It also felt more comfortable. As expected, both erythema scores and papule counts decreased following treatment with systemic tetracycline and topical metronidazole. Davis Company CONTINUED PDF Page #2 2  PG The relapse rate for rosacea after treatment with either oral tetracycline or metronidazole cream. Nielsen The 1% metronidazole gel, however, contains niacinamide, which helps with the redness, as well as papulopustules; however, to get reimbursed patients must first fail treatment with the 0.75% metronidazole, or pay out of pocket, and in some cases the 1% metronidazole gel will still not be approved by payers.

 PG Treatment of rosacea with 1% metronidazole cream: a double-blind study. In the randomized double-blind phase, the use of topical metronidazole significantly prolonged the disease-free interval and minimized recurrence compared with subjects treated with the vehicle. In 1 study, most of the overall effects of metronidazole were observed within the first 3 weeks. Like tetracyclines, however, metronidazole has no effect on telangiectasia. 2002;205(3):265-70. doi: 10.1159/000065849.Conde JF, Yelverton CB, Balkrishnan R, Fleischer AB Jr, Feldman SR.Claros-Chacaltana FDY, Aldrovani M, Kobashigawa KK, Padua IRM, Valdetaro GP, de Barros Sobrinho AAF, Abreu TGM, Laus JL.Int Ophthalmol. Abstract

 CNStawiski 2016 Mar 18;9:71-7. doi: 10.2147/CCID.S98091. Eighteen (42%) of 43 subjects applying the vehicle experienced relapse, compared with 9 (23%) of 39 subjects applying metronidazole gel (In a majority of subjects studied, continued treatment with metronidazole gel alone maintains remission of moderate to severe rosacea induced by treatment with oral tetracycline and topical metronidazole gel.© 2020 American Medical Association. Springer While the group differences were not statistically different (Data related to subjects applying topical metronidazole were analyzed to determine if clinical markers could identify subjects prone to relapse. How to use Metronidazole 0.75 % Topical Gel.  J
Evaluation of topical metronidazole gel in acne rosacea. However, the tendency to develop relapses or recurrences persists for many years. Subjects were followed up monthly for up to 6 months to determine the relapse rate for the 2 treatment groups.

Springer However, if control of erythema is maintained, development of further telangiectasia may be stifled.  JHSober

It came to my attention when I was looking around for other topical creams that might help limit my rosacea symptoms – As far as I can tell, I have papulopustular rosacea (the type with lots of spots in the usual rosacea places). Please enable it to take advantage of the complete set of features! Perhaps metronidazole has a direct subtle effect on blood vessels, but more likely metronidazole works by stopping events leading to inflammation that may smolder without papules or pustules in untreated patients.  JVHjorth The difference in relapse rates during the first 6 months of treatment between the 2 treatment groups was statistically significant; fewer subjects experienced relapse in the group treated with topical metronidazole gel (After combined treatment with oral tetracycline and topical metronidazole, the mean lesion counts (papules and/or pustules) were 0.9 for the metronidazole group and 0.5 for the vehicle group. If inflammation stops, the only residual erythema is that of dilation of blood vessels.  EE Impact of topical metronidazole on the skin and colon microflora in subjects with rosacea. Women are more likely to be affected than men.Fortunately, rosacea and its acneform components (papules and pustules) can be effectively treated in most patients.  EE Impact of topical metronidazole on the skin and colon microflora in subjects with rosacea.  CFH A follow-up of tetracycline-treated rosacea.  PG A double-blind study of a 1% metronidazole cream versus systemic oxytetracycline therapy for rosacea. Also, the study established the safety of using metronidazole during a 9-month period; no subjects withdrew because of an adverse effect from the application of metronidazole gel.In conclusion, topical metronidazole used along with systemic tetracycline produced significant improvement in 104 (92%) of 113 subjects with rosacea.

 NSchmidt At that time the tetracycline dosage was lowered to 250 mg twice daily for 2 weeks, then 250 mg daily for 2 weeks, and then treatment with tetracycline was stopped.