20 September, 2017

Ivermectin or Soolantra as a rosacea treatment

This blog is aimed at rosacea subtype 1, with skin flushing, redness and burning. But very often these division lines for categories are not holding up, and I get pimples and outbreaks too. Never long lived and not very often, but it seems interesting to also focus now on a rosacea treatment that aims to treat the pimples and skin outbreaks from rosacea. The product is called IVERMECTIN. It has been on the market for a long time already as a medication that is effective against many types of parasites. It is also used to treat conditions like head lice, scabies and river blindness.
But recently, topical ivermectin (Soolantra) has been approved by the FDA for treatment of the inflammatory lesions of rosacea. Researchers (Stein et al) reported back in 2014 that ivermectin 1% cream was safe and effective for the treatment of inflammatory lesions from papulopustular rosacea, based on 2 randomized, controlled, double-blind, identically designed studies of ivermectin 1% cream versus vehicle applied once daily for 12 weeks.

Ivermectin comes in a pill (powder) or cream form and can be either applied to the skin or taken by mouth (the eyes should be avoided). Applying it topically is what is approved now for rosacea, but some people have also taken ivermectin in pill form already, under doctors guidance, with success. It has been a topic of interest on the Rosacea Forums for well over a decade now, as an experimental treatment option for the pimples that rosacea can cause.

Long has it been debated whether or not rosacea could have a bacterial cause, or perhaps a demodex mite cause. It is still not clear what causes it exactly, and it looks like rosacea is a gathering term for a ton of different skin problems that share the same red facial skin symptom, but that can have very different causes, including bacterial infections, demodex mite infestations, auto-immune conditions, allergies, food intolerances, blood vessel disorders and so on. Ivermectin can kill demodex skin mitesDemodex folliculorum as they are officially called, live in the hair follicles and sebaceous glands of the facial skin. There are two types, demodex folliculorum live in hair follicles, primarily on the face, as well as in the meibomian glands of the eyelids; demodex brevis live in the sebaceous glands of the skin (the skin areas that naturally are producing more oil/sebum). They are a natural part of the human skin and part of a natural balance with bacteria and other microorganisms, but science has highlighted recently that people with rosacea have more of these skin mites than people with normal functioning skin; up to four times as many demodex mites, in fact. And it has also been suggested that people with rosacea have an abnormal immune skin reaction to these mites, which causes our skin to break out, turn red and itchy.

Patients with demodicosis may have eye irritation, itching and scaling of eyelids (blepharitis or eyelid dermatitis). There may be lid thickening, loss of lashes (madarosis), conjunctival inflammation and decreased vision. Also dry eyes, reddened, crusty, itchy, burning eyelids, abnormal eyelash growth and inflammation of the cornea [keratitis], abnormal corneal blood vessel growth [neovascularization], and the development of nodular bumps of scar tissue on the cornea.
Increased numbers of demodex mites have also been observed in the following conditions:
Demodex folliculorum – rough skin due to increased scale within hair follicles; slight redness and sandpaper-like texture of the skin due to follicular scale. It can cause irritation and burning sensation.
Demodectic frost of the ear – frosted, gritty follicular scaling of the ear lobe and helix
Rosacea, particularly asymmetrical papulopustular or granulomatous variants
Some cases of perioral dermatitis (also affecting periorbital or periauricular sites)
Otitis externa (auricular demodex) 

A 2012 Chinese meta-analysis found that people with acne vulgaris had almost three times the likelihood of demodex infestation. Because the mites have an aversion to light, they conduct most of their business at night and crawl back into the hair follicles in the morning, causing skin itching then on the eye lids or skin.

The theory now is that people with rosacea, might have a specific skin type that favors demodex colonies to thrive, with skin that has specific lipid qualities that offers the right living circumstances for demodex mites. It is also possible that people with rosacea have a weaker skin barrier function.
Another theory is that rosacea skin itself is the cause of the extra demodex numbers, because rosacea skin is a usually little bit warmer in temperature than 'healthy' skin. And this can be a good breeding ground for different micro-organisms. However, evidence appears to be mounting that an overabundance of Demodex may possibly trigger an immune response in people with rosacea, or that the inflammation may be caused by certain bacteria associated with the mites. Dr. Frank C. Powell, consulting dermatologist at Mater Misericordiae Hospital in Dublin, Ireland, noted that the mites are most plentiful in the same regions of the face that are most commonly affected by rosacea — the cheeks, nose, chin and forehead — and that large quantities of mites have been found in biopsies of rosacea papules and pustules.

