Metrogel side effects alcohol

Metrogel Vaginal


METROGEL-VAGINAL affords minimal peak serum levels and systemic exposure (AUCs) of metronidazole compared to 500 mg oral metronidazole dosing. Although these lower levels of exposure are less likely to produce the common reactions seen with oral metronidazole, the possibility of these and other reactions cannot be excluded presently. Data from well-controlled trials directly comparing metronidazole administered orally to metronidazole administered vaginally are not available.


Patients with severe hepatic disease metabolize metronidazole slowly. This results in the accumulation of metronidazole and its metabolites in the plasma. Accordingly, for such patients, metronidazole vaginal gel should be administered cautiously.

Known or previously unrecognized vaginal candidiasis may present more prominent symptoms during therapy with metronidazole vaginal gel. Approximately 6-10% of patients treated with METROGELVAGINAL developed symptomatic Candida vaginitis during or immediately after therapy.

Disulfiram-like reaction to alcohol has been reported with oral metronidazole, thus the possibility of such a reaction occurring while on metronidazole vaginal gel therapy cannot be excluded.

METROGEL-VAGINAL contains ingredients that may cause burning and irritation of the eye. In the event of accidental contact with the eye, rinse the eye with copious amounts of cool tap water.

Information for the Patient

The patient should be cautioned about drinking alcohol while being treated with metronidazole vaginal gel. While blood levels are significantly lower with METROGEL-VAGINAL than with usual doses of oral metronidazole, a possible interaction with alcohol cannot be excluded.

The patient should be instructed not to engage in vaginal intercourse during treatment with this product.

Carcinogenesis, Mutagenesis, Impairment Of Fertility

Metronidazole has shown evidence of carcinogenic activity in a number of studies involving chronic oral administration in mice and rats. Prominent among the effects in the mouse was the promotion of pulmonary tumorigenesis. This has been observed in all six reported studies in that species, including one study in which the animals were dosed on an intermittent schedule (administration during every fourth week only). At very high dose levels (approximately 500 mg/kg/day), there was a statistically significant increase in the incidence of malignant liver tumors in males. Also, the published results of one of the mouse studies indicate an increase in the incidence of malignant lymphomas as well as pulmonary neoplasms associated with lifetime feeding of the drug. All these effects are statistically significant. Several long-term oral dosing studies in the rat have been completed. There were statistically significant increases in the incidence of various neoplasms, particularly in mammary and hepatic tumors, among female rats administered metronidazole over those noted in the concurrent female control groups. Two lifetime tumorigenicity studies in hamsters have been performed and reported to be negative.

These studies have not been conducted with 0.75% metronidazole vaginal gel, which would result in significantly lower systemic blood levels than those obtained with oral formulations.

Although metronidazole has shown mutagenic activity in a number of in vitro assay systems, studies in mammals (in vivo) have failed to demonstrate a potential for genetic damage.

Fertility studies have been performed in mice up to six times the recommended human oral dose (based on mg/m²) and have revealed no evidence of impaired fertility.


Teratogenic Effects

Pregnancy Category B

There has been no experience to date with the use of METROGEL-VAGINAL in pregnant patients. Metronidazole crosses the placental barrier and enters the fetal circulation rapidly. No fetotoxicity or teratogenicity was observed when metronidazole was administered orally to pregnant mice at six times the recommended human dose (based on mg/m²); however, in a single small study where the drug was administered intraperitoneally, some intrauterine deaths were observed. The relationship of these findings to the drug is unknown.

There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, and because metronidazole is a carcinogen in rodents, this drug should be used during pregnancy only if clearly needed.

Nursing Mothers

Specific studies of metronidazole levels in human milk following intravaginally administered metronidazole have not been performed. However, metronidazole is secreted in human milk in concentrations similar to those found in plasma following oral administration of metronidazole.

Because of the potential for tumorigenicity shown for metronidazole in mouse and rat studies, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

Safety and effectiveness in children have not been established.

