Can Finacea (azelaic acid) 15% gel and ivermectin cream be used to treat rosacea?

Combination of Finacea 15% Gel and Ivermectin Cream for Rosacea Treatment

Yes, Finacea (azelaic acid) 15% gel and ivermectin 1% cream can be effectively used together to treat rosacea, particularly for patients with inflammatory lesions. 1, 2

Evidence for Individual Treatments

Azelaic Acid 15% (Finacea)

• FDA-approved for inflammatory lesions of rosacea, with clinical studies showing up to 51% success rate (defined as "clear" or "almost clear") after 12 weeks of treatment 3
• Available in 15% gel and foam formulations, producing significant reduction in inflammatory lesion counts from baseline (from 17.5-17.8 to 6.8-8.9 lesions) 3
• Works through multiple mechanisms including anti-inflammatory effects by reducing reactive oxygen species 4

Ivermectin 1% Cream

• FDA-approved in 2014 for inflammatory lesions of rosacea with once-daily application 3
• Demonstrated superior efficacy compared to vehicle in clinical trials, with 38.4-40.1% of patients achieving treatment success (defined as "clear" or "almost clear") at 12 weeks 3
• Works by reducing Demodex folliculorum density and downregulating inflammatory markers 3
• In head-to-head studies, ivermectin 1% cream showed superior efficacy to metronidazole 0.75% cream, with 84.9% vs 75.4% of patients achieving "clear" or "almost clear" ratings 3

Combination Therapy Approach

• The British Journal of Dermatology recommends considering combination therapy for moderate to severe rosacea to achieve more rapid control 1, 2
• Multiple cutaneous features of rosacea often require simultaneous treatment with different agents targeting various inflammatory pathways 2
• The complementary mechanisms of action between different treatments provide scientific rationale for combination therapy 5

Treatment Algorithm Based on Severity

1. For mild papulopustular rosacea:

   • Start with either topical azelaic acid 15% gel or ivermectin 1% cream as monotherapy 1

2. For moderate papulopustular rosacea:

   • Consider combination of topical therapy (azelaic acid 15% gel or ivermectin 1% cream) 1, 2
   • If rapid control is needed, add oral doxycycline 1

3. For severe papulopustular rosacea:

   • Combination of topical ivermectin plus oral doxycycline is recommended 1

Application and Usage

• Apply Finacea 15% gel twice daily to affected areas 4
• Apply ivermectin 1% cream once daily 3, 6
• When using both products, apply one in the morning and one in the evening to minimize potential irritation

Efficacy of Combination Approach

• Targeting multiple inflammatory pathways simultaneously may provide better control of symptoms 5
• Network meta-analysis shows ivermectin 1% cream has greater efficacy compared to azelaic acid 15% gel when used individually, suggesting potential complementary benefits when used together 7

Common Pitfalls to Avoid

• Ignoring maintenance therapy: Up to two-thirds of patients may relapse when therapy is discontinued 1
• Poor adherence due to skin irritation: Up to 89% of patients may discontinue therapy within a month if irritation is not addressed 1
• Not addressing all phenotypic features: Multiple cutaneous features may require simultaneous treatment with different agents 1, 2
• Overlooking general skincare measures: Sun protection (SPF 30+), gentle cleansers, and moisturizers are essential adjuncts to pharmacological treatment 1, 2

Monitoring and Follow-up

• Assess improvement in inflammatory lesion counts and erythema after 4-6 weeks of treatment 3
• Consider maintenance therapy with the minimum effective regimen after achieving control 2
• Monitor for potential adverse effects including skin burning sensation, pruritus, dry skin, and skin irritation 6