Aczone vs MetroGel

Aczone: An anti-inflammatory gel for red, tender acne. It is not a retinoid and not a standard antibiotic, so it suits skin that cannot tolerate either. MetroGel: A long-standing prescription gel or cream for the bumps and pustules of rosacea. It calms inflammation rather than treating an infection.

Reviewed by Dr. Schwarz, Board-Certified Dermatologist

Which one?At a glance What it treats Diagrams How you take it Results Side effects Safety Cost When you stop Questions

Which one is right for you?

Choose Aczone if…

Choose for red, tender acne when skin can't tolerate a retinoid or you want to avoid a standard antibiotic.

Inflamed spots rather than blackheads
Sensitive skin that reacts to retinoids
You want a morning step that sits well under makeup

Choose MetroGel if…

Choose for rosacea bumps and pustules as a gentle, inexpensive long-standing cream.

Rosacea bumps and pimples
Sensitive skin that reacts to stronger creams
You want a cheap generic

Fine together

Can you take them together?

They treat different conditions and can share a routine if you have both acne and rosacea. Use them at different times of day to limit irritation.

At a glance

● Aczone

● MetroGel

Type

Topical anti-inflammatory (dapsone gel)

Topical anti-inflammatory (metronidazole)

What it does

Calms red, tender acne spots

Calms rosacea inflammation

Best for

Inflamed acne

Rosacea bumps and pustules

Prescription

Yes

Form

Gel, 5% or 7.5%

Gel, cream or lotion

How often

7.5% once daily; 5% twice daily

0.75% twice daily; 1% once daily

Course length

Ongoing

Time to results

4–12 weeks

8–12 weeks

Main side effect

Mild dryness

Mild stinging or dryness

Blood tests

None for the gel

None

Pregnancy

Check with your clinician

Cost

Moderate; generic available

Low; generic available

What it treats

Compare uses by strength of evidence. Evidence level describes confidence in a benefit, not its size.

Evidence level

Aczone

MetroGel

Strong evidenceMost established uses

Acne

Reduces inflamed breakouts in large trials.

Redness and fine superficial vessels across a light-skinned cheek and nose.

Rosacea

Reduces bumps and pimples.

Moderate evidenceSome supportive research

—

Perioral Dermatitis

Helps clear the rash.

Limited evidenceEarly or small studies

Rosacea

Small studies show fewer bumps.

—

Little evidence

dark keratin plugs in dilated pores on the nose and adjacent left cheek, with the face turned to the person’s right on light skin.

Blackheads

Weaker on clogged pores than retinoids.

Acne

Not a standard acne treatment.

Not effective

Acne Scarring

Doesn't change scars.

Post-Inflammatory Redness

Doesn't fade lingering redness.

How it works

Aczone. Dapsone gel helps calm inflammatory acne. 1. May calm neutrophil activity: Can reduce some inflammatory actions of these immune cells. 2. May reduce inflammatory oxidants: Can limit release of tissue-irritating molecules. 3. Reduces inflamed acne spots: Red bumps and pimples can improve over time. — Open full-size diagram
Diagram explanation and sources
May calm neutrophil activity: Can reduce some inflammatory actions of these immune cells. May reduce inflammatory oxidants: Can limit release of tissue-irritating molecules. Reduces inflamed acne spots: Red bumps and pimples can improve over time.
The acne mechanism is unknown. Neutrophil and oxidant explanations are proposed based on experimental studies, not established as the cause of topical clinical benefit.
Source 1 · Source 2 · Source 3

MetroGel. Metronidazole helps calm inflammatory rosacea. 1. May reduce inflammatory oxidants: Can limit reactive oxygen released by immune cells. 2. Helps calm inflammation: Reduces the inflammatory activity around skin lesions. 3. Reduces bumps and pimples: Rosacea spots gradually become less active. — Open full-size diagram
Diagram explanation and sources
May reduce inflammatory oxidants: Can limit reactive oxygen released by immune cells. Helps calm inflammation: Reduces the inflammatory activity around skin lesions. Reduces bumps and pimples: Rosacea spots gradually become less active.
The rosacea mechanism is not fully established. Reactive-oxygen effects derive from experimental systems and are presented as a proposed explanation; this does not imply killing Demodex or treating all redness.
Source 1 · Source 2 · Source 3

How you take it

Treatment plan

When to Apply: Clean dry skin, whole affected area. The 7.5% gel once a day, the 5% gel twice, usually in the morning so the night is free for a retinoid.

How to Start: Full strength from day one. It dries clear and sits well under makeup and sunscreen.

If It Irritates: Uncommon — usually mild dryness a moisturizer settles. With benzoyl peroxide at the same moment it can turn skin temporarily orange-brown, which is harmless and avoided by using the two at different times of day.

If It’s Not Working: Give it twelve weeks. There is no step up in strength, so the next move is adding or changing a drug.

When to Apply: A thin layer over the whole affected area, not dabbed on individual spots. Twice a day for 0.75%, once a day for 1%. Apply to clean dry skin and let it settle before moisturizer or sunscreen.

How to Start: Straight in at full frequency — this is one of the gentler prescription topicals. If your skin is very reactive, use it once daily for a week first.

If It Irritates: Mild stinging or dryness in the first week is usually the base, not the drug. Moisturizer underneath settles it, and switching from gel to cream helps most people.

