Usage of Metronidazole

Applying the topical gel or cream is quite simple. While instructions are likely provided with your prescription, a small amount placed on the tip of your finger and then lightly massaged into the affected area is necessary. Ensure the area of skin is clean first and dry. Letting the area dry and avoiding contact with clothing is essential. Ensure you wash your hands after application of the gel.

Proper skincare routines when using Metronidazole

Maintaining a good skincare routine is essential even if you don’t suffer from acne. Certain occupations leave people more prone to skin breakouts due to the work conditions. At the same time, excessive perspiration from working out or participating in sports can also leave you susceptible to breakouts. It is vital to clean vulnerable areas of the skin, especially the face, to prevent acne breakouts from occurring with a non-soap-based cleanser.

Consistent and long-term use for best results

As with any prescribed medication, metronidazole gel works best when used consistently to treat affected areas of the skin. Please heed your dermatologist or doctor’s instructions and only stop the treatment on their advice.

Combining other treatments with other acne therapies

Metronidazole is a prescription medication used topically. It doesn’t usually interact with other acne therapies (in pill form) or other drugs. Many acne or acne rosacea sufferers use Metronidazole in combination with other acne therapies (often containing azelaic acid) and rely on it in the short term.

However, before using metronidazole gel, you must talk to your healthcare provider about any medicines you are using, including other prescription medications, vitamins, and other supplements. Drug interactions of any kind may reduce their effectiveness.

Metronidazole Side Effects and Allergies

If any of the following allergic reactions occur after applying metronidazole cream, seek immediate medical help:

  • Hives,
  • Trouble breathing,
  • Swelling in and around the face, especially the lips, tongue, throat,
  • Any numbness, tingling, or burning in the hands or feet,
  • Any stinging or burning on the affected area.

Some more common side effects people may experience with metronidazole include:

  • Light burning or stinging,
  • Skin redness and irritation,
  • Dry, scaly, and itchy skin,
  • Cold or flu-like symptoms, including a stuffy nose, sneezing, or a sore throat.

Caution against using Metronidazole

If allergic reactions occur after applying the topical gel, seek immediate medical attention. If you are allergic to any ingredients in metronidazole topical gel, alert your doctor or dermatologist.

When to see a doctor

While an overdose of Metronidazole topical gel is not expected nor considered dangerous, someone may wish to seek emergency medical help or call their local poison help hotline if they swallow the gel.

Because rosacea and other acne-related skin conditions are not considered life-threatening, emergency medical help is not recommended. However, if it affects mental health and quality of life, seeking medical help to reduce the severity of acne may prove highly beneficial. After this consultation, topical Metronidazole may be prescribed to help reduce the appearance of acne.

Read also: Using Oral Antibiotics for Acne

Frequently Asked Questions

Yes. Metronidazole topical gel, or as it is colloquially referred to, ‘metrogel,’ is a safe product when taken as prescribed by a dermatologist or medical professional.

Each prescription medication has its strengths and weaknesses according to the person it is prescribed to. Your dermatologist or doctor will be able to determine which one of the acne therapies is right for you and may switch your prescriptions if one proves more effective than the other.

Topical Metronidazole gel has a reasonable rate of clearing acne-covered areas of skin and has mixed effects when it comes to the prevention of reoccurring.

While Metronidazole won’t work instantly on acne and other related skin conditions like pimples, whiteheads, and blackheads, these should be reduced within two to three days of using the gel.

Yes. Metronidazole is an effective acne therapy; however, it is available on a prescription base and not over the counter.

As with many prescription medications, results and the severity of acne and other related skin conditions vary from person to person. Many people who have used metronidazole topical gel report an effective short-term solution in their acne treatment but not necessarily long-term prevention.

People with severe acne are often prescribed Metronidazole in combination with other existing acne therapies.

The content on Doctor Alexa’s blog is reviewed by Advanced practice registered nurses or pharmacist and is intended for educational purposes only. This information should not be relied upon as professional medical counsel. Be sure to always consult with your physician about the dangers and benefits of any medication, treatment or procedure.

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