Is oral Ivermectin (antiparasitic medication) effective for treating rosacea?

From the Guidelines

Oral ivermectin is not a recommended treatment for rosacea, as the current evidence supports the use of topical ivermectin for this condition. The most recent and highest quality study, published in 2024 1, demonstrates the efficacy of topical ivermectin 1% cream in reducing inflammatory lesions and Demodex mite density in patients with rosacea. This study shows that once-daily topical ivermectin 1% cream leads to clinical improvement and downregulation of inflammatory markers.

Key points to consider:

• Topical ivermectin 1% cream is FDA-approved for the treatment of inflammatory lesions of rosacea 1
• A 12-week pilot study demonstrated clinical improvement and reduced Demodex mite density with once-daily ivermectin cream 1% 1
• A pivotal phase 3 trial showed that ivermectin 1% cream is effective in treating moderate-to-severe rosacea, with 38.4% and 40.1% of subjects achieving treatment success in two parallel studies 1
• The global rosacea consensus panel recommends topical ivermectin as a first-line treatment for moderate to severe rosacea, particularly for patients with papulopustular rosacea 1

In contrast, oral ivermectin is not mentioned as a recommended treatment for rosacea in the provided evidence. While oral ivermectin may have anti-inflammatory and antiparasitic effects, its use for rosacea is not supported by the current evidence. Therefore, topical ivermectin 1% cream is the preferred treatment option for rosacea, and oral ivermectin should not be used as a first-line treatment.

From the Research

Effectiveness of Oral Ivermectin for Treating Rosacea

• There are no research papers to assist in answering this question as the provided studies focus on the effectiveness of topical ivermectin for treating rosacea, not oral ivermectin.

Topical Ivermectin for Treating Rosacea

• Topical ivermectin 1% cream is an effective treatment option for papulopustular rosacea, with studies showing a significant reduction in inflammatory lesion count compared to other treatments such as azelaic acid and metronidazole 2, 3, 4, 5.
• Topical ivermectin has been shown to be more effective than metronidazole in preventing relapse, with a numbers needed to treat (NNT) of 10.5 at 12 weeks of treatment 5.
• However, relapse after discontinuation of treatment is common, with approximately two-thirds of patients relapsing within 36 weeks 5.

Other Treatments for Rosacea

• Other effective treatments for rosacea include azelaic acid, metronidazole, and doxycycline, with varying degrees of efficacy and safety profiles 3, 6.
• Brimonidine has been shown to be effective in reducing erythema in rosacea, with a significant improvement in patient-assessed outcomes 3.