Acne rosacea is a common skin condition characterized by flushing episodes, erythema, telangiectasia, and recurrent crops of inflammatory papules and pustules that involve the face in a symmetrical distribution. A pilot study was conducted to compare topical 5 percent permethrin cream and 0.75 percent metronidazole gel in the treatment of acne rosacea. Six patients began treatment with 0.75 percent metronidazole gel twice daily to the right side of the face and permethrin 5 percent cream applied daily to the left side. Clinical evaluation was performed every two weeks. Five patients completed the study. The patients were treated for a range of seven to ten weeks. There were minimal adverse effects. Moderate improvement was seen on both sides.