MetroGel vs Soolantra

MetroGel: A long-standing prescription gel or cream for the bumps and pustules of rosacea. It calms inflammation rather than treating an infection. Soolantra: A once-daily cream for the bumps and pustules of rosacea. It calms inflammation and reduces the mites that live in facial follicles, but it does not treat flushing or fixed redness.

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 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

Choose Soolantra if…

Choose for rosacea bumps and pustules as a once-daily cream that often clears them — it doesn't treat flushing or fixed redness.

Rosacea bumps and pimples
You want once-daily use
You'll give it 12–16 weeks

Alternatives, not combined

Can you take them together?

Both treat rosacea bumps. Most people use one; Soolantra is often a little more effective.

At a glance

● MetroGel

● Soolantra

Type

Topical anti-inflammatory (metronidazole)

Topical antiparasitic and anti-inflammatory (ivermectin 1%)

What it does

Calms rosacea inflammation

Calms inflammation and reduces Demodex mites

Best for

Rosacea bumps and pustules

Prescription

Yes

Form

Gel, cream or lotion

Cream

How often

0.75% twice daily; 1% once daily

Once daily

Course length

Ongoing

Time to results

8–12 weeks

4–16 weeks

Main side effect

Mild stinging or dryness

Mild burning or dryness

Blood tests

None

Pregnancy

Check with your clinician

Cost

Low; generic available

Moderate; generic available

What it treats

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

Evidence level

MetroGel

Soolantra

Strong evidenceMost established uses

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

Rosacea

Reduces bumps and pimples.

Rosacea

Reduces bumps and pimples.

Moderate evidenceSome supportive research

Perioral Dermatitis

Helps clear the rash.

—

Little evidence

Acne

Not a standard acne treatment.

The finger webs and wrist on fair light skin, with small red bumps, several thin gray burrow lines a few millimetres long, and scratch marks across the area.

Scabies

Scabies needs permethrin or ivermectin tablets.

Not effective

Post-Inflammatory Redness

Doesn't fade lingering redness.

Post-Inflammatory Redness

Doesn't fade redness alone.

Acne

Not an acne treatment.

How it works

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

Soolantra. Ivermectin helps settle rosacea bumps and pimples. 1. Reduces Demodex mites: Kills mites that may contribute to rosacea inflammation. 2. May calm immune signals: Anti-inflammatory effects may also help skin settle. 3. Reduces bumps and pimples: Inflammatory rosacea lesions gradually improve. — Open full-size diagram
Diagram explanation and sources
Reduces Demodex mites: Kills mites that may contribute to rosacea inflammation. May calm immune signals: Anti-inflammatory effects may also help skin settle. Reduces bumps and pimples: Inflammatory rosacea lesions gradually improve.
The label states that the rosacea mechanism is unknown. Anti-parasitic and anti-inflammatory actions are supported by a small in-vivo pilot; clinical efficacy has randomized-trial support. Demodex is not the sole cause of rosacea.
Source 1 · Source 2 · Source 3

How you take it

Treatment plan

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.

When to Apply: Once a day, usually at night, on clean dry skin. A pea-sized amount for the whole face, spread thinly rather than dabbed on bumps. Keep it off the eyes, lips and inside of the nose. Moisturizer and sunscreen go on top once it has dried.

How to Start: Once daily from day one. No build-up schedule, and twice a day speeds nothing up.

If It Irritates: Mild burning, stinging or dryness early on is common; moisturizer before or after usually settles it. A flare of bumps in the first two to four weeks happens and passes. It does not mean the cream is wrong.

If It's Not Working: Give it twelve weeks before judging, up to sixteen for the full effect. There is one strength, so the next step is adding something else, often azelaic acid or an oral antibiotic, not more cream.

Monitoring

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.

No blood tests or laboratory monitoring. Very little is absorbed through intact skin, far below the amounts involved with the tablets.

Monitoring is a conversation at around twelve weeks: have the bumps reduced, is the cream comfortable, is anything separate needed for redness. People stay on it for years without a dose change, because nothing accumulates.

Irritation after months of comfortable use usually points to a change in the routine or a second problem such as contact dermatitis, worth reviewing rather than pushing through.

When you’ll see results

Approximate windows, not promises.

● MetroGel

● Soolantra

First few minutes

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

First few minutesApplying it: A pea-sized amount once a day, thinly over the whole face.

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.

Weeks 1 to 2

Weeks 1 to 2Adjusting: Mild burning, dryness or itching. Some get a short flare as mite numbers drop. Little visible change yet.

Weeks 2 to 4

Weeks 2 to 4First change: Fewer new pustules, which clear before the firm red bumps. The face looks calmer before the count is obviously lower.

Weeks 4 to 12

Weeks 4 to 12Working: Steady reduction in bumps and pustules. Most of the gain happens here, and background pink fades as the inflammation settles.

Weeks 12 to 16

Weeks 12 to 16Judge it here: The point the trials measured, where most people were rated clear or almost clear.

Side effects

Sorted by what to do about them.

MetroGel

Soolantra

Common

Mild stinging, dryness or itch

Common

Mild burning or stinging
Dry skin

Tell your doctor

Rosacea worsening

Tell your doctor

Rosacea worsening

Stop and get care

Swelling or trouble breathing

Stop and get care

Swelling or trouble breathing

Safety and who should avoid it

Pregnancy

Use care

Ask the doctor managing your pregnancy.

Use care

Ask the doctor managing your pregnancy.

Breastfeeding

Use care

Discuss with your clinician.

Use care

Discuss with your clinician.

Children

Not used

Adults mainly.

Not used

Adults only.

Monitoring

None

Judge at 8–12 weeks.

None

Judge at 12–16 weeks.

Key interactions

None important for topical

—

None known

—

Other cautions

Use care

Keep out of eyes.

Use care

Keep out of eyes.

Cost and getting it

Getting it and cost

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.

Sold as Soolantra, with generic ivermectin 1% cream now available in some markets. Price varies widely between pharmacies and plans, and many plans want metronidazole or azelaic acid tried first.

A tube lasts a while, since a pea-sized amount covers the whole face once a day. If cost is the barrier, price generic ivermectin cream, a pharmacy discount card, or generic metronidazole or azelaic acid.

When you stop

Comes back?

Bumps often return within months.

Bumps can return months after stopping.

Taper needed?

No.

After the last dose

Many keep it as maintenance.

Restarting usually works.

Common questions

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.

Soolantra:Does it get rid of the redness in my face?

Not the kind most people mean. It reduces redness from inflamed bumps, so the face looks calmer. It does not stop flushing or remove visible vessels; those need brimonidine or oxymetazoline, or laser and light.

Soolantra:Why did my rosacea get worse in the first two weeks?

A short early flare is common, probably because dying mites release material the immune system reacts to. It settles within a few weeks.

Soolantra:Is this the same as taking ivermectin tablets?

Same drug, completely different medicine. The cream goes on the face, almost none enters the bloodstream, and it treats skin only.

Soolantra:How long will I need to use it?

Rosacea is managed, not cured, so most people use it long term. Bumps return within a few months of stopping.

Soolantra:Can I use it alongside other rosacea treatments?

Yes, and combinations are common: a redness treatment in the morning and ivermectin at night, or ivermectin with oral doxycycline.

Soolantra:Do I need to change my pillowcases because of the mites?

No. These mites live in the follicles of nearly every adult face. They are not caught from bedding, pets or people, and cleaning does not change their numbers.

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