Metronidazole
Metronidazole is a prescription-only antibiotic used to treat the inflamed papules and pustules of rosacea, where its benefit is thought to be anti-inflammatory as well as antibacterial.
Metronidazole settles the inflamed papules and pustules of rosacea, and as those spots clear the redness around them fades with them. It is an antibiotic, although in rosacea the benefit is thought to come from calming inflammation as much as from acting on bacteria. In the UK, topical Metronidazole is available by prescription only. At City Skin Clinic, your doctor may prescribe Metronidazole alone or alongside other actives, in a cream or gel compounded for you, at a strength and protocol to suit your skin.
What Is Metronidazole and How Does It Work?
Metronidazole is a prescription antibiotic used on the skin to treat rosacea. It belongs to a group of drugs called nitroimidazoles, which are used against certain bacteria and parasites. In the UK, topical Metronidazole has been licensed for rosacea since 1997.
Rosacea is not an infection and Metronidazole’s mechanism in the condition has never been established. The effect may be anti-inflammatory, antibacterial or both. Metronidazole also does not treat every type of rosacea. It works on the papules and pustules, which are the raised red spots that come and go in flares, as well as on the inflamed redness around them. Persistent background flushing and visible blood vessels respond much less well to it. Your doctor will advise what type of rosacea you have and what a topical formula can and cannot help with.
How City Skin Clinic Uses Metronidazole
We sometimes use topical Metronidazole in our custom rosacea treatments, as a cream or a gel. Your doctor will set the strength and whether to pair it with other actives around your skin, your overall health and what else you want treated.
Metronidazole is an antibiotic, so your doctor will be deliberate about how long you use it and what goes alongside it. Many patients are also treating hyperpigmentation, the early signs of skin ageing or acne at the same time. A compounded formula covers all of that in one cream or gel. Your doctor may pair Metronidazole with one or more of the following:
- Ivermectin: the other prescription rosacea active we use, working through a different route. The pairing is a clinical judgement rather than a trialled combination, because the two have not been tested together in a published study.
- Azelaic acid: calms the inflammation behind rosacea and clears spots, whilst not being an antibiotic.
- Niacinamide: supports the skin barrier and reduces redness, which matters when skin is already reactive.
- Tretinoin: added where there are lines, texture or pigment to treat alongside the rosacea.
When each course finishes, the same doctor reviews how your skin has responded and adjusts your next formula if anything needs changing.
How Do You Get Topical Metronidazole in the UK?
Topical Metronidazole is available in the UK on prescription only. There is no over-the-counter version and no cosmetic equivalent. You have two routes to it, and which one suits you depends on what else your skin needs.
The first is as a licensed product. There are four topical Metronidazole medicines that hold a UK licence for rosacea. A prescriber decides whether one is right for you, and you use it as it comes following their instructions. The second is a compounded formula. Here, a doctor writes a prescription for your skin and a specialist pharmacy makes it up, so the strength can be set for you and other actives can go into the same cream or gel. Compounded medicines are unlicensed, because each one is made for a single patient rather than manufactured to a standard product licence.
To access our custom skin treatments, you will need to complete the online consultation form or book a virtual video consultation with one of our doctors first. Your doctor will assess your skin, design a formula around what it needs and look after you afterwards. The same doctor stays with you, adjusts the treatment course by course and answers your questions by email.
Personalised Treatment Fees (3 Month Supply)
VIRTUAL CONSULTATION£30
Your doctor designs your treatment and looks after you throughout. Consultation fee credited in full against your first treatment.
PERSONALISED SKIN TREATMENT£90-150
A 3-month supply of your compounded cream or gel, when used on the face. £90 for a once-daily formula and £150 for a twice-daily treatment. Delivery and your doctor's ongoing aftercare included.
Treatment Time
15 Minutes
Duration of effect
3-4 Months
Back to Work
Same Day
There is no subscription and no auto-renewal. Each course is a single order you place yourself.
Licensed or Compounded Metronidazole
Topical Metronidazole can be prescribed as a licensed product or in a custom formula made individually for you. Which route suits you depends on your skin, what else you are treating and whether one active at a fixed strength is enough. The four licensed products are Rozex cream, Rozex gel, Metrogel and Acea. This is how they compare with compounded formulas:
| Licensed prescription products | Compounded formula | |
|---|---|---|
| Strength | 0.75%, the same in all four | Set for you, up to 1% |
| What it is for | Inflammatory papules and pustules of rosacea | Inflammatory rosacea alongside any other skin concerns |
| Other actives | Metronidazole alone | Combined with other actives if useful |
| Base | Cream or gel depending on brand | Cream or gel |
| Medical input | Prescriber decides suitability and protocol | Doctor assesses, designs and reviews each course |
| Adjusted over time | Same product each time | Rebuilt course by course as your skin responds |
| Licensing | Licensed for rosacea in adults | Unlicensed, made for each patient by a specialist pharmacy |
| Shelf life once dispensed | Longer, as a batch-made product | Around three months, because it is made fresh |
How Effective Is Metronidazole for Rosacea?