But it is also possible that demodex mites are just one part of the puzzle with rosacea, as research has also shown recently that people with rosacea tend to have immune related events taking place inside the body that contribute to rosacea's development, involving such substances as kallikreins, cathelicidins and mast cells. Most rosacea triggers, from ultraviolet light damage to bacterial infections that trigger an immune response in the body, have one thing in common: they have been shown to activate the specific enzyme receptor-2 (TLR-2), which normally is only used to fight off legit enemies for out own health, but in our case they trigger skin inflammation and causes us to develop symptoms of rosacea, including papules (bumps) and pustules (pimples).


The link between Demodex and rosacea has been very controversial for a long time. Partly because it does not explain ALL cases of rosacea. But science has now confirmed that Demodex mite infestation is an important factor in rosacea. It is suggested that it especially plays a role in rosacea subtype 2 with skin outbreaks, bumps and pimples. My own dermatologists have said numerous times to me that for subtype 1 with flushing and burning, demodex mites play no role. However, even this might be old news, as researcher Dr. James Del Rosso, adjunct clinical professor of dermatology at Touro University College of Osteopathic Medicine in Henderson, Nev. states:

“The classic ‘subtypes’ of rosacea appear to reflect variations in inflammatory and immunologic responses which in some cases may be induced by Demodex mites. For example, in one study, individuals with erythematotelangiectatic rosacea (subtype 1) were found to have higher facial counts of Demodex mites than those with papulopustular rosacea (subtype 2). It has been suggested that the higher Demodex counts lead to degradation of the follicular wall as the mites attempt to improve their survival. This loss of follicular wall integrity then triggers an immunologic response that reduces the number of Demodex mites, with papules and pustules subsequently emerging from the augmented perifollicular inflammation that occurs.”

Dr. Fabienne Forton, a dermatologist in private practice in Brussels, Belgium, suggested both an indirect and a direct role for the mites themselves in the development of the disorder. Skin infections and disruption of the skin barrier stimulate toll-like receptors to induce cathelicidin production, and the complaint of sensitive skin in rosacea patients often disappears when the number of mites is reduced to normal by treatment, she noted.

I take from this quote that the diagnostic evidence for a possible demodex mite infection would still be the presence of papulas and pustulas, even for subtype 1 patients. I have read patient reviews for a year now on Ivermectin or Soolantra cream and users mentioned that apart from their pimples, the overall redness of the skin also decreased. This in itself could make Ivermectin potentially a treatment option for subtype 1 as well. An if I can go by the statement of dr. James Del Rosso, subtype 1 rosacea sufferers have been found to often (sometimes?) ALSO have demodex infestations, and found to have even higher counts of demodex mites than those with rosacea subtype 2. However, research on this topic just started and scientists declare themselves that more research is needed to get to the bottom of all this. Not everyone is convinced that demodex mites are really the culprit here.

Symptoms of demodex skin infestations, called demodicosis, are (small) papules, pustules and fine scaling of the skin. Demodicosis can mimic rosacea symptoms, but usually does not respond at all to traditional rosacea therapy and treatments. it does respond well to treatment options to kill the demodex mites, especially with Ivermectin or Permethrin cream. Other treatments that have been said to have effect are treatment with Borax, Tea Tree Oil, Sulphur or Hypochlorous acid (HOCl). You can best ask your dermatologist to do a skin scraping, and then have your doctor do a mite count under the microscope. He or she can then confirm if you have more than normal numbers of demodex mites on your skin.
Another way of finding out if demodex mites cause YOUR rosacea symptoms to worsen or even to exist at all, is of course to try ivermectin cream for yourself. There is always the risk that some ingredients in it cause a skin reaction, but other than that, a skin clearance on ivermectin cream is another way to self diagnose.

Here you can read many more pubmed research articles on demodex mites. And here is a good comprehensive oversight article on demodex mites and rosacea.

I have seen numerous fabulous success stories now on social media and in rosacea health groups. I cannot and won't use their skin pictures here, but many showed severe skin outbreaks and skin redness before the use of Ivermectin or Soolantra, and near clearance of their skin symptoms after a few months of use. I will gather public user info below, but first explain what treatment options are and what other things can be done about a demodex mite problem.

All reviews are found on public forums and websites, and under 'wrote' (behind user names) are links to the exact source.

Soolantra cream

Soolantra has been brought on the market recently. It uses the good old Ivermectin anti-parasite at 1%, and they have put this active ingredient in a gel base that is similar to cetaphil cream.