Metronidazole and alcohol

A 32-year-old man develops diarrhea after receiving amoxicillin/clavulanate to treat an infection following a dog bite. He is diagnosed with Clostridium difficile and prescribed a 10-day course of metronidazole. He has no other medical problems. He will be the best man at his brother’s wedding tomorrow. What advice should you give him about alcohol use at the reception?

A. Do not take metronidazole the day of the wedding if you will be drinking alcohol.

B. Take metronidazole, do not drink alcohol.

C. It’s okay to drink alcohol.

For years, we have advised patients to not use alcohol if they are taking metronidazole because of concern for a disulfiram-like reaction between alcohol and metronidazole. This has been a standard warning given by physicians and appears as a contraindication in the prescribing information. It has been well accepted as a true, proven reaction.

Is it true?

As early as the 1960s, case reports and an uncontrolled study suggested that combining metronidazole with alcohol produced a disulfiram-like reaction, with case reports of severe reactions, including death.1, 2, 3 This was initially considered an area that might be therapeutic in the treatment of alcoholism, but several studies showed no benefit.4, 5

Caroline S. Williams and Dr. Kevin R. Woodcock reviewed the case reports for evidence of proof of a true interaction between metronidazole and ethanol.6 The case reports referenced textbooks to substantiate the interaction, but they did not present clear evidence of an interaction as the cause of elevated acetaldehyde levels.

Researchers have shown in a rat model that metronidazole can increase intracolonic, but not blood, acetaldehyde levels in rats that have received a combination of ethanol and metronidazole.7 Metronidazole did not have any inhibitory effect on hepatic or colonic alcohol dehydrogenase or aldehyde dehydrogenase. What was found was that rats treated with metronidazole had increased growth of Enterobacteriaceae, an alcohol dehydrogenase–containing aerobe, which could be the cause of the higher intracolonic acetaldehyde levels.

Jukka-Pekka Visapää and his colleagues studied the effect of coadministration of metronidazole and ethanol in young, healthy male volunteers.8 The study was a placebo-controlled, randomized trial. The study was small, with 12 participants. One-half of the study participants received metronidazole three times a day for 5 days; the other half received placebo. All participants then received ethanol 0.4g/kg, with blood testing being done every 20 minutes for the next 4 hours. Blood was tested for ethanol concentrations and for acetaldehyde levels. The study participants also had blood pressure, pulse, skin temperature, and symptoms monitored during the study.

There was no difference in blood acetaldehyde levels, vital signs, or symptoms between patients who received metronidazole or placebo. None of the subjects in the study had any measurable symptoms.

Metronidazole has many side effects, including nausea, vomiting, headache, dizziness, and seizures. These symptoms have a great deal of overlap with the symptoms of alcohol-disulfiram interaction. It has been assumed in early case reports that metronidazole caused a similar interaction with alcohol and raised acetaldehyde levels by interfering with aldehyde dehydrogenase.

Animal models and the human study do not show this to be the case. It is possible that metronidazole side effects alone were the cause of the symptoms in case reports. The one human study done was on healthy male volunteers, so projecting the results to a population with liver disease or other serious illness is a bit of a stretch. I think that if a problem exists with alcohol and metronidazole, it is uncommon and unlikely to occur in healthy individuals.

So, what would I advise the patient in the case about whether he can drink alcohol? I think that the risk would be minimal and that it would be safe for him to drink alcohol.

1. Br J Clin Pract. 1985 Jul;39(7):292-3.

2. Psychiatr Neurol. 1966;152:395-401.

3. Am J Forensic Med Pathol. 1996 Dec;17(4):343-6.

4. Q J Stud Alcohol. 1972 Sep;33: 734-40.

5. Q J Stud Ethanol. 1969 Mar;30: 140-51.

6. Ann Pharmacother. 2000 Feb;34(2):255-7.

7. Alcohol Clin Exp Res. 2000 Apr;24(4):570-5.

8. Ann Pharmacother. 2002 Jun;36(6):971-4.

Dr. Paauw is professor of medicine in the division of general internal medicine at the University of Washington, Seattle, and he serves as third-year medical student clerkship director at the University of Washington. Contact Dr. Paauw at [email protected]

What is Metrogel used for?

