Ivermectin clears Untreatable Rosacea

Written by on October 23, 2007 in Demodex Mites, Ivermectin, Papules & Pustules with 4 Comments

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.

Recalcitrant papulopustular rosacea in an immunocompetent patient responding to combination therapy with oral ivermectin and topical permethrin

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.

Further Extracts

A 68-year-old healthy man presented with a 6-year history of PPR recalcitrant to multiple therapies, including topical and oral metronidazole, doxycycline, and erythromycin. The patient reported occasional pruritus but no flushing.

He had been treated unsuccessfully with permethrin cream 5%, and skin scrapings from prior examinations revealed Demodex infestation.

Physical examination demonstrated numerous erythematous papules and pustules with associated scale on his face, ears, and upper neck. Skin biopsy showed acute and chronic folliculitis with numerous Demodex organisms.

A diagnosis of rosacea like demodicidosis was rendered.

Because of the previously failed response to permethrin monotherapy, a combination of oral ivermectin 12 mg once weekly for 2 weeks and permethrin cream 5% applied 3 times weekly was prescribed. The permethrin cream was continued for 3 months for maintenance.

The patient misunderstood the dosage instructions and actually took 3 mg daily of oral ivermectin for a total dose of 24 mg. At 3-month follow-up, he showed marked improvement and sustained this response for at least 9 months.

The pathogenic role of D folliculorum in rosacea is controversial and a clear separation between rosacealike demodicidosis and rosacea exacerbated by Demodex infestation often is difficult to establish. In our patient, however, the diagnosis of demodicidosis mimicking rosacea is more appropriate.

The presence of pruritus and perifollicular scaling, lack of flushing, demonstration of Demodex organisms with associated folliculitis on histopathology, and the patient’s dramatic response to antimite therapy after several conventional rosacea therapies were unsuccessful all support the diagnosis of rosacealike demodicidosis.

Ivermectin is an acaricidal agent that has been successful in the treatment of scabies, lice, and helminthic infections, but is not US Food and Drug Administration approved for use in human mite infections.


Our patient was recalcitrant to multiple therapies, including permethrin cream 5%; however, the combination of oral ivermectin and topical permethrin resulted in substantial clinical improvement of his rosacealike demodicidosis.

When Demodex infestation is demonstrated in a patient with PPR and the patient is recalcitrant to standard rosacea therapy or permethrin monotherapy, oral ivermectin in combination with permethrin cream 5% should be considered as a safe and effective therapeutic option.

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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4 Reader Comments

  1. Geri Healy says:

    The new rosacea treatment, Soolastra is $300, and my insurance won’t cover it. Ivermectin is available at most farm supply stores. How can I make my own??

  2. Rosy Cheeks says:

    Buy the paste in the long box made for worming horses (make sure ivermectin is the only active ingredient–there are others). When you open the box, you will notice that the dispenser is marked for various weights. Human and horse dosing is the same by weight (200 mcg/kg), so just dose according to the markings for a hypothetical very small horse with your same weight. Works great for me . . .

  3. Hugh Gass says:

    Dear Dr, Rosy
    You might want to have your Dr. (or you can problably do it yourself) do a Lepto titer and urine PCR then treat yourself for lepto after taking horse medicine that was quite likely contaminated with rodent urine/droppings during mfg. Check out “Moon Blindness” good studies show cases after ivermectin deworming. Make sure you spread the word how you screwed your FDA, Drs, pharmacists, healthcare system with your internet degree.

  4. Dr Jarns says:

    Soolantra is a topical cream. I use Ivermectin Paste Dewormer by Durvet and it costs like $6.20 per tube. It is an apple flavored oral paste for horses that I use topically. It is 1.87% Ivermectin compared to 1% in Soolantra but it seems to be very effective and I have read many positive results from other people that have tried it as well. It is a little greasy so I put it on before bed rather than in the morning on the effected areas on my face from rosacea.

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