SOOLANTRA cream contains the following inactive ingredients:

*carbomer copolymer type B (a hydrophilic thickener; emulsion stabilizer; gel forming)

*cetyl alcohol (an emollient; emulsion stabilizer; thickener - not considered irritating for the skin)
*citric acid monohydrate (a buffering agent; pH adjuster - not considered irritating for the skin)
*dimethicone (antifoaming; emollient; skin protecting - not considered irritating for the skin)
*edetate disodium (chelating agent)
*glycerin (solvent; moisturizer - not considered irritating for the skin)
*isopropyl palmitate (solvent; fragrance; synthetic ester; moisturizer - can be comedogenic)
*methylparaben (Preservatives, Antimicrobial - can irritate the skin in very sensitive skintypes. Parabens, including methylparaben, mimic the effects of estrogen in the human body.)
*oleyl alcohol (surfactant; viscosity control; emulsifier - can be comedogenic and can be a skin irritant)
*phenoxyethanol (preservative; fragrance stabilizer - can be a skin irritant as it dries out the skin)
*polyoxyl 20 cetostearyl ether (hydrophilic emulsifier; surfactant)
*propylene glycol (solvent; humectant; viscosity controlling - safe ingredient but can cause skin irritation or allergy for very sensitive skintypes)
*propylparaben, (Preservatives, Antimicrobial - can irritate the skin in very sensitive skintypes. Parabens, including methylparaben, mimic the effects of estrogen in the human body.)
*purified water 
*sodium hydroxide (pH adjuster)
*sorbitan monostearate (emulsifier; non-ionic surfactant composed of sweetener sorbitol and  stearic acid, a naturally occurring fatty acid.)
*stearyl alcohol (emulsion stabilizer; emollient; foam booster; thickener, composed of sweetener sorbitol and a naturally occurring fatty acid. Can be comedogenic and can be a skin irritant)

Ivermectin cream

Soolantra is a very expensive cream, especially for people who are in the United States or in countries where health insurance does not cover its costs. Soolantra uses Ivermectin as an active ingredient, and all its other ingredients are inactive and therefore not needed. A cheap and eye raising alternative to Soolantra is to simply buy Ivermectin online. It is used for animals including horses as an antiparasite injection, but many dozens of rosacea patients in health groups I am in have so far purchased these creams/injections online and used a small drop of it on their skin daily, with really good results; clearer skin, paler skin. The percentage of Ivermectin is slightly higher in these creams/injections as in Soolantra (1,87% compared to 1%) but dermatologists who I have heard about or from so far have said that this percentage difference should be no problem. If anything, it might work faster, better and for a whole lot less money. These products are available for as little as $5,-. My own doctor prescribed me Soolantra (to try on my red chin and eyelashes and eyebrows that have lost so much hair over time), but the preservative in it or perhaps
another ingredient makes my skin burn. I am therefore trying out an ivermectin injection (I just bought the one in the blue and white picture below here), as it is pure and I can mix a tiny drop with some water and apply it to my eyebrows to see if the red rashes disappear. the same for the scabs on my eyelashes

Each syringe contains: ivermectin - 1.87%
With these injectables, which I will use in a small drop, mixed with water, on my face (NOT inject it in my skin!! That is nรณt the idea of all this), there is a pure form of Ivermectin. No problems of topical ivermectin or Soolantra creams burning or irritating my skin additionally. No chemical smell from the creams used for cattle this way either. And no, you will not end up whinnying or develop a taste for fresh grass :) 

The ivermectin from (horse) injectables or from horse cream will have different inactive ingredients than Soolantra. So if someone had a bad reaction to Soolantra cream, then using the ivermectin might give a better result if the bad reaction was because of some of its other ingredients. But the active ingredient is the same, only slightly higher in % in the horse products. So if Soolantra just didn't work for your rosacea, then chances are slim that ivermectin will work. Btw they are also used for small animals like bunnies and guinea pigs and they are incredibly sensitive to medication, so it is quite safe for humans too :)

Other treatment options

-Benzyl benzoate solution
-Permethrin cream
-Sulfur ointment (for instance ZZ-cream
-Crotamiton cream
-Selenium sulfide wash
-Metronidazole gel
-Salicylic acid cream
-Mercury oxide 1% ointment  (very harsh on the skin, you much better use ivermectin)

Use mild shampoo on hair and eye lashes every day
Cleanse the face twice daily with a non-soap cleanser
Avoid oil-based cleansers and greasy makeup
Exfoliate periodically to remove dead skin cells
Wash sheets and pillowcases in hot water and dry with the hottest possible dryer setting to kill the mites that might otherwise jump from bedding to faces.
Pillowcases should be changed regularly – up to every day or every second day. Pillows should be properly washed with concentrated powder (full cap) and 10-15 drops of tea tree oil in washing machine.
Realize that demodex mites love dead skin cell build up and old make-up:  consider not using makeup for a week, and discard old makeup.
Not washing your face at night or sleeping with make up on your face can make you more vulnerable to an infestation of demodex mites.
Women who wear mascara or a lot of eye make up tend to have a higher prevalence of demodex mites on their eyelashes.

