From the Guidelines
Ivermectin 1% cream is a highly effective treatment for rosacea, particularly for inflammatory lesions, as demonstrated by its ability to reduce Demodex mite density and improve cutaneous inflammatory markers 1. The treatment has been shown to be effective in clinical trials, with a pivotal phase 3 trial demonstrating that 38.4% and 40.1% of subjects achieved treatment success, defined as an Investigator's Global Assessment (IGA) score of "clear" (0) or "almost clear" (1) at 12 weeks, compared to 11.6% and 18.8% in the vehicle groups 1. Key benefits of ivermectin 1% cream for rosacea include:
- Reduction of Demodex mite density and improvement of cutaneous inflammatory markers 1
- Clinical improvement in inflammatory lesions of rosacea, with 16 out of 20 subjects achieving an IGA score ≤ 1 (clear or almost clear) in a 12-week pilot study 1
- Fewer adverse effects, such as skin dryness, compared to vehicle groups 1
- Efficacy and safety comparable to azelaic acid 15% gel in 40-week extension studies 1 Treatment with ivermectin 1% cream should be applied once daily to affected areas of the face, with a pea-sized amount typically sufficient for the entire face, and continued for at least 12 weeks to see optimal results 1.
From the Research
Efficacy of Ivermectin for 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.
- Topical ivermectin 1.0% cream has anti-inflammatory and acaricidal activity against Demodex mites, which may contribute to its efficacy in treating papulopustular rosacea 3.
- Ivermectin has been compared to metronidazole, with ivermectin being more effective in terms of improving symptoms and preventing relapse 3.
Mechanism of Action and Combination Therapy
- Ivermectin's mechanism of action involves anti-inflammatory and acaricidal properties, which may provide a more etiologic approach to treating rosacea 4.
- Combination therapy with topical ivermectin cream and systemic doxycycline may provide an optimal treatment approach for papulopustular rosacea, targeting multiple inflammatory pathways 4.
Monitoring and Treatment Outcomes
- Novel smartphone technology, such as Scarletred®Vision, can support monitoring rosacea-associated signs and symptoms, including erythema and invisible symptoms like stinging and burning 5.
- Ivermectin 1% cream has been shown to improve not only papules and pustules but also erythema and invisible skin symptoms, with significant reductions in stinging, burning, dryness, and itching 5.
Clinical Use and Expert Opinion
- Topical ivermectin 1% cream has emerged as a novel agent for the treatment of papulopustular rosacea, with a potential role as a single or combination agent 6.
- Despite its efficacy, poor adherence to topical ivermectin 1% cream remains an issue, highlighting the need for education and support to optimize treatment outcomes 6.