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Topical Antiparasitic — Rosacea Pregnancy: Avoid — limited systemic absorption but insufficient safety data in pregnancy; azelaic acid preferred for rosacea in pregnancy

Ivermectin Cream (Topical)

Brand names: Soolantra

Adult dose

Dose: 1% cream — apply a pea-sized amount to each of 5 facial areas (forehead, chin, nose, each cheek)
Route: Topical
Frequency: Once daily
Max: Once daily application
Indicated for moderate-to-severe papulopustular rosacea in adults. Superior to metronidazole 0.75% in head-to-head trials (ATTRACT). Mechanism: anti-inflammatory and antiparasitic (kills Demodex folliculorum mites — implicated in rosacea pathogenesis). Onset 4 weeks; full effect 12 weeks.

Paediatric dose

Dose: Not applicable topical/kg
Route: Topical
Frequency: Once daily
Max: Not established in children
Not licensed in children for rosacea

Dose adjustments

Renal

No dose adjustment required (topical)

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Not licensed in children for rosacea

Clinical pearls

  • ATTRACT trial: ivermectin 1% cream superior to metronidazole 0.75% cream in reducing inflammatory lesion count and IGA success rate — now considered first-line topical by many guidelines
  • Demodex folliculorum hypothesis: density of Demodex mites is significantly higher in rosacea patients — ivermectin's antiparasitic mechanism directly targets this
  • Oral ivermectin (200 mcg/kg single dose) is used systemically for scabies and strongyloidiasis — completely different indication and route from topical Soolantra
  • NICE CKS: both metronidazole and ivermectin are recommended for papulopustular rosacea; ivermectin preferred for moderate-severe disease
  • Maintenance therapy: rosacea is chronic; long-term topical treatment reduces relapse rate — IGA should be assessed at 12 weeks to confirm response
  • Combine with oral doxycycline 40 mg MR for moderate-severe disease — topical ivermectin + oral doxycycline is effective combination

Contraindications

  • Hypersensitivity to ivermectin

Side effects

  • Skin burning/stinging (transient)
  • Skin irritation
  • Dryness
  • Pruritus

Interactions

  • Negligible at topical doses

Monitoring

  • IGA score at 12 weeks
  • Skin tolerability

Reference: BNFc; BNF 90; ATTRACT Trial (Taieb et al. Br J Dermatol 2015); BAD Rosacea Guidelines 2017; NICE CKS Rosacea. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways