Ivermectin (also known as Soolantra) is in my experience the most effective topical treatment for inflammatory, papulopustular rosacea.
Ivermectin operates through a powerful dual mechanism. First, it is recognised that patients with rosacea tend to have more demodex mites within the skin. Ivermectin is a highly effective antiparasitic agent that eradicates the overpopulation of Demodex mites removing a trigger for inflammation. Second, independent of its mite-killing abilities, ivermectin possesses profound intrinsic anti-inflammatory properties that directly soothe the reactive immune pathways within the skin tissue.
It is applied once daily (typically at night) and is usually very well tolerated. During the first two weeks of treatment, it is possible to experience a temporary worsening of symptoms. If effective it can be continued indefinitely.
