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This just published article is describing some clinical work has been concluded that proposes using topical Ivermectin (Soolantra) to treat ocular rosacea. Soolantra so far has only been approved as a treatment for the papules and pustules of rosacea.
Soolantra is thought to be effective against rosacea because of its anti-demodex and anti-inflammatory properties.
The paper is authored by Martin Schaller, from the Department of Dermatology, Eberhard Karls University Tuebingen in Germany. Dr. Schaller is known to rosacea sufferers through his research into a new way to diagnose rosacea, and how Soolantra works.
We can see from the above photos at baseline, 14 weeks and 35 weeks that the patient enjoyed significant relief from their symptoms. We also learn that their demodex mite count dropped to zero.
The Demodex mite count using Standardized Skin Surface Biopsies (SSSB) prior to therapy was 21 mites per cm2. After 14 and 35 weeks of monotherapy with 1% ivermectin daily no mites could be detected.
Dr. Schaller was a member of the Bayer, Galderma and Marpinion advisory board during the past 2 years and has received lecture fees from AbbVie, Bayer Healthcare, Galderma and La Roche‐Posay.
Dr. Schaller was kind enough to provide a copy of the paper as only the title is available online.
Treating Ocular Rosacea with Soolantra
The paper describes the following treatment regimen;
The patient was instructed to apply one small pea size (approximately 1 gram) of cream on the forehead, chin, nose and cheeks (i.e. a total of 5 pea-sized amounts).
The product was to be spread in a thin film over the entire face. In addition, he was asked to apply one half pea-sized amount on each closed eyelid and next to the lid edges while carefully avoiding the eyes.
So you can see the instructions are to apply the Soolantra cream to the closed eyelid, around the lid edges, but not on the eye as irritation will occur.
A new Ocular Rosacea Treatment?
Hopefully this research might lead to another viable ocular rosacea treatment. Professor Schaller points out, though, that a large randomised clinical trial is needed before this result can be confirmed and a new ocular rosacea treatment approved.
Successful therapy of ocular osacea with topical ivermectin.
M. Schaller, K. PietschkeBr J Dermatol. 2018 Mar 12. doi: 10.1111/bjd.16534. [Epub ahead of print]
Soolantra Off Label
This is an example of an off-label treatment that may be of benefit to rosacea sufferers. Doctors are allowed to prescribe prescription-only treatments for conditions for which they were not offically FDA approved, on the condition that they take into consideration the known risks. All drugs have risks and you need to be sure that you understand the additional risks you may be exposing yourself to from an off-label usage. See Off Label Treatments for Rosacea for more information.
This would so be welcome as I’m tired of resorting to Minocycline. Is Soolantra available in Canada?
Answering my own equation, Soolantra is sold as Rosier in Canada.
In addition to severe ocular rosacea, I have an allergy/ sensitivity to the preservatives used in otc eye drops for dry eyes. I can use the preservative free individual ampoules. My condition has been well controlled for two years using the following:
I am on Doxycycline USP 40 mg capsule – one a day. My ophthalmologist prescribed preservative free eye drops Dexamethasone .01% which I have compounded every two weeks and I use one drop in each eye at bedtime
I use ocusoft baby eyelid wipes to wash my lids ( I was sensitive to adult preparations) in the morning followed by gauze wipes and warm water. ( I found that the detergent residue on face washers caused breakouts).
At night I use gauze and warm water to wash my eyelids.
During the day, I use the individual ampoules of eye drops for dry eyes ( “Refresh Optive Advanced” is my favorite.) If my eyes become itchy during the day, I do a gentle lid scrub with gauze squares and warm water.
Hope my treatment success might translate to success for someone else!
You could potentially cure the condition in just 2 weeks with oral ivermectin+oral metronidazole and avoid potential damage to your eyes, corneas and meibomin glands. The 2 oral drugs are available as generics about $13 with insurance or about $52 full retail. The oral treatment will work to quickly kill the mites in the glands. The topical treatment is only effective on the surface of the skin as you cannot put it in the glands or follicles. That explains why the topical treatment takes so much longer than the oral treatment. The 2 treatment protocols together could be even more effective.
