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.
Key Points
- 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.
- Ivermectin works by reducing Demodex mite populations on the skin and has anti-inflammatory properties that help calm rosacea flares.
- Side effects are generally mild and may include skin irritation, dryness, or burning.
- Patients should continue using gentle skin care products and sun protection while using ivermectin, as these complement the medication's effectiveness.
Efficacy and Safety
- A 12-week pilot study demonstrated clinical improvement with in vivo reduction of demodex mite density and improved cutaneous inflammatory markers with once-daily ivermectin cream 1% 1.
- A pivotal phase 3 trial showed that ivermectin 1% cream versus vehicle for moderate-to-severe rosacea resulted in higher treatment success, defined by IGA as “clear” (0) or “almost clear” (1) at 12 weeks, with 38.4% and 40.1% of subjects achieving treatment success compared with 11.6% and 18.8% in the vehicle groups 1.
- A head-to-head comparison study found that ivermectin 1% cream provided superior results compared with metronidazole 0.75% cream, with a longer time until relapse and a more durable response 1.
Recommendations
- Topical ivermectin 1% cream should be considered as a first-line treatment option for rosacea, particularly for the papulopustular subtype, due to its efficacy and safety profile 1.
- Patients should be advised to apply a pea-sized amount to each affected area of the face once daily, preferably in the evening after cleansing, and to continue using gentle skin care products and sun protection while using ivermectin.
From the Research
Efficacy of Ivermectin for Rosacea
- Ivermectin 1% cream has been shown to be effective in treating inflammatory lesions of rosacea, with significant improvements in symptoms and health-related quality of life compared to vehicle and metronidazole 0.75% cream 2.
- A network meta-analysis found that ivermectin 1% cream led to a significantly greater likelihood of success compared to azelaic acid 15% gel and metronidazole 0.75% cream at 12 weeks 3.
- Ivermectin 1% cream has also been shown to be effective in reducing inflammatory lesion count and improving symptoms of rosacea, with a significant reduction in inflammatory lesion count compared to azelaic acid 15% gel and metronidazole 0.75% cream at 12 weeks 3.
Safety and Tolerability
- Ivermectin 1% cream has been found 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 systematic review found that ivermectin 1% cream had a lower risk of developing any adverse event or treatment-related adverse event compared to azelaic acid 15% gel 4.
Clinical Guideline Recommendations
- Clinical guidelines have yielded different treatment algorithms and conflicting recommendations for the use of ivermectin 1% cream in the treatment of papulopustular rosacea, although it is generally considered an effective treatment option 4.
- The use of ivermectin 1% cream has been recommended as a first-line treatment option for papulopustular rosacea, with the convenience of once-daily application 2.
Novel Uses and Technologies
- A pilot study found that ivermectin 1% cream significantly reduced invisible symptoms of rosacea, such as stinging and burning, dryness, and itching, and improved erythema and skin texture 5.
- Another study found that topical ivermectin 1% cream was effective in treating both cutaneous and ocular rosacea, with significant improvements in subjective symptoms, skin findings, and ocular changes 6.