Rosacea is a chronic skin condition that affects millions of people around the world. People who have it often find it hard to manage the redness, irritation and bumps that come with it. Despite how widespread it is and the impact it can have on people’s lives, the exact causes and definitive treatments remain elusive. However, one surprising treatment that has shown real promise for rosacea is ivermectin cream. In this article we explore what ivermectin is, how it works for rosacea and the best way to add it to your skincare routine.
What is Ivermectin?
Ivermectin is an antimicrobial drug that has had wide uses for decades, most famously against parasitic infections. Researchers first developed it in the 1960s for veterinary purposes, and it quickly found its way into human medicine thanks to its effectiveness against various parasitic diseases including worms. More recently, it has gained ground in dermatology because of its multifunctional effects. The main actions on the skin that make ivermectin attractive include the following.
- Antiparasitic: Ivermectin targets and eliminates parasitic organisms such as Demodex mites, which are common in conditions like rosacea and demodicosis. It is also highly effective against scabies mites. It works by binding to the parasites’ nerve and muscle cells, which paralyses and eventually kills them.
- Anti-inflammatory: Through its strong anti-inflammatory effects, ivermectin reduces redness, swelling and irritation. This makes it particularly useful for inflammatory conditions like rosacea and seborrheic dermatitis.
- Antibacterial: Ivermectin also has mild antibacterial properties that can reduce the bacterial overgrowth often linked to skin irritation or secondary infections. Because these antibiotic properties are mild, ivermectin is most useful where bacteria and inflammation coexist.
- Antioxidant effects: Emerging research suggests ivermectin may have antioxidant properties that help neutralise free radicals and reduce oxidative stress. If further research confirms this, it could mean ivermectin supports overall skin health and helps prevent premature skin ageing.
How Does Ivermectin Work for Rosacea?
Rosacea is a complex condition, but two factors very likely drive its symptoms. These are inflammation and an overgrowth of Demodex mites on the skin. These microscopic organisms live in the hair follicles and sebaceous glands. They are harmless in most people, but in excessive numbers they can irritate the skin and trigger the redness, swelling and acne-like bumps typical of rosacea.
In 2014, the FDA approved ivermectin 1% cream (sold as Soolantra) for papulopustular rosacea. This subtype shows up as persistent redness, swelling and acne-like bumps. It can be both physically uncomfortable and emotionally distressing, which makes effective treatment important. Two properties make ivermectin effective here.
- Antiparasitic: Ivermectin targets and eliminates Demodex mites, significantly reducing their numbers. By tackling this root cause, it helps minimise the irritation and inflammation that their overgrowth brings.
- Anti-inflammatory: Beyond its antiparasitic action, ivermectin has potent anti-inflammatory effects. These calm redness and swelling, which promotes more healthy and resilient skin.
What are the Benefits of Ivermectin for Rosacea?
Ivermectin has quickly become one of the most popular treatments for rosacea, and with good reason. By targeting both the underlying triggers and the resulting inflammation, it can deliver visible improvement over time. For many people this means fewer flare-ups, less redness and smoother, more even-toned skin. The key benefits of ivermectin for rosacea include the following.
- Targeted action: Unlike general anti-inflammatory treatments, ivermectin tackles one of the root causes of rosacea, the Demodex mites.
- Ease of use: As a topical cream, ivermectin is easy to apply and slots into most skincare routines.
- Fewer side effects: Compared with oral treatments, ivermectin cream is less likely to cause systemic side effects.
- Long-term results: Many people see ongoing improvement with consistent use, and it is safe for prolonged use.
How long results take varies from person to person, so patience matters with ivermectin. Some people notice improvement within a few weeks, but most only see significant results after 8 to 12 weeks of consistent use. The gains also tend to build up gradually. Over time, you may find your skin becomes less reactive and your flare-ups less frequent.
Where Do You Get Ivermectin?
First of all, this is a prescription-only medication. To get ivermectin cream you will need to consult a doctor or other medical provider who can assess your skin and decide whether it suits your rosacea or other concern. They may prescribe Soolantra, which is the licensed treatment, or some doctors may recommend a compounded formulation of ivermectin cream. Specialised pharmacies typically prepare compounded rosacea treatments, and these can be tailored to your skin or combined with other ingredients like azelaic acid or metronidazole. Your provider should then offer regular follow-ups to track your progress and adjust your plan as needed.
How Do You Use Ivermectin in Your Skincare Routine?