The oral treatment is much cheaper than Soolantra which will cost the insurance company or uninsured patient over $500 per tube. The oral treatment might not be recommended for some patients depending on their drug tolerance and health issues.
The combined oral treatment worked for me.
https://www.sciencedirect.com/science/article/pii/S120197121201315X
Will ask my ophthalmologist; this looks quite promising. Did you feel any side effects especially from the metronidazole?
Thanks, Elaine!
No, I didn’t have any side effects. You cannot drink alcohol while taking the oral metronidazole and for 72 hours after finishing the last tablet. Good luck!
So is this a continuous treatment or for X number of days? Either wayI’m feeling encouraged that through you and John Lafarge, relief may be near..especially for my eyes.
Yes, this is a 2 week treatment. It is 2 doses of oral Ivermectin taken 1 week apart on an empty stomach with a large glass of water. The doses of Ivermectin are based on your weight. 200 micrograms per Kilogram of body weight. For me, the dosage worked out to 12mg or oral Ivermectin per dose. At the same time you take oral Metronidazole 250 mg, 3 times a day for the 2 week time frame (no alcohol while taking the oral metronidazole for the 2 weeks + 72 hours after last tablet). Then you are done!
I had occular rosacea/blepharitis demodex for years. It was misdiagnosed as allergic conjunctivitis. I finally figured out what the real problem was when it got really bad last year. That is when I found that paper. The oral treatment worked. I am six weeks post treatment. Eyes and skin are clear. Hope this helps!
Hi Frank,
I’ve been on Rosiver for almost 2 years. Worked for me. Noticed dramatic improvement in 10 days. I am now on a maintenance plan and use it twice a week.
Redness around forehead, cheeks and eyes is completely gone.
I had a bad demodex problem. Mites are now killed.
All the best.
Much appreciated John, Thanks!
Elaine, looks like I may have difficulty obtaining oral ivermectin. Called my local pharmacy and sure enough they can only get under special approval.Will have to convince my Doc. In ematime I’ll ask hi to prescribe Rosiver.
https://www.theglobeandmail.com/news/national/why-world-beating-tropical-drugs-are-so-hard-to-get-incanada/article33469954/
Frank,
My family doctor prescribed the oral treatment for me when I explained the problem with the mites. I had been using Cliradex wipes which really helped. But I could not stop using the Cliradex or the mites came right back. The oral treatment really helped – for me the mites were really entrenched in my eye lids and skin. I’m at 6 weeks post oral treatment and still clear..
The Soolantra should help in the meantime. Some people have been able to use just the topical and clear them. I hope which ever solution you end up with, it works!
Good Luck!
Elaine
Hi Elaine. I know this is a very old post but hope it reaches you. I have just started this treatment and I was wondering if the results were permanent for you? It’s hard to find others who have tried the combined oral treatment. Thank you so much
Hi Alma,
Yes, I am still clear at 3.75 years post Oral Ivermectin + Oral Metronidazole combined drug 2 week treatment. I understood by the Oral Ivermectin worked, it killed the demodex. I had to do more research to understand why the Oral Metronidazole helped, I realized that I had Small Intestinal Bacterial Overgrowth (SIBO) for decades misdiagnosed as “Gee, it must be a bug or something you ate”. I never connected my long time persistent gut issues with the skin and eye issues. Unfortunately, neither did my doctors. They were all misdiagnosed as 3 unrelated problems.
SIBO causes the immune system in the gut to malfunction leading to a demodex overpopulation on the skin. The demodex causes the surface issues with Rosacea Subtype 2 with papules and pustules. The demodex also cause blepharitis demodex in the eyes also known as ocular rosacea or Rosacea Subtype 3. Oral Metronidazole cured my SIBO. The Oral Ivermectin killed off the demodex overpopulation bringing relief in just 2 weeks for my eyes and skin. I only recently ran into articles about SIBO and rosacea connection. I realized that not only had my skin and eyes cleared but all the intestinal issues were gone as well. Oral Metronidazole is highly effective against at least 2 of the bacteria known to cause SIBO. Its also highly effective against H. Pylori bacteria than has been associated with stomach ulcers and Rosacea Subtype 1. Some strains of H Pylori are resistant to Oral Metronidazole and may require a different antibiotic to treat it these days. Doctors in Europe discovered in the 1980’s that Oral Metronidazole was really effective for their Rosacea patients but at the time they did not know why it worked. Depending on the type of bacteria causing the SIBO, a different antibiotic may work better for other people with SIBO. There are 8 to 12 different strains of bacteria that can cause SIBO.