  • Treating spots and redness associated with a chronic skin disorder called acne rosacea.
  • Reducing the bad smell associated with malodorous fungating tumours.

How does Metrogel work?

Metrogel contains the active ingredient metronidazole, which is a type of medicine called an antibiotic.

Metronidazole kills bacteria by interfering with their genetic material (DNA). It kills a wide variety of bacteria that are known collectively as anaerobic bacteria. This type of bacteria don’t need oxygen to grow and multiply. They can infect skin wounds and ulcers and produce an offensive odour. Metronidazole is applied to malodorous fungating tumours to kill these bacteria and reduce the associated smell.

Metronidazole is also applied to the skin to treat a chronic inflammatory condition called acne rosacea. In this condition there is long-term inflammation of the cheeks, nose, chin, forehead, and/or eyelids, with increased redness or acne-like eruptions in these areas of the face.

Metronidazole is used to help clear up spots and cysts associated with the condition, and it also reduces redness. It is not fully understood how metronidazole helps in rosacea, because no specific bacteria have been found to cause the condition. However, it is thought to work by controlling any infection and reducing inflammation in the skin.

It usually takes two to three months of applying metronidazole to the skin to clear up the spots in rosacea, so it is important to persevere with the treatment as prescribed by your doctor, even if it doesn’t seem to make much difference to start with.

How do I use Metrogel?


  • Metrogel should be applied to the affected areas of the face twice a day, morning and evening.
  • Wash and dry the face before applying Metrogel.
  • Apply the gel in a thin layer, taking care to avoid the eyes, and rub it in well.
  • Wash your hands after application.
  • If you forget an application don’t worry, just carry on as before.
  • Keep using Metrogel regularly twice a day for as long as your doctor tells you to. Repeat courses may sometimes be needed, or your doctor may recommend using it on a long-term or intermittent basis. Follow the instructions given by your doctor.

Malodorous fungating tumours

  • Your nurse will usually carry out your wound care.
  • The wound should be cleansed thoroughly before applying the gel over the whole affected area. This should then be covered with a non-stick dressing.
  • Metrogel should be applied to the wound once or twice a day.

What should I know before using Metrogel?

  • Metrogel is for external use on the skin only.
  • Take care to avoid getting the gel in the eyes or inside the nostrils or mouth. If you accidentally get the gel in these areas, rinse it out with plenty of warm water.
  • Avoid exposing the treated areas of skin to strong sunlight or sunlamps because this can make the treatment less effective.
  • If your skin becomes irritated while using the gel you should use it less frequently or stop using it for a few days. If irritation persists, consult your doctor.
  • When taken by mouth metronidazole can interact with alcohol, causing unpleasant reactions such as hot flushes, abdominal cramps, nausea, vomiting, headache and palpitations. This is very unlikely to happen if you drink alcohol while using Metrogel on your skin, because only small amounts of metronidazole are absorbed into the blood. However, if you have a reaction like this after drinking alcohol you should avoid drinking alcohol until after you have finished your course of treatment with Metrogel.

Who should not use Metrogel?

  • This medicine is not recommended for children.

Metrogel should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using Metrogel and inform your doctor or pharmacist immediately.

Can I use Metrogel while pregnant or breastfeeding?

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • Metronidazole passes into the bloodstream in very low amounts after application to the skin. However, as its safety during pregnancy has not been fully established Metrogel should only be used during pregnancy if considered essential by your doctor. Ask your doctor for further advice.
  • When metronidazole is taken by mouth it passes into breast milk. Even though when metronidazole is applied to the skin it is only absorbed into the bloodstream in very low amounts, Metrogel should not be used by breastfeeding mothers unless considered essential by your doctor. Seek further medical advice from your doctor.

What are the possible side effects of Metrogel?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with Metrogel. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Common (affect between 1 in 10 and 1 in 100 people)

  • Skin discomfort (burning or stinging) or irritation at application site. See above.
  • Skin dryness, redness or itching.
  • Worsening of rosacea. See your doctor if you think this medicine is making your skin worse.