Metronidazole is licensed in the UK as a topical treatment for the papules, pustules and redness of rosacea. This is what the evidence shows:
- Papules and pustules: this is the effect the licence rests on. The Cochrane review of rosacea treatments pooled three placebo-controlled trials and found doctors rated Metronidazole roughly twice as likely as placebo to produce a clear improvement, at a risk ratio of 1.98. Cochrane graded that moderate quality evidence.
- Redness: the licensed indication covers the erythema of rosacea, and the redness around active spots settles as those spots clear. Persistent background flushing and visible blood vessels without breakouts may require other treatments.
Improvement tends to begin after three to six weeks. The licensed products set an average treatment period of three to four months, extended by a further three to four months where there is clear benefit and stopped where there is not. Your own course is not fixed to those figures. Your doctor reviews how your skin has responded at the end of each course and tells you what the next one should be.
Ultraviolet light converts Metronidazole into an inactive form, so its effect drops significantly on skin that has been out in strong sunlight or under a sunbed. This is not a burning risk, and phototoxic reactions have not been reported in the trials. It is a reason to keep treated skin out of strong sun, so that the treatment carries on working.
What Strengths Does Metronidazole Come In?
Every licensed topical Metronidazole in the UK is 0.75%. That covers all four of them, and no licensed topical is made at a higher strength. Compounded formulas can contain Metronidazole at lower or higher strengths (usually up to 1%). The strength in custom formulas is set by your doctor based on evidence, your skin and overall health.
What Are the Side Effects of Metronidazole?
Most side effects of topical Metronidazole are local, mild and confined to where you apply it. Common side effects include:
- Dry skin, redness and flaking: the most frequent reactions, usually early in a course.
- Itching, stinging or burning: uncomfortable rather than dangerous, and a reason to apply the treatment less often for a while.
- Skin irritation.
- Worsening of rosacea: listed as a common reaction. If your rosacea gets worse rather than better, tell your doctor instead of pushing on.
Less often, people report a metallic taste, numbness, tingling or nausea. Applied too close to the eyes it can make them water, so keep it away from the eye area and off the lips and nostrils.
Because so little of the drug passes through the skin, the systemic side effects associated with Metronidazole tablets are less likely with the cream or gel. Always tell your doctor about any symptoms when you start a new medication. Any reaction that is severe, spreading or accompanied by swelling of the face needs immediate medical review.
Who Should Not Use Metronidazole?
Topical Metronidazole does not suit everyone. Your doctor will go through your history before prescribing it to ensure it is safe and appropriate. Below are some of the situations that rule it out or call for extra care:
- Pregnancy and breastfeeding: we do not put Metronidazole in formulas for anyone who is pregnant, trying to conceive or breastfeeding. The licensed products take a softer line and allow use where it is clearly needed. Rosacea treatment is not usually urgent, so our position is to wait or use other actives like Azelaic acid instead.
- Cockayne syndrome: Metronidazole must not be used by anyone with this rare inherited condition. Sudden severe liver injury has been reported, so this is an absolute contraindication.
- A history of blood disorders: Metronidazole belongs to a drug family that calls for care in anyone with a history of blood disorders. Tell your doctor if this applies to you, or if you take warfarin or another anticoagulant. Although the amount absorbed from a cream is small, INR changes have occasionally been reported alongside topical use.
- Allergy to Metronidazole or to anything in the base: cream and gel bases may also contain preservatives and alcohols that a small number of people react to.
- Under 18: We do not treat anyone under age of 18 anyway and the license does not cover this age group.
Google Reviews
I would highly recommend City Skin Clinic. I have had a great experience with Dr Amel so far. She is extremely knowledgable and has explained my treatment plan in detail. I had a lot of questions initially and this was met with fast and in depth responses by Dr Amel. The ordering and delivery of the product is quick and easy and Dr Amel has remained in contact throughout my treatment to check progress. It has only been a couple of months but I have already seen an improvement in my hair and trust that I will continue to do so.
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I’ve been going to see Amel for about a year now and am very happy with the results. The service she provides is very personalised and has made a real difference to how my skin looks and feels. I would definitely recommend City Skin Clinic even if you have tried other, similar services.