Small Intestinal Fungal Overgrowth (SIFO) has the same symptoms as SIBO but is caused by a fungus instead of a bacteria. A person can have SIBO and/or SIFO. Both can be treated with oral drugs.
Good luck, I hope the treatment helps you as much as it helped me! If not you may want to get tested for SIBO and SIFO to determine if one or both of them are causing the problem A different antibiotic and/or an oral antifungal drug may work better for the specific bug(s) causing your issues. An endoscope test is the gold standard for diagnosing the specific cause of SIBO and/or SIFO.
Wow, I can’t tell you how much it means to me that you replied! Thanks so much for all of this information. I have not heard of this but I will look into it further. I’ve never had GI issues before but you never know. The stress of the eye problems I’ve had have turned me into a hypochondriac and I’m so paranoid about side effects from the metronidazole and it’s causing some anxiety. But I saw in your earlier comments that you didn’t have any side effects so that’s great to know. I’m wrapping up day 3 of the 14 day treatment. Do you happen to remember how long it took for your eyes to improve?
Correct, I had no side effects at all. I did always make sure to take the Oral Metronidazole with food which avoided any stomach side effects.
Make sure you take the 2nd dose of Oral Ivermectin on the 8th day of treatment – The oral Ivermectin is the one dose per week drug. Any demodex eggs that hatch after the first dose of Ivermectin killed the adult demodex need to be wiped out too – so they cannot breed more. My eye condition was very severe, eyelashes falling out, and eyes were super dry. My eye oil glands were severely clogged up. I had this problem literally for decades. So for me the eye improvement happened over a period of months.
What really helped me in the short run was to use the Thermalon dry eye moist heat compress that you can warm for 10-20 seconds in the microwave. The Thermalon dry eye moist heat compress is available at most drugstores like Walgreens, other home stores and online. The first time I used the warm eye compress. it caused a thick grey line of debris to ooze out of the eye meibomian oil glands. I was astonished. Use the warm compress several times a day can really help clear the clogged eyelid oil glands. It will help them work better. In the meantime, a moisturizing eye drop like Systane Balanced or Bausch and Lomb Soothe XP, etc. can really help moisturize severely dry eyes. These are natural tears formulas plus a moisturizing agent, an “oily” film, that help keep the water part of your tears from evaporating as fast. It helps temporarily replace the oily part of the tear film that the meibomian glands in the eyelids should produce when they aren’t clogged up.
Thank you so much for replying and for typing out all of this information and your experience! I really appreciate it. And SO happy this treatment worked for you and you’re doing better now. Fingers crossed it will for me too!
Hi Alm,
I came across your post and am wondering if you might be able to give me an update as to your progress. I too, would like to go this route as my eyes are horribly itchy and I find no relief in any drops. By day end I want to scream! Have you had any side effects from the oral meds? How is your rosacea; clearing hopefully? I do hope this reaches you as I am quite excited by the prospects!
I took the 2 week, 2 drug combined oral treatment with 2 once week doses of Oral Ivermectin along with Oral Metronidazole (250 mg, 3 times daily with food, no alcohol). I am still clear nearly 4 years later. I’ve been doing more research reading medical papers as to why the the Oral Metronidazole works.
In short, Small Intestinal Bacterial Overgrowth (SIBO) occurs with a high rate among people with Rosacea Subtypes 2 (with papules and pustules) and 3 (ocular rosacea also known as blepharitis demodex). Oral Metronidazole is highly effective at treating at least 3 of the 8 or more types of bacteria known to cause SIBO.
