Dual anti‐inflammatory and anti‐parasitic action of topical ivermectin 1% in papulopustular rosacea

Abstract

Topical ivermectin 1% cream acts by a dual, anti-inflammatory and anti-parasitic mode of action against rosacea by killing Demodex spp. in vivo, in addition to significantly improving clinical signs and symptoms in the skin.

Papulopustular rosacea and rosacea‐like demodicosis: two phenotypes of the same disease?

“…A more probable hypothesis is that the numerous mites are responsible for both conditions and that these two ‘entities’ should therefore be considered as two phenotypes of a single disease. This would explain the similar symptoms, similar histology, similar Dds and the similar response to the same acaricidal treatment . This hypothesis is also compatible with other arguments that support the active role of Demodex in rosacea …”

Antibiotic Resistance Considerations of Importance to Clinical Dermatologists

“…[30][31][32][33][34] As a result, many of the studies of therapies used to treat rosacea (eg tetracyclines, azelaic acid, ivermectin) especially with presence of papulopustular lesions, appear to affect inflammatory pathways/modes of action unrelated to an underlying bacterial trigger that appear to be operative in rosacea pathophysiology (eg inhibition of matrix metalloproteinases, downregulation of cathelicidin pathway, reduction in number of Demodex mites). [35][36][37][38][39][40][41][42][43] The large body of evidence supporting an inflammatory pathogenesis of rosacea that is not triggered by a bacterial etiology has led globally to rosacea management recommendations supporting that avoidance of an antibiotic effect whenever possible is favorable in order to reduce the emergence of antibiotic-resistant bacteria. [44][45][46][47] In their rosacea medical management guidelines, the American Acne & Rosacea Society stated the following: "The lack of data supporting a bacterial component definitively related to the pathogenesis of rosacea suggests overall that medical therapies which are anti-inflammatory in nature are best considered for initial treatment of rosacea, especially the inflammatory (papulopustular) subtype, with oral antibiotic agents used in cases that are poorly responsive to a reasonable trial of topical therapy and/or oral anti-inflammatory therapy".…”

“…44 To achieve this, available topical agents with demonstrated anti-inflammatory effects, efficacy, and safety in rosacea would include azelaic acid and ivermectin. 41,42,[44][45][46][47][48][49] Sub-antibiotic dose doxycycline (such as the modified-release 40 mg capsule once daily or 20 mg immediate-release tablet twice daily) provides anti-inflammatory effects with efficacy and favorable safety for rosacea, without inducing antibiotic selection pressure. 40,[44][45][46][47]50 …”

Successful therapy of ocular rosacea with topical ivermectin

“…A dual anti‐inflammatory and antiparasitic effect of topical ivermectin cream (Soolantra ® , Galderma Laboratories, Fort Worth, TX, U.S.A.) in papulopustular rosacea has recently been demonstrated . A highly significant reduction of Demodex mites and inflammatory genes, in addition to a decrease in protein expression, was observed within 6 weeks of treatment .…”

“…A dual anti‐inflammatory and antiparasitic effect of topical ivermectin cream (Soolantra ® , Galderma Laboratories, Fort Worth, TX, U.S.A.) in papulopustular rosacea has recently been demonstrated . A highly significant reduction of Demodex mites and inflammatory genes, in addition to a decrease in protein expression, was observed within 6 weeks of treatment . As both cutaneous and ocular rosacea are associated with elevated counts of Demodex mites and thereby frequently occur concurrently, we sought to evaluate the effect of topical 1% ivermectin in a 50‐year‐old man with papulopustular rosacea and blepharoconjunctivitis without corneal involvement.…”