Uncommon (affect between 1 in 100 and 1 in 1000 people)

  • Tingling or numbness.
  • Metallic taste.
  • Nausea.
  • Watery eyes if applied too closely to the eyes.

Unknown frequency

  • Inflammation of the skin (contact dermatitis).

Read the leaflet provided with the gel, or talk to your doctor, nurse or pharmacist if you want any more information about the possible side effects of Metrogel. If you think you have experienced a side effect, did you know you can report this using the yellow card website?

Can I use Metrogel with other medicines?

When metronidazole is applied to the skin it is absorbed into the bloodstream only in very low amounts and so is very unlikely to affect any other medicines that you are taking by mouth.

On very rare occasions, people taking coumarin anticoagulant medicines such as warfarin have found that using this medicine has enhanced the effect of their anticoagulant.

Other medicines containing metronidazole

Other brands of metronidazole that are applied to the skin:

  • Acea gel.
  • Anabact gel.
  • Metrosa gel.
  • Rozex cream and gel.
  • Rosiced cream.
  • Zyomet gel.

Metronidazole for oral, rectal and vaginal use:

  • Flagyl suppositories.
  • Flagyl tablets.
  • Norzol suspension.
  • Zidoval vaginal gel.

Metronidazole tablets, suspension and injection are also available without a brand name, ie as the generic medicine.

Last updated 02.12.2014


Generic Name: metronidazole topical (MET roe NYE da zole)
Brand Name: MetroCream, MetroGel, MetroGel Pump, MetroLotion, Noritate, Rosadan

Medically reviewed by on Oct 7, 2019 – Written by Cerner Multum

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What is MetroGel?

Metronidazole is an antibiotic that fights bacteria in the body.

MetroGel (for the skin) is used to treat skin lesions caused by rosacea.

MetroGel may also be used for purposes not listed in this medication guide.

Important Information

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

You should not use MetroGel if you are allergic to it.

To make sure MetroGel is safe for you, tell your doctor about all your medical conditions and allergies.

MetroGel is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether metronidazole topical passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I use MetroGel?

Use MetroGel exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor.

Wash and gently dry your skin before applying MetroGel

Apply the medication in a thin layer and rub in completely. You may apply cosmetics after using MetroGel.

Do not use MetroGel to treat any skin condition that has not been checked by your doctor.

Use this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics.

Call your doctor if your symptoms do not improve, or if they get worse while using MetroGel.

Store MetroGel at room temperature away from moisture or heat.

What happens if I miss a dose?

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the medicine at the next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

An overdose of metronidazole applied to the skin is not expected to produce life-threatening symptoms.

What should I avoid while using MetroGel?

Do not take by mouth. MetroGel is for use only on the skin. If this medication gets in your eyes, rinse with water.

Do not use topical metronidazole in the vagina.

MetroGel side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have severe stinging or burning when you apply MetroGel.

Common side effects may include:

  • mild burning or stinging;

  • numbness or tingly feeling in your hands or feet;

  • mild skin redness or irritation;

  • dry, scaly, or itchy skin;

  • nausea; or

  • metallic taste in your mouth.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect MetroGel?

It is not likely that other drugs you take orally or inject will have an effect on topically applied metronidazole. But many drugs can interact with each other. Tell each of your health care providers about all medicines you use, including prescription and over-the-counter medicines, vitamins, and herbal products.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 7.03.

Medical Disclaimer

More about MetroGel (metronidazole topical)

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  • 30 Reviews
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  • Drug class: topical anti-rosacea agents

Consumer resources

  • MetroGel Pump
  • MetroGel (Metronidazole Cream, Gel, and Lotion)
  • MetroGel (Metronidazole Gel and Cleansing Lotion)
  • Metrogel Topical (Advanced Reading)

Other brands: MetroCream, Vandazole, MetroLotion, Noritate, … +4 more

Professional resources

  • MetroGel (FDA)
  • … +1 more

Other Formulations

  • MetroGel-Vaginal

Related treatment guides

  • Perioral Dermatitis
  • Rosacea

How does this medication work? What will it do for me?