If It’s Not Working: Give it eight to twelve weeks. If bumps keep coming, the next step is usually azelaic acid or ivermectin, or a low-dose oral treatment. If redness or visible vessels are the problem, this drug was never going to fix them.

Monitoring

No routine blood tests for the gel. Unlike dapsone tablets, you do not need G6PD testing first, because so little is absorbed.

You can stay on this for years, and nothing accumulates. Review is clinical, at about twelve weeks and then yearly.

No blood tests and no routine monitoring. Almost none of the drug reaches the bloodstream from the skin, so the cautions on metronidazole tablets do not transfer.

Monitoring means a review at eight to twelve weeks to decide whether it is doing enough, then occasional check-ins if you stay on it for years. Long-term use is normal here.

Watch for rosacea in the eyes. A facial gel does not treat it, so mention gritty, burning or persistently dry eyes rather than reaching for drops off the shelf.

When you’ll see results

Approximate windows, not promises.

● Aczone

● MetroGel

Weeks 1 to 4

Weeks 1 to 4Red, tender spots calm down. Blackheads and whiteheads look unchanged.

Weeks 4 to 8

Weeks 4 to 8Fewer new inflamed spots.

After 12 weeks

After 12 weeksIf inflamed acne has not improved, move on. Judge it on red spots only — it was never going to fix clogs.

First few minutes

First few minutesApplying it: A thin layer over the whole affected area, not spot-treating.

Weeks 1 to 3

Weeks 1 to 3Adjusting: Little visible change. Stinging or dryness, if it happens, shows up and settles here, faster with a moisturizer alongside.

Weeks 3 to 6

Weeks 3 to 6Working: Fewer new bumps and pustules, and the existing ones look less angry.

Weeks 8 to 12

Weeks 8 to 12Judge it here: Where the trials measured their main result. Most people see a clear drop in inflamed bumps, and some background redness lifts with them.

Beyond 12 weeks

Beyond 12 weeksHolding: Continued use holds the result. Stopping is the usual reason rosacea comes back.

Side effects

Sorted by what to do about them.

Aczone

MetroGel

Common

Mild dryness or oiliness
Orange tint if used with benzoyl peroxide at the same time

Common

Mild stinging, dryness or itch

Tell your doctor

Irritation that doesn't settle

Tell your doctor

Rosacea worsening

Stop and get care

A spreading rash or blisters
Breathlessness, pale skin or blue-tinged lips

Stop and get care

Swelling or trouble breathing

Safety and who should avoid it

Pregnancy

Ask first

Discuss with your clinician.

Use care

Ask the doctor managing your pregnancy.

Breastfeeding

Ask first

Discuss with your clinician.

Use care

Discuss with your clinician.

Children

9 and older

Approved from age 9 (7.5%) or 12 (5%).

Not used

Adults mainly.

Monitoring

None routine

Unlike dapsone tablets, no blood tests.

None

Judge at 8–12 weeks.

Key interactions

Check

Benzoyl peroxide at the same time (orange tint); oral dapsone.

None important for topical

—

Other cautions

Avoid

Allergy to dapsone or sulfones.

Use care

Keep out of eyes.

Cost and getting it

Getting it and cost

Generic dapsone gel comes in both strengths and costs far less than it used to, though still more than generic clindamycin or benzoyl peroxide. Some plans want prior authorization, usually after a retinoid.

Generic metronidazole gel, cream and lotion are widely available and among the cheaper rosacea prescriptions. Coverage is generally good, and this is often what plans want tried first.

Branded versions and the once-daily 1% products cost more. Since the higher strength has not been shown to clear rosacea better, you are paying for convenience.

If the quoted price seems high, ask about the other forms and strengths — the gap can be large for the same drug.

When you stop

Comes back?

Yes. Red spots come back within weeks to a couple of months.

Bumps often return within months.

Taper needed?

No rebound and no taper.

No.

After the last dose

Inflammation returns to its old level.

Many keep it as maintenance.

Common questions

Aczone:Why did my face turn orange?

Benzoyl peroxide and dapsone applied together can leave a temporary orange-brown tint on skin and light-colored facial hair. It washes off and is harmless. Use them hours apart.

Aczone:Do I need a G6PD test first?

Not for the gel. That belongs to dapsone tablets, where far more of the drug reaches the bloodstream.

Aczone:Will it clear my blackheads?

No. It works on inflammation. Blackheads need a retinoid.

Aczone:Is it an antibiotic?

No. It is a sulfone with anti-inflammatory action, which is why resistance is not the same concern.

MetroGel:How long before I see a difference?

Early change around three to four weeks. Judge it fairly at eight to twelve weeks.

MetroGel:Will it help my redness?

It helps the redness that comes with inflamed bumps. Persistent background redness and visible vessels need different treatments, so be clear about which one bothers you.

MetroGel:Can I drink alcohol while using it?

The alcohol warning belongs to the tablets, not the gel, since so little is absorbed. Alcohol is a common rosacea trigger in its own right, which is a separate question.

MetroGel:Gel or cream?

Gel for oilier skin, cream for dry or easily irritated skin, lotion in between. Same drug, so pick on comfort.

MetroGel:Can I use it with other rosacea treatments?

Usually yes. It is often paired with azelaic acid, a redness-reducing gel, or low-dose oral treatment. Check the combination with your doctor.

MetroGel:Do I have to stay on it forever?

Not forever, but longer than most people expect. Rosacea usually returns within weeks to months of stopping, so treatment often continues at a reduced frequency once the skin settles.

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