From the Guidelines
Ivermectin cream should not be used daily for long-term rosacea maintenance without medical supervision, as the standard recommended regimen is to apply a pea-sized amount once daily for up to 4 months, after which your doctor should reassess your condition. The medication works by reducing inflammation and killing Demodex mites that may contribute to rosacea flares, as demonstrated in a 12-week pilot study of 20 subjects with IGA scores ≥ 3, where clinical improvement was observed with in vivo reduction of demodex mite density and improved cutaneous inflammatory markers with once-daily ivermectin cream 1% 1. Using the medication continuously beyond the prescribed treatment period may lead to unnecessary side effects like skin irritation, burning sensation, or dry skin, and could potentially reduce its effectiveness over time. For long-term rosacea management, a comprehensive approach is more effective, including:
- Gentle skin care
- Sun protection
- Trigger avoidance
- Intermittent use of prescription treatments as needed If your rosacea symptoms persist or frequently recur, consult with your dermatologist about developing a personalized maintenance plan, which might include periodic courses of ivermectin rather than continuous daily use, as suggested by a head-to-head comparison study where ivermectin 1% cream was compared to metronidazole 0.75% cream in a 16-week trial, showing that ivermectin provided superior results compared to metronidazole 1.
From the Research
Ivermectin Cream for Rosacea
- Ivermectin 1% cream is a topical agent indicated for the once-daily treatment of inflammatory lesions of rosacea 2.
- It has anti-inflammatory properties and broad-spectrum anti-parasitic activity, which contribute to its efficacy in treating rosacea 2, 3.
- Studies have shown that ivermectin 1% cream is effective in improving the symptoms of rosacea, including reducing inflammatory lesion count and improving health-related quality of life 2, 4, 5.
- Ivermectin 1% cream has been compared to other topical treatments, such as metronidazole and azelaic acid, and has been found to be more effective in some cases 4, 5.
- The cream is well-tolerated, with common treatment-related adverse events including skin burning sensation, pruritus, dry skin, and skin irritation, each occurring with low incidence (<2%) 2.
Long-Term Use of Ivermectin Cream
- Extension studies have shown that ivermectin 1% cream continues to provide benefit for up to 52 weeks of treatment 2.
- However, relapse after discontinuation of treatment is common, with about two-thirds of patients relapsing within 36 weeks 4.
- More research is needed to establish the clinical benefit of ivermectin's acaricidal action in preventing relapse compared to other non-etiologic treatment approaches 4.
Daily Use of Ivermectin Cream
- Ivermectin 1% cream is approved for once-daily use 2.
- There is no evidence to suggest that using ivermectin cream more frequently than once daily is necessary or effective 2, 4, 5.
- In fact, using ivermectin cream as directed (once daily) has been shown to be effective in improving the symptoms of rosacea and is well-tolerated 2, 4, 5.