How is Ivermectin used in dermatology ? This recently published paper is of interest because it mentions the possibility of treating rosacea with ivermectin (stromectol).
Sadly there is but a sole reference to treating rosacea with Ivermectin ; and whats more, this paper is not new to us. The research that this paper references was brought to our attention by Dr. Linda Sy in 2000 (see demodex mites ivermectin effective treatment ?). In her 2000 post Dr. Sy gave us the full text of that paper. Note that the cited 1999 paper refers to just one patient and there remains no published double blind study linking eradication of demodex by ivermectin to rosacea relief.
So this 2005 paper is interesting from the point of view of the general applicability of ivermectin to skin diseases, but doesn’t add to the rosacea/ivermectin story.
Another bit of history from the archives was the promotion of an anti-mite treatment called kwellada lotion that contains 5% permethrin. This was followed by several reports of bad reactions to this treatment.
The status of demodex folliculorum and its role in rosacea is still an open area of study. It has been difficult to prove that there is or isn’t a link between the mite and rosacea. In my mind, demodex mites remain as an innocent bystander.
Ivermectin: pharmacology and application in dermatology
International Journal of Dermatology, Volume 44 Page 981 – December 2005. Pharmacology and therapeutics, Assen L. Dourmishev, Lyubomir A. Dourmishev, and Robert A. Schwartz
Abstract: Ivermectin is a synthetic derivative of the antiparasitic class of compounds known as avermectins. It is a macrolide endectocide with activity against both endoparasites with cutaneous tropism (Strongyloides stercoralis, Ancylostoma braziliense, Cochliomyia hominivorax, Dermatobia hominis, Filaria bancrofti, Wucheria malayi, Onchocerca volvulus, Loa-loa) and ectoparasites such as Sarcoptes scabies, Pediculus humanus, Demodex folliculorum, and Cheyletiella sp. Ivermectin is of great interest in the treatment of patients with different forms of scabies, head lice, demodecidosis, cutaneous larva migrans, cutaneous larva currens, myiasis, and filariasis.
Ivermectin has a structure similar to that of macrolide antibiotics, but without antibacterial activity. It is used against a wide range of endoparasites (nematodes) and ectoparasites (insects, acarine) of animals and humans. The interest of dermatologists in ivermectin therapy grew when promising results were observed in the treatment of human ectoparasitoses such as scabies.
Mode of Application in Humans
Contraindications to ivermectin therapy are allergic sensitization, nervous system disorders, pregnancy, and lactation. Ivermectin therapy should not be recommended for children younger than 5 years or less than 15 kg in weight.
Application in Dermatology:
Ivermectin is used in dermatology against some parasitic infestations in humans with cutaneous tropism. The drug is of great interest in the treatment of patients with different forms of scabies, human body lice, head lice, demodecicosis, cutaneous larva migrans, cutaneous larva currens, myiasis, and filariasis.
Others diseases with probably parasitic origin
A patient with follicular, papulopustular rosacea-like eruption with a long history of unsuccessful treatment also responded to the ivermectin therapy.
Safety and Adverse Reactions: The 20-year ivermectin history of effective control for millions of people suffering from microfilarial diseases indicates that it is an extremely safe drug. The results from several trials of ivermectin in the Onchocerciasis Control Programme in West Africa show a low prevalence of adverse reactions, most of which were mild and transient. Severe reactions were observed in only 1.83% of 50,929 treated patients. Transient and mild adverse reactions have been reported in 24% of filarial disease patients, with signs and symptoms including anorexia, asthenia, headache, arthralgia, myalgia, fever, and eosinophilia.
Conclusions: Oral ivermectin treatment offers several advantages over standard therapy of scabies, pediculosis, demodecidosis, larva migrans, myiasis, filariasis, and other parasitic infestations with cutaneous tropism. More studies are required to precisely define the optimal therapeutic uses for ivermectin in dermatology.