From the Guidelines
Ivermectin is a recommended treatment option for ocular rosacea, particularly in the form of topical 1% cream applied once daily to affected areas, as it has been shown to reduce Demodex mite populations and decrease inflammatory mediators, thereby controlling both the inflammatory and infectious components of the condition 1.
Treatment Approach
When considering treatment for ocular rosacea, it's essential to prioritize a comprehensive approach that addresses both the symptoms and the underlying causes.
- Topical ivermectin 1% cream is a preferred option due to its efficacy in reducing Demodex mite density and improving cutaneous inflammatory markers, as demonstrated in a 12-week pilot study and subsequent phase 3 trials 1.
- The treatment duration for ivermectin typically ranges from 12-16 weeks, although some patients may require longer courses.
- It's crucial to combine ivermectin treatment with good eyelid hygiene practices, including warm compresses and gentle cleansing of the eyelid margins.
- Patients should also continue using artificial tears if experiencing dry eye symptoms and avoid triggers that exacerbate rosacea, such as spicy foods, alcohol, and extreme temperatures.
Supporting Evidence
The use of ivermectin in treating ocular rosacea is supported by high-quality evidence, including a pivotal phase 3 trial that demonstrated the efficacy of topical ivermectin 1% cream in reducing inflammatory lesions and improving symptoms 1.
- Additionally, a review of the current treatment landscape for rosacea highlights the importance of considering the relationship between Demodex folliculorum density and markers of inflammation in the skin of rosacea patients 1.
- Other treatment options, such as oral azithromycin and topical azelaic acid, may also be effective, but ivermectin remains a preferred choice due to its targeted mechanism of action and favorable safety profile 1.
Clinical Considerations
When prescribing ivermectin for ocular rosacea, clinicians should be aware of potential side effects and interactions, although these are generally mild and well-tolerated.
- Regular follow-up with an ophthalmologist or dermatologist is recommended to monitor response and adjust treatment as needed.
- Patients should be informed of the potential benefits and risks of ivermectin treatment and encouraged to report any adverse effects or concerns.
From the Research
Treatment Options for Ocular Rosacea
- Topical ciclosporin ophthalmic emulsion has been shown to be effective in improving quality of life for people with ocular rosacea, although the quality of evidence is low 2
- Omega-3 fatty acids and cyclosporine ophthalmic emulsion are also recommended for ocular rosacea, based on evidence-based treatment recommendations 3
- There is a need for further studies on the treatment of ocular rosacea, as the current evidence is limited 2
Ivermectin for Rosacea
- Topical ivermectin has been shown to be effective in treating papulopustular rosacea, with high-quality evidence supporting its use 2, 4, 5
- Ivermectin appears to be slightly more effective than topical metronidazole for papulopustular rosacea, based on one study 2
- Topical ivermectin is also recommended for maintenance therapy, along with topical metronidazole and topical azelaic acid 3
Other Treatment Options for Rosacea
- Topical azelaic acid, metronidazole, and brimonidine are also effective in treating rosacea, with moderate to high-quality evidence supporting their use 2, 4, 5
- Oral doxycycline and isotretinoin are also associated with improvements in rosacea, with high-quality evidence supporting their use 2, 4, 5
- Laser and light-based therapy may also be effective in treating rosacea, although the quality of evidence is lower 2, 5