Dr Amel is fantastic - she was very transparent in her call with me in terms of what she thought would be best for me, and has over the course of the year since always been very prompt and generous in her responses to my email queries. Highly recommended!
City Skin Clinic allows me to get tretinoin delivered when I am running out rather than a subscription basis. Not only that but I cannot praise their customer service enough. They have been so helpful in all skincare advice not just the tretinoin. The response times are incredible and I feel like a valued customer with a personalised advisor. I have used other companies before and have been recommended others, but I’m not even tempted to move away from City Skin Clinic. They really are amazing.
I'm very pleased with the service and product I have received from City Clinic. The process for prescription is easy enough to follow and I'm very satisfied with my skin improvement.
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I appreciate the prompt responses and the treatment I am receiving is going well.
I used the online consultation form and received a very quick response with detailed advice about a treatment plan. My two prescription products arrived a couple of days later in the post and I've already had great results in reducing pigmentation on my face after only 4 weeks of use. I'm really pleased with the results and the service and advice I've received from City Skin Clinic has been excellent.
City Skin Clinic helped me find a Treatment plan that really helped my skin problem of pigmentation /malasma.
Amel is amazing she always takes time to understand your concern and will always give you the best treatment and advice and the results have been amazing. Thank you!
I’ve been receiving treatment at City Skin Clinic with Dr Amel and I couldn’t be happier with the experience. From the start, Dr Amel was professional, knowledgeable and genuinely attentive to my skin concerns — she took the time to listen and tailor a plan that suited my needs. Many aspects of the process were clear and reassuring, and I felt well supported throughout. What stood out most was the ongoing support: Dr Amel has continued to check in, answer my questions promptly, and adapt my plan as needed, which has made a real difference in my progress. Overall, a thorough, caring and highly recommended clinic experience.
I cannot recommend Dr Amel highly enough. She is genuinely the best skincare specialist I’ve ever worked with. From the very first consultation she took the time to understand my concerns in detail, explain the science behind everything, and create a personalised plan that actually delivered results rather than promises.
My skin has transformed under her care. Years of stubborn hyperpigmentation, uneven tone and texture that I thought I’d never get on top of have improved more than I thought was possible. Every step of the process has been guided, monitored and adjusted so thoughtfully. She never rushes, she always explains the why behind each change, and she makes you feel like you’re in the hands of someone who genuinely cares about your outcome.
What stands out most is how responsive and reassuring she is. Anytime I had a question or worry, she replied with real clarity and expertise. She pays close attention to detail, picks up on things I wouldn’t even notice, and makes you feel completely supported throughout the whole treatment plan.
If you want a clinician who is knowledgeable, meticulous, honest, and truly invested in achieving the best results for you, Dr Amel is exactly that. My confidence in my skin has never been better, and I’m so grateful to her for the care, patience and expertise she’s given me.
I got in touch having been frustrated with breakouts and early ageing signs. I have been so impressed by the level of communication, empathy and support I have received. It feels so much more caring/personal than booking with other well known brands in this space (who often more of a subscription based model) I would really recommend this company - and Dr Amel - to anyone wanting professional advice and support with their skin concerns
In desperation I trawled the internet looking for alternatives and found this wonderful company. From the very first video consultation, I was listened to and given a plan which worked! I cannot praise Amel enough. She has given such good advice; she responds almost immediately and is so very sensible. I feel cared forand know I am in the most professional and capable hands. My skin has improved significantly and is now brighter, more even toned and hydrated. I am impressed to the extent that I paid for my darling daughter to have a consultation as well. In her words- "Amel is just lovely. She is THE best!" What more can I say??? I won't be going anywhere else as I have complete faith in the company and highly recommend them.
I had a fantastic experience with CitySkinClinic. The online consultation was incredibly convenient and cost just £30 - excellent value for such a professional and personalised service. I was pleased and surprised that the cost of the consultation came off the price of the treatment Dr Amel was extremely easy to talk to, answering all my concerns with great care and professionalism. She was very prudent and thoughtful in her recommendations which made me feel confident and well looked after
Since using the cream my skin has noticeably improved in texture and firmness making me look healthier and less tired. My sun damage spots have also disappeared
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I'm not even halfway through my treatment for hyperpigmentation and I've achieved amazing results thanks to City Skin Clinic. The service has been effortless, professional, reliable and most of all very personalised unlike some of the other online clinics where you just fill in a form and wait for treatment in the post. I would definitely recommend to anyone who wants even looking skin!
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Frequently asked questions
Authored by:
Aesthetic Doctor & Medical Director BSC (HONS) MBBS MRCS PHD
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611