From the Guidelines
Ivermectin 1% cream is a highly effective treatment option for rosacea, particularly for the papulopustular subtype, with a significant reduction in lesion counts and improvement in inflammatory markers, as demonstrated in a pivotal phase 3 trial 1. The most common formulation is topical ivermectin 1% cream, applied once daily to affected areas of the face.
- Treatment typically continues for 12-16 weeks, though many patients use it long-term for maintenance therapy.
- A thin layer should be applied to clean, dry skin, avoiding the eyes and lips.
- Improvement is usually seen within 2-4 weeks, with maximum benefits after 3-4 months of consistent use. Ivermectin works by reducing Demodex mite populations (microscopic mites that live in facial skin and may trigger inflammation in rosacea patients) and also has anti-inflammatory properties that help calm redness and reduce bumps 1.
- Side effects are generally mild and may include skin irritation, dryness, or burning.
- For severe cases, oral ivermectin may occasionally be prescribed by dermatologists, but topical application is the standard first-line treatment.
- Patients should continue other rosacea management strategies alongside ivermectin, including gentle skin care, sun protection, and avoiding known triggers. In comparison to other treatments, ivermectin 1% cream has been shown to be superior to metronidazole 0.75% cream in a head-to-head comparison study 1, with a longer time until relapse and a more durable response.
- A network meta-analysis also concluded that ivermectin 1% cream is a more effective treatment option compared to other topical rosacea treatments 1.
From the Research
Efficacy of Ivermectin in Treating Rosacea
- Ivermectin 1% cream has been shown to be effective in treating inflammatory lesions of rosacea, with improvements in symptoms and health-related quality of life 2.
- The medication has anti-inflammatory properties and broad-spectrum anti-parasitic activity, which may contribute to its efficacy in treating rosacea 2.
- Studies have demonstrated that ivermectin 1% cream is effective in reducing the number of inflammatory lesions in patients with papulopustular rosacea, with significant improvements seen in almost clear, mild, moderate, and severe forms of the disease 3.
Comparison with Other Treatments
- Ivermectin 1% cream has been compared to metronidazole 0.75% cream, with ivermectin showing greater efficacy in improving symptoms of rosacea 2.
- A systematic review of evidence and clinical guideline recommendations found that ivermectin 1.0% cream is an effective treatment option for papulopustular rosacea, with a lower relapse rate compared to metronidazole 4.
Safety and Tolerability
- Ivermectin 1% cream has been shown to be well-tolerated, with the most common treatment-related adverse events (skin burning sensation, pruritus, dry skin, and skin irritation) occurring with low incidence (<2%) 2.
- A retrospective study found that ivermectin 1% cream was effective and safe in treating papulopustular rosacea, with no significant adverse events reported 3.
Treatment of Cutaneous and Ocular Rosacea
- A pilot study found that once-daily topical treatment with ivermectin 1% cream was effective in improving symptoms of cutaneous and ocular rosacea, with significant improvements seen in subjective symptoms, skin findings, and ocular changes 5.
- An expert opinion review highlighted the potential of ivermectin 1% cream as a novel agent for the treatment of papulopustular rosacea, with its ability to target the Demodex mite, which is increased in patients with rosacea 6.