Metronidazole not working for rosacea after 8 weeks - what next?
If metronidazole is going to work, most people notice an improvement within 4 to 8 weeks, with the maximum benefit by about 12 weeks. If there has been little change after 8 to 12 weeks of daily use, it is reasonable to move on. The right next step depends on which features of rosacea are still there.
Spots and bumps still present
Ivermectin (Soolantra) is, in my experience, the most effective cream for the inflammatory spots of rosacea, and it often works where metronidazole has not. Azelaic acid is an alternative. Where spots are widespread, or the eyes are affected, a few months of an oral tetracycline such as lymecycline settles the inflammation, after which a cream can often maintain control.
Mainly redness
If the spots have gone but the face is still red, the cause is usually dilated blood vessels, which no cream removes. Vascular laser treats these directly.
Is it definitely rosacea?
When a rosacea treatment does not work, it is worth checking the diagnosis. Perioral dermatitis, seborrhoeic dermatitis, steroid-induced rosacea and acne can all look similar, and some are made worse by the wrong treatment. A skincare routine containing irritants can disturb the skin barrier, keeping rosacea active.
Metronidazole not working?
I can confirm the diagnosis, identify which features of your rosacea are still active, and set out the treatments most likely to work. Consultations can be in person or remote.
Related Articles
- Metronidazole for rosacea
- Ivermectin (Soolantra) for rosacea
- Tetracyclines for rosacea
- Do I really have rosacea?
