Ivermectin (topical)

Evidence by route

About this ingredient

Topical Ivermectin is an antiparasitic drug from the avermectin group. Systemically (oral) used since the 1980s against onchocerciasis and strongyloidiasis (Nobel Prize 2015). In dermatology – topical 1% cream (Soolantra by Galderma) for papulopustular rosacea, FDA-approved 2014, EMA 2015. In Spain – Soolantra (Galderma) prescription-only in pharmacies, in dedicated packaging. Mechanism. Paralyzes Demodex folliculorum and Demodex brevis mites, which show increased skin density in rosacea. Additionally – anti-inflammatory action by suppressing LPS-induced IL-1β and TNF-α expression in keratinocytes and monocytes. Both mechanisms likely act together. Where applied. Papulopustular rosacea (subtype II by NRS classification), perioral dermatitis, demodicosis. Used once daily in the evening as a thin layer on affected skin. Course 3-4 months, sometimes repeated. Evidence base. Stein 2014, Taieb 2015 RCTs (910 patients, 16 weeks) – ivermectin 1% outperforms metronidazole 0.75% in reducing inflammatory papules and pustules (~75% vs 65% IGA success). Cochrane review 2019 (van Zuuren) – ivermectin 1% is second-line drug after azelaic acid 15% in papulopustular rosacea. Safety. EMA SmPC: burning, erythema, peeling in first 1-2 weeks in 10-20% of patients (Stein 2014). Resolves spontaneously. Systemic absorption is minimal – no risks typical of oral ivermectin. Pregnancy – FDA category C, in EU "not recommended" (EMA SmPC). Systemic oral ivermectin in pregnancy is contraindicated. Topical EU and US data are limited, but with minimal absorption the risk is considered theoretical. Lactation – use with caution (EMA SmPC). Alternatives in pregnancy: azelaic acid 15-20% (topical), zinc picolinate.

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