Metronidazole belongs to the class of medications called antibiotics. Metronidazole topical medication is used to treat certain inflamed skin rashes, such as rosacea, which has also been called “adult acne.” It is not known how this medication works to treat rosacea, but it is believed to work by killing bacteria and reducing inflammation. This medication reduces the symptoms of rosacea such as inflammation and redness of the skin. You should notice significant improvement in your symptoms in about 3 to 4 weeks.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

The clear, colorless gel contains metronidazole 0.75%. Nonmedicinal ingredients: carbomer 940, edetate disodium, methylparaben, propylene glycol, propylparaben, purified water, and sodium hydroxide.

The aqueous gel contains metronidazole 1%. Nonmedicinal ingredients: betadex, edetate disodium, hydroxyethyl cellulose 250 HHX, methylparaben, niacinamide, phenoxyethanol, propylene glycol, propylparaben, and purified water.

How should I use this medication?

Apply and rub in a thin film of the topical gel, cream, or lotion twice daily, morning and evening, to the entire affected area after washing. For some strengths of metronidazole topical, your doctor may advise you to apply a thin film once daily to the affected area.

You should notice significant improvement in your symptoms in about 3 to 4 weeks. If your symptoms do not improve within this time period, call your doctor. Before applying the medication, cleanse any area to be treated. If you use cosmetics, you may apply them after applying metronidazole topical cream, gel, or lotion and after the medication has dried.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important to use this medication exactly as prescribed by the doctor. Keep using this medication for the full course of treatment. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use metronidazole topical if you are allergic to metronidazole or any ingredients of the medication.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • blurred vision
  • dry skin
  • eye irritation
  • redness or other signs of skin irritation not present before use of this medication
  • itching
  • stinging or burning of the skin
  • dermatitis (skin rash)
  • nausea or stomach upset

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • symptoms of a serious allergic reaction (such as swelling of the face, lips, tongue, or throat; skin rash; hives; or difficulty breathing)

Some people may experience side effects other than those listed.Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Blood disorder: If you have a blood disorder, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Exposure to sun: This medication can make you more sensitive to the sun. Avoid exposure to excessive sunlight, including sunlamps and tanning beds, when using the metronidazole topical gel, cream, or lotion.

Eye irritation: Avoid getting this medication in the eyes. Topical metronidazole has been reported to cause irritation of the eyes. Do not use it in or close to the eye. If contact does occur, flush your eye(s) with water.

Skin irritation: If local irritation occurs, speak to your doctor. Your doctor may advise you to use the medication less frequently, stop using it temporarily, or stop using it altogether.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are using topical metronidazole, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between metronidazole topical and any of the following:

  • alcohol
  • clotrimazole
  • disulfiram
  • lopinavirother topical (skin-applied) medications
  • tipranavir
  • warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than the ones listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source:

Rosacea’s symptoms can cause patients embarrassment, which pharmacists can help relive with important treatment information.

Rosacea is a chronic, inflammatory disorder of the skin. It affects almost 16 million American adults. It is poorly understood, yet it is spreading worldwide. Rosacea causes inflammation of the nose, cheeks, chin, eyelids, or forehead. It can also cause redness of the face and pus-filled bumps similar to acne. Often it affects the eyes, causing inflammation of the eyelids. It is more common in women, but in men it can result in a more severe disorder. Rosacea causes redness in the face, eventually causing very small red bumps. The disorder usually begins between the ages of 30 and 60 years.

Because of the redness and acnelike aspect of the disorder, rosacea can cause social and psychological problems if symptoms are not controlled. Often, people with rosacea tend to have a lower self-esteem. They avoid social and professional gatherings, and even contact with friends and family, because of the embarrassment caused by the symptoms.

Rosacea tends to have phases:

• Pre-rosacea—In the beginning, skin flushing is seen. Then redness and the appearance of small visible blood vessels sets in. The redness is due to the dilation of blood vessels in the skin.

• Vascular Rosacea—At this point, the symptoms start to worsen, and the skin becomes very sensitive. There is inflammation on the nose and checks.

• Inflammation—The last stage involves bumps or red blisters on the nose, cheek, forehead, or chin.

What Causes Rosacea?