Adding ivermectin to your routine is fairly easy, but it is vital to follow your prescriber’s instructions on frequency, amount and length of the course. A typical protocol usually looks like the following.
- Cleanse properly: Start with a gentle, non-stripping cleanser, ideally one free from harsh fragrances, alcohol or exfoliating acids, since these can irritate rosacea-prone skin. Cleansing twice a day, morning and evening, removes dirt, oil, skincare and makeup.
- Apply ivermectin as directed: After cleansing, pat your skin dry with a soft towel. Take the prescribed amount and apply it evenly to the affected areas, usually once daily in the evening unless your doctor advises otherwise. Avoid broken or irritated skin, and keep the cream away from your eyes and mouth.
- Moisturise: This is crucial for maintaining hydration and supporting your skin barrier, especially if your skin feels dry or tight. Choose a product made for sensitive skin to minimise irritation.
- Protect: In the morning, always finish with a broad-spectrum sunscreen of at least SPF 30. Sunscreen matters even more for rosacea-prone skin, since UV rays can trigger flare-ups and worsen redness.
- Do not go rogue: Use ivermectin exactly as prescribed. Overuse will not speed up results and could cause irritation, which actually sets you back.
What are the Safety & Side Effects?
Ivermectin is generally safe and effective for many people with papulopustular rosacea. Like any medication, though, it can cause side effects. Common ones include the following.
- Temporary skin dryness
- Mild redness or irritation
- A sensation of warmth or stinging after application
These symptoms are usually mild and settle as your skin adjusts. Rarely, more serious problems such as an allergic reaction can occur, which is why a patch test first is important. If you have severe or persistent side effects, consult your treating doctor. Ivermectin may also not suit everyone, including the following.
- People with ocular rosacea (affecting the eyes) or erythematotelangiectatic rosacea (redness without bumps) may need alternative treatments.
- People with sensitive skin need to take care, since irritation can occur at first.
- Doctors generally do not recommend ivermectin skincare during pregnancy or breastfeeding unless they specifically advise it, since its safety in these settings is not fully established.
What are the Alternatives to Ivermectin for Rosacea?
Although ivermectin is a highly effective treatment for some types of rosacea, it is not the only option. Depending on your symptoms, skin type and severity, your dermatologist may recommend other treatments, either on their own or combined with each other or with ivermectin.
- Topical metronidazole: This anti-inflammatory cream has been a mainstay in rosacea treatment for years. It is particularly good at reducing redness and inflammation, and doctors often use it for milder cases or alongside other therapies.
- Azelaic acid: This versatile ingredient is known for its anti-inflammatory, antimicrobial and skin-brightening properties. It can reduce redness and bumps whilst improving overall texture, which makes azelaic acid an excellent alternative or companion to ivermectin.
- Niacinamide: A soothing ingredient with anti-inflammatory properties, niacinamide strengthens the skin barrier and reduces redness. It works well alongside prescription treatments like ivermectin.
- Tretinoin: Low doses of tretinoin can help rosacea by improving texture, promoting cell turnover and reducing inflammation. However, tretinoin can be irritating, so it needs careful introduction under guidance.
- Oral antibiotics: Doctors often prescribe low doses of medications like doxycycline for more severe or widespread rosacea. They work by reducing inflammation and calming flare-ups.
- Laser and light therapy: For persistent redness, visible blood vessels or flushing, treatments like pulsed dye laser (PDL) or intense pulsed light (IPL) can be highly effective. These target the blood vessels beneath the skin to reduce redness.
Ivermectin treats a wide range of skin conditions including rosacea, scabies, demodicosis, lice infestations, acneiform eruptions and seborrheic dermatitis. This comes down to its many benefits, including its ability to target parasites and calm inflammation. It is a valuable treatment for pustular rosacea, since it offers a targeted and easy-to-use option for a complex, multifactorial condition. That said, ivermectin is not a miracle cure or a silver bullet. It does not suit everyone or every type of rosacea, and it may not be enough on its own. As such, always seek help from a medical provider who can help you start the best treatment for you.
At City Skin Clinic, we are passionate about personalised skincare. We offer custom compounded treatments with prescription-strength ingredients including ivermectin, metronidazole, tretinoin and hydroquinone where appropriate. Our doctors treat a range of conditions including rosacea, acne and scars, hyperpigmentation, melasma and skin ageing via bespoke compounded treatments designed around you. Book a video consultation or start your online consultation today. Your journey towards great skin starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical professional with any concerns about your skin or treatment options.
