Ivermectin is a versatile medication that comes in various forms, but its cream formulation has a specific and important role in dermatology. The 1% topical cream, often sold under the brand name Soolantra, is a prescription-only product that has become a key treatment option for a specific type of rosacea.
What is ivermectin cream?
Ivermectin is a macrocyclic lactone, a class of drugs known for their anti-parasitic and anti-inflammatory properties. When formulated as a 1% topical cream, its primary purpose is to address inflammatory skin conditions, particularly rosacea. Its mechanism of action is multifaceted, addressing potential root causes of inflammation rather than simply masking symptoms.
The primary use: treating papulopustular rosacea
The most prominent and FDA-approved use for ivermectin 1% cream is for the treatment of inflammatory lesions caused by papulopustular rosacea. This subtype of rosacea is characterized by persistent facial redness, as well as red bumps (papules) and pus-filled pimples (pustules). By applying the cream to the affected areas, patients can experience a significant reduction in these inflammatory symptoms.
Benefits for rosacea include:
- Reduction of bumps and pimples: Clinical studies have shown ivermectin cream to be effective at reducing the number of inflammatory lesions.
- Decrease in facial redness: While primarily targeting papules and pustules, the cream's anti-inflammatory properties can also help lessen overall facial redness.
- Improvement in quality of life: By effectively managing the visible symptoms of rosacea, ivermectin cream has been shown to improve the patient's overall quality of life.
How ivermectin cream works on the skin
The exact mechanism for how ivermectin cream improves rosacea is not fully understood, but it is believed to be related to its dual action as an antiparasitic and anti-inflammatory agent. The theory points to the role of Demodex mites and the inflammatory process they may trigger.
Mechanism of action:
- Targeting Demodex mites: People with rosacea often have a higher density of Demodex folliculorum mites in their skin's hair follicles compared to those without the condition. Ivermectin is a potent agent against these microscopic parasites. By killing the mites, it reduces the inflammatory response they cause.
- Reducing inflammation: Beyond its antiparasitic effect, ivermectin also has direct anti-inflammatory properties. It inhibits the expression of certain inflammatory mediators in the skin, which helps to calm the redness and swelling associated with rosacea.
Off-label uses and other applications
While FDA-approved for rosacea, ivermectin cream has been used off-label for other conditions based on its antiparasitic and anti-inflammatory properties. Off-label use refers to prescribing a medication for a condition or dosage other than what it was initially approved for. Such use is legal but should always be done under the direct supervision of a healthcare provider.
- Scabies: Ivermectin cream has been used topically as an off-label alternative for treating scabies, including in certain cases for newborns. Studies comparing its efficacy to permethrin have shown comparable results in many cases of uncomplicated scabies.
- Perioral Dermatitis: Some case reports suggest ivermectin cream can be an effective treatment for perioral dermatitis, a rash around the mouth. The condition's potential links to microbial factors, similar to rosacea, may explain its effectiveness.
- Head Lice: It is important to note that a different formulation, ivermectin 0.5% topical lotion (Sklice), is used to treat head lice infestations, not the cream.
Potential side effects
Like all medications, ivermectin cream can cause side effects, though they are generally mild and uncommon.
- Burning or stinging sensation: A transient burning or stinging at the application site is one of the most frequently reported side effects.
- Skin irritation or dryness: Some patients may experience mild skin irritation, itching, or dryness during treatment.
- Allergic reaction: Though rare, a severe allergic reaction can occur, with symptoms like rash, swelling, or difficulty breathing.
Comparison of topical rosacea treatments
| Feature | Ivermectin 1% Cream (e.g., Soolantra) | Metronidazole 0.75% or 1% Cream (e.g., MetroGel) | Azelaic Acid 15% Gel (e.g., Finacea) |
|---|---|---|---|
| Mechanism | Antiparasitic (Demodex mites) and anti-inflammatory. | Anti-inflammatory, reduces reactive oxygen species. | Anti-inflammatory, reduces microbial growth. |
| Application | Once daily. | Twice daily. | Twice daily. |
| Efficacy | Often superior to metronidazole for inflammatory lesions. | Effective for inflammatory lesions, less effective than ivermectin in studies. | Effective for inflammatory lesions and some redness. |
| Tolerability | Generally well-tolerated, low incidence of irritation. | Can cause mild irritation and application site discomfort. | Can cause burning, stinging, and irritation. |
| Cost | Can be more expensive than generic metronidazole or azelaic acid. | Less expensive generic alternatives are widely available. | Costs can vary; often more expensive than metronidazole. |
| Onset | Improvement often seen starting around 4 weeks. | Improvement may take longer to appear. | Variable onset of action. |
How to apply ivermectin cream safely
To ensure proper use and maximize effectiveness, follow these guidelines provided by your doctor and the manufacturer's instructions, such as those found on the FDA website for Soolantra.
- Cleanse the skin: Wash the affected areas of the face with a mild, non-irritating cleanser and pat dry before application.
- Apply a small amount: Use a pea-sized amount of cream for each affected area of the face (forehead, nose, chin, each cheek).
- Spread a thin layer: Apply the cream evenly in a thin layer across the skin.
- Avoid sensitive areas: Do not apply the cream to the eyes, lips, or inside the nostrils.
- Wash hands: Always wash your hands thoroughly after applying the medication.
Conclusion
Ivermectin cream serves as an effective, once-daily prescription treatment for the inflammatory lesions of papulopustular rosacea. Its unique combination of antiparasitic and anti-inflammatory action addresses key factors potentially driving the condition, such as Demodex mites and underlying skin inflammation. While its primary and approved role is for rosacea, evidence suggests its utility in off-label applications like certain types of scabies and perioral dermatitis. Despite its general tolerability, patients should be aware of potential side effects and adhere strictly to a healthcare provider's instructions for safe and effective use. As always, a doctor should be consulted for proper diagnosis and to determine the most appropriate treatment plan for your specific skin condition.