Doctors do not really understand what causes rosacea. Researchers think it is probably due to the environment or could run in families. Treatment and lifestyle modifications are aimed at reducing the symptoms and improving the skin.

You are more likely to develop rosacea if you:

  • Tend to blush easily
  • Have fair skin
  • Are a woman
  • Are between the ages of 30 and 60 (rosacea is more common during menopause)
  • Have a family history of rosacea

Rosacea Triggers

A number of factors can make rosacea worse.

These include:

  • Hot beverages or spicy foods
  • Alcohol
  • Extremes in temperature
  • Too much sunlight
  • Strenuous exercise
  • Certain medications, such as steroids or high blood pressure medicine
  • Uncontrolled stress or anger

The first step in treating rosacea is avoiding your known triggers, which vary from person to person. A good place to start is to stay away from skin lotions and makeup that can aggravate the problem. Avoid extremes in temperature, spicy foods, alcohol, and stress or emotional problems. You should also limit sun exposure, especially if you are taking medication that makes you more sensitive to the sun, such as certain diuretics and antibiotics.

Alcohol can aggravate the symptoms, but people who do not drink alcohol can develop rosacea. Without proper treatment, rosacea can worsen and the skin can become disfigured, with more redness, bumps, and thickening of the skin.

Treatment for Rosacea

Although there is currently no cure for rosacea, there are ways to control the symptoms (Table). The more unsightly symptoms of rosacea can be minimized with the use of creams and antibiotics. Creams are usually used before antibiotics to avoid unnecessary side effects from antibiotics, such as nausea, vomiting, diarrhea, photosensitivity, allergic reactions, and vaginal yeast infections. Creams have proved to be safer and have fewer side effects. Metronidazole gel works as well as some antibiotics and is the treatment of choice. Some patients will feel stinging and burning of the skin when using metronidazole. Metronidazole is available in both an oral (pill) and topical (cream, gel, lotion) form. Both forms can cause a flushing reaction, so avoid alcohol during treatment.

Low-dose oral antibiotics, such as doxycyline, may have faster results than the cream alternatives. When symptoms are more severe, or during a flare-up, antibiotics are used first. Your doctor may prescribe a combination of topical and oral antibiotics.

Retinoids, including topical tretinoin and low-dose oral isotretinoin, are similar to vitamin A. Doctors sometimes prescribe these to treat rosacea when antibiotics fail. Retinoids may help reduce the appearance of pus-filled or red bumps, but sometimes make skin redness and spider veins look worse.

If you use retinoids, avoid supplements with vitamin A, which can cause serious side effects when taken in excess. Glycolic acid facial peels can also sometimes help control rosacea symptoms. If there is thickening of the skin, laser treatments, although costly, are another option. Electrocautery, in which a device delivers a low-powered electrical current, can also help improve the appearance of thickened skin, as well as destroy visible blood vessels. If rosacea has affected the eyes, artificial tears for the dryness and an antibiotic gel for the eyelids are usually prescribed. In some cases, oral antibiotics are needed to clear up the symptoms.

Several natural remedies have been studied and have been shown to relieve symptoms to some degree. Many nonprescription products are available as a combination of these. Natural or herbal products and ingredients that may ease rosacea symptoms include:

• Chrysanthellum indicum cream

• Green tea cream

• Niacinamide cream

• Licorice

• Apple cider vinegar

• Feverfew

• Oatmeal

• Lavender

• Chamomile

• Tea tree oil

• Camphor

Keeping it in Control

Many times patients must work with their doctors to maintain a skin regimen, which should involve good, gentle cleansing with no scrubbing. Patients with rosacea should use mild skin care products and effective sunscreens. A moisturizer with ingredients such as ceramides, glycerin, and hyaluronic acid is preferable.

Even when medication is needed, one of the most important factors in treatment is keeping triggers in control. Rosacea is a disorder than can be managed, but symptoms must be monitored in the rare severe cases. PT

Dr. Rouzeau is a pharmacist who has worked in retail and health systems pharmacy, and Dr. Pelegrin is a pharmacist for Publix Pharmacy.

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