In this case report of one patient, the papules and pustules of rosacea were difficult to treat until oral ivermectin was included in the treatment regime.
This 2007 paper is similar to a 2002 paper, Treatment of rosacea-like demodicidosis with oral ivermectin and topical permethrin cream. The 2002 paper is also a case report of a single patient with recalcitrant symptoms.
Note that topical permethrin may well be too harsh for many rosacea sufferers. Back in 2000, a a project that proposed using topical permethrin was suddenly canceled after reports surfaced of strong negative reactions to permethrin.
I would suggest that these results are the exception rather than the rule when approaching how to treat your rosacea.
Cutis. 2007 Aug;80(2):149-51., Allen KJ, Davis CL, Billings SD, Mousdicas N. Indiana University School of Medicine, Indianapolis 46202, USA.
A 68-year-old healthy man presented with papulopustular rosacea (PPR) recalcitrant to multiple therapies, including permethrin cream 5%. Histologic examination detected the presence of chronic folliculitis and numerous Demodex organisms. A diagnosis of rosacealike demodicidosis was rendered, and the patient was treated with oral ivermectin and permethrin cream 5%, resulting in resolution of the folliculitis. Demodex infestation should be considered in any patient with rosacealike dermatitis resistant to conventional rosacea therapies. If infestation is demonstrated in these patients, oral ivermectin in combination with topical permethrin is a safe and effective therapeutic option.
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