Some medical studies have shown that the very expensive antibiotic Rifaximin was effective for some Rosacea patients. Rifaximin is the go to drug for some types of E. Coli infections. E. Coli is another bacteria that can cause SIBO. Oral Metronidazole is available as a very inexpensive generic.
I had SIBO for decades misdiagnosed as “gee, it must be either a bug or something you ate”. No doctor ever connected it to the skin and eye problems separately misdiagnosed as bacterial acne and allergic conjunctivitis. One I took this 2 week, 2 drug treatment all 3 conditions cleared up.
Most of the human immune system is in the gut. SIBO and its fraternal twin condition, Small Intestinal Fungal Overgrowth (SIFO), both suppress the body’s ability to control microscopic demodex skin mites. The demodex get overpopulated as a result. The demodex are what’s causing the surface skin and/or eye issues for people with these types of rosacea. Kill the bacteria that is causing the SIBO and it allows your immune system to return to normal and control the demodex.
The Oral Ivermectin is excellent for quickly killing off the overpopulation of demodex.
SIBO and SIFO may occur separately or together. SIFO requires treatment with oral anti-fungal drugs. SIBO requires antibiotics. The correct antibiotic needs to be prescribed for the type of bacteria causing the SIBO. There is a screening breath test for SIBO. The best test is an endoscope test that collects a small sample of fluid from the small intestine. The fluid is cultured to identify the bacteria and/or fungus causing the skin and eye issues.
Some people prefer to treat with more natural remedies and probiotics. A very healthy diet, high in fiber and low in sugar can help. Adding probiotics either through food and/or supplements can also be beneficial. The diet approach can work but it also can take longer.
After 12 months on Doxycycline (Australia) and a stomach ulcer to show for it, I have used 2 x tubes of Soolantra over 6 months. I have completely cleared my Rosacea, apart from a few small bumps that arise ONLY when my ulcer has been playing up – if i’ve had a bad stomach guaranteed the Rosacea flares up. I am now using my third tube of Soolantra, twice a week on maintenance plus a few dabs on the occasion Rosacea spot as spot treatment. I wish I had tried this cream prior to going on the Doxy, I would have literally saved my stomach. Whilst I understand how debilitating this condition is, my thoughts are to AVOID all oral medications and give Soolantra a go first.
Hi , did you find that you broke out in bumps and spots straight from using soolantra and if so how long for ? I recently posted that I’m in week 5 and my skin has been alot worse wondered how long it was till you started seeing improvements .
Great thanks I’ll try and get the face wash thank you
I have had red checks for almost two years I have tried slontra,finacea, avene redness, rofade and some I can’t remember. Can someone please tell me what had cleared there redness up on there face??
Try colloidal silver topically as well as orally. It worked great for taming the redness. I make my own now, but you can purchase Sovreign Silver at Walgreens (they will order it for you if not in stock). It’s about $20 for an ounce. Expensive in the longterm, which is why I bought my own machine to make it myself. Don’t worry about it turning you blue, which only happens to people who extremely consume it over many, many years time. Smaller particle ionic silver doesn’t collect in the body which is what Sovreign Silver is. Research it for yourself. It has so far healed my ear infection, eye infection, a sore on my dog, my hubby’s eczema. I take about an ounce daily as a preventive. Try it! What do you have to lose!
Comments via facebook posting.
“This is encouraging, but soolantra is overpriced. Ivermectin can be purchased cheaply at the farm store….maybe I could make a topical.”
“Ivermectin cream 1% (sold as rosier in Canada) ‘cured’ my rosacea. A 60g tube sells for $193 CN but luckily I have an insurance plan so it costs me $40. I only use it now for flare-ups so a tube lasts 10 months. It took about 2 months initially to get the rosacea under control.”
“I used it for my ‘periocular dermatitis’. Or at least that’s what name the dermatologist gave it. Soolantra ‘cured’ my pd and rosacea.”
“Soolantra has cured my rosacea. I used daily for 6 MO I now use nothing no flares no problems.”
“I use Soolantra and it is SERIOUSLY the miracle cream!”
