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Soolantra Is a New Topical Treatment for Rosacea

The FDA has approved an intriguing topical cream (Soolantra) from and old drug (ivermectin) that shows promise as a treatment for rosacea.

Rosacea is sometimes also called acne rosacea, although it is not at all the same condition as adolescent acne. Rosacea typically appears in adulthood, making cheeks and forehead red and creating fine red lines under the skin. The condition may often result in pimple-like blemishes as well. The eyes and nose can also be affected. A fascinating drug called ivermectin may offer an interesting treatment for rosacea.

W.C. Fields and His Famous Nose!

Chronic irritation and inflammation can lead to an enlarged, bulbous nose. W. C. Fields is often cited as the poster boy for this condition, called rhinophyma. It is not something to make fun of. You can see what it looks like by going to this link (Eplasty, May 1, 2015)

Most dermatologists will admit that there is no obvious cause of rhinophyma. It used to be believed that overindulgence in alcoholic beverages could cause a deformed nose. That is now considered bogus. The article in Eplasty notes: 

“Historically, rhinophyma was erroneously considered to be linked with alcohol consumption because substances such as alcohol and caffeine can cause local vasodilation, which worsens the symptoms. This alleged association with alcohol has caused much social stigma and loss of self-esteem in patients suffering from the disease, with several nicknames for the condition such as ‘whiskey nose’ and ‘rum nose.’”

A Range of Treatments for Rosacea

There are many possible treatment for rosacea, but not everyone benefits from each intervention. Some people get relief using dandruff shampoo to cleanse the face. Here is an in-depth review of selenium sulfide in shampoos such as Selsun Blue. While this may help some people, others need a more aggressive approach.

The FDA has approved a fascinating cream (new for this use, though an old drug) that may be of interest.

Q. I have suffered with rosacea for a long time. People always stare at my blemishes and red face, which makes me extremely self-conscious. My doctor prescribed Metrogel, which had no noticeable impact on the pimples or on the redness. Is there a more effective medication?

Please do not recommend a home remedy. I have tried several to no avail.

A. We understand your reservations about home remedies. Such approaches are rarely, if ever, tested scientifically.

You may want to ask your dermatologist about a prescription cream called ivermectin (Soolantra). This medication was originally developed as an oral drug to treat a terrible parasitic disease called river blindness (onchocerciasis). It also works against many other parasites and has been used widely in veterinary medicine for worm infestations.

When used topically as a cream or lotion it has been found to be effective against scabies, lice and the mites (Demodex) that may trigger inflammatory rosacea skin reactions. A study suggests that ivermectin performed a bit better than metronidazole (Metrogel) in reducing rosacea symptoms (Springerplus, July, 2016).

Sadly, the drug is pricey. Without insurance, you might pay more than $200 for a tube of Soolantra, though the company (Galderma) does offer an online coupon.

A Disconcerting Treatment for Rosacea:

Q. I have suffered from rosacea for years. After I used metronidazole for too long and found it ineffective, my doctor recommended Soolantra.

When the drug store wanted $298 for a little tube, I researched the main ingredient (ivermectin). You can get a large tube of ivermectin paste at twice the strength for about $2.50 or less from veterinary supply stores. It’s used to treat horses for various types of worms.

My red skin is caused by Demodex mites. I think that is why ivermectin worked like magic for me.

The paste is quite drying, though. After a while, I was able to dab the ivermectin just on my red spots instead of my whole face. I also change my pillowcases every night and wash them in hot water to kill the mites.

A. Rosacea is an inflammatory skin condition characterized by redness and bumps. Demodex mites, which are normal inhabitants of facial skin, sometimes trigger this inflammatory response (Dermatology and Therapy, Dec. 2020). 

Ivermectin is an anti-parasitic drug that is active against scabies mites and lice. The FDA approved topical use of ivermectin for the treatment of rosacea a few years ago. As you discovered, however, the brand name cream is shockingly expensive.

We cannot approve of ever using veterinary products! The higher concentration might cause unexpected complications. Generic ivermectin cream is now available at substantial savings. You may want to ask your dermatologist to prescribe the generic formulation.

A Meta-Analysis of Ivermectin:

An article in the journal Dermatologic Therapy (Jan. 2020) concluded:

“This meta-analysis gives strong evidence that ivermectin is the most effective topical treatment. Besides, this agent provides the greatest psychological benefit as it satisfies the stigmatization of rosacea patients as well as the impairment of social and working life with a sustained better QoL [quality of life] above other alternatives.”

photo credit M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara under CC license 2.0 (original photo cropped)

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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  • Siddiqui, K., et al, "The efficacy, safety, and tolerability of ivermectin compared with current topical treatments for the inflammatory lesions of rosacea: a network meta-analysis," Springerplus, July 22, 2016, doi: 10.1186/s40064-016-2819-8
  • Husein-ElAhmed, H. and Steinhoff, M., "Efficacy of topical ivermectin and impact on quality of life in patients with papulopustular rosacea: A systematic review and meta-analysis," Dermatologic Therapy, Jan. 2020, doi: 10.1111/dth.13203
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