“Soolantra gave me my “life” back”
“After using Soolantra for two weeks, the skin on my face was as soft as a babies behind. I’m not kidding! after four weeks my breakouts stopped. I’m also on a low dose of doxycycline. I do have a lot of red capillaries under my skin so I will have to see if I need them zapped once summer is here.”
“LOVE Soolantra – I have tried Minocycline in past and this time took it and 1 week in had a horrible reaction (purpura) – Soolantra has made my skin soft and within 2 weeks almost all red is gone and skin is close to normal”
“Expensive and didn’t help me”
” I used it for 10 days last May, my skin felt like it was on fire. Had a reaction to the mixing agent, took 3-4 days to recover after discontinuing”
Does anyone know where to purchase oral ivermectin? Thanks!!!
“I paid $85… it was a huge outlay.. but on the chance it worked i save up the money.. it has helped me.”
I’ve had ocular rosacea for 9 years now and have tried everything from Tetracyclines (Minomycin), Lipiflow, IPL (both E-Eye and Lumenis), tea-tree oil cleansers and currently 1% Ivermectin cream. My eyes reacted to the additives in Soolantra when I used it on my face so would not be willing to use it on my eyelids, but I have recently had 1% Ivermectin cream compounded here in Australia with a simpler base. I have been using it for 2 weeks and so far it has only had a marginal effect but it may be useful for others on this forum. The compounding pharmacy is the Wesley Pharmacy in Brisbane and the base they use is Versapro which I believe does have a bit of preservative but not all the additives of Soolantra and much less expensive. A Sydney pharmacy told me they have compounded it in an eye ointment base as well.
Hi , I’ve had rosacea for 2 years I’ve tried so many things but nothing has worked to date . I was given soolantra I’m on my 5 week I’ve experienced more cyts bumps ,whiteheads ect than I was getting before everyday I’m getting a new one is this normal or should i stop using it
It sounds like you are having a major die off of demodex skin mites. If so, that is a very good thing and it means the Soolantra is working. The mites are dying. I would keep using it. The mites live and die on a 14-24 day cycle. Its important to keep using it through at least 2-3 cycles to make sure all the eggs the last batch laid are dead. The first die off is usually the worst. The population should be dropping sharply. If you stop too soon they can rebound. Keep using it as long as the doctor prescribed it usually 12-16 weeks (3 or 4 months).
Thank you so much for replying, I hope you are right it hasn’t seemed to been any better yet if any thing over the 5 weeks maybe worse but I’ve been told to use it till April so I will try to persevere
I agree with Elaine. Keep at it. I had a terrible breakout including red patches but persevered. One trick I think helps in my case is, after properly washing away the facial soap (I use Cetaphil’s PRO DERMACONTROL Oil Control Foam Wash), I do a last rinse using cold water. Pat dry, wait 5 mins then apply the cream. My skin is smoother, less ruddy, whiteheads are no more and redness lessened.
At the 3rd month I went from once daily to every other day with no relapse. In February it’ll be 4 months after which I’ll decrease the frequency further to perhaps every 2nd or 3rd day.
Thank you for your advice I will look for the face wash I really appreciate it
Can I ask you at which point in to using soolantra did the papules stop appering on a daily basis for you ,it feels like a daily battle at the moment ?
I’d say by month 2, papules and pustules (most prominent on my nose) had waned considerably. Only thing which is not going away are red patches on both nostrils. I may do a 2 week course of Blephamide; the same Blephamide prescribed for blepharitis which contains steroid and sulphur.
I’m assuming you’re at week 6 so keep at it. I’ll cheer you on if need be 🙂
Thank you so much for answering my message and for your support I really appreciate you taking the time to get back to me
Odd, logged me in with wordpress instead of Facebook. Oh well…
I am in Brazil and a laboratory here has made up a 1% Ivermectin plus 2% Telangyn cream for my ocular rosacea treatment, 30 ml cost was $77 no prescription required. I will post back once I have started the treatment.
https://pubmed.ncbi.nlm.nih.gov/34173370/
New study for ocular rosacea