Tea Tree Oil
At high concentrations, tea tree oil is a potent killer of Demodex mites. Scientists discovered that Demodex mites can be killed by 100% tea tree oil application during 4 minutes and by 50% tea tree oil during 15 minutes. The problem is that solutions of 100% tea oil, and even of 50%, are very irritating to the skin and eyes. It should never be applied undiluted, as it can do major damage and is even toxic at this percentage. One possible approach is to thoroughly wipe the eyelashes and eyebrows with a diluted solution of tea tree oil, from 5% to 50%. Be aware of the potential of tea tree oil to really irritate at higher doses. 
In one study, a daily lid wipe with a 5% solution of tea tree oil reduced both the numbers of mites and the perceived itchiness of the eyes. Until recently, tea tree oil was the main method of keeping the mites in check. Duration of treatment should be at least 6 weeks, as demodex mites have a life cycle of 14-18 days, and could be up to 6-12 month in some cases. Tea tree oil seems to not be as effective as Ivermectin in controlling the skin outbreaks, and it also has a higher potential to irritate the skin. I would try Ivermectin before Tea Tree Oil, personally... 

Antibiotics & Steroids
An antibiotic steroid ointment can help prevent the mites from moving. It may even suffocate them. The combination of antibiotics and steroids is also a standard treatment for blepharitis. The steroid reduces inflammation, which is caused by the mites, the bacteria, and treatments like tea tree oil wipes. In addition, the antibiotic helps control the bacteria, but most demodex mites survive applications of metronidazole cream. Also, STEROIDS ARE A KNOWN ROSACEA WORSENER, and can even cause rosacea. This is not a good treatment therefore for people with rosacea. 
Besides, steroids can worsen glaucoma, while chronic use of antibiotics can lead to the development of bacteria that are resistant to the antibiotics.

Hypochlorous Acid
Hypochlorous acid (HOCl) is a naturally occurring substance produced by white blood cells as a first defense against microbial invaders. Its antimicrobial properties were recognized more than 100 years ago, when solutions containing HOCl were used to combat infections in the wounds of soldiers injured in WWI. Only recently, however, has it been possible to manufacture a stable, pure version of HOCl. HOCl has potent antimicrobial properties. Laboratory studies show that it effectively kills the nymph form of the Demodex mites, as well as the Bacillus oleronius and Staphylococcus aureus bacteria that live on eyelids and that are found inside the Demodex gut. In addition, HOCl also neutralizes the inflammatory toxins released by both mites and bacteria. Moreover, unlike tea tree oil, HOCl is completely non-toxic and non-irritating. Amazon and other online companies sell eye drops like these

Permethrin also sometimes can be used against Demodex mites. This medicine originally was used for treatment from scabies. It works similar to Ivermectin. Here is some more info on permethrin for rosacea: 

Galderma released promotional before and after photographs of someone who has used Soolantra for 12 weeks
(please scroll down for Soolantra/Ivermectin user reviews)

Soolantra Before (left) and after (right) Pictures showing a decrease in skin outbreaks.

I have seen many dozens of pictures by now from rosacea patients who posted reviews and personal skin pictures on private social media health groups. These pictures are not to be used on a public blog post, and I had to look for public pictures to illustrate the effects Ivermectin can have on rosacea therefore. But what the many private user pictures have been showing, is that Ivermectin seems to be able to calm skin outbreaks, pimples, p&p's but also background redness and sandpaper-like red skin structure significantly down. Some people showed perfect calm skin with 'normal' skin colour. Others showed good improvement of rosacea symptoms. I have not seen pictures of severe facial flushers who found relief from Ivermectin. Some reviewers have mentioned that their face flushing has stopped since using Ivermectin/Soolantra however. I think that this is a rare result most likely, and users should expect only for Ivermectin to seriously reduce the number of skin pimples and outbreaks and also to bring dry red skin back to a better skin colour and structure. There are people who do not respond well to either Soolantra or Ivermectin. Some people have their rosacea worsened. Many have their rosacea temporarily worsened, as things seem to get worse before they get better (as written above, this might have to do with mite die off processes in the skin). 

(Source) "Having both a bottle of injectable (livestock) Ivomec (10mg/ml, 1% Ivermectin) and Cetaphil cream on hand, I mixed up a small batch to see what would happen. I added 2 squirts of Cetaphil cream and 16 drops of Ivomec to a small stainless steel bowl and mixed them with a small metal spatula.  The two ingredients combined easily with no distinct separation.  I applied the mixture to my face, neck and decolletage.

Observations after 24 hours (3 applications):
Face feels calm - not inflamed. Itching has diminished on face, neck and decolletage but seems more pronounced in my scalp. Small red dots have appeared across cheeks.  Particularly on the right cheek which is the side I sleep on. My dermatologist is up to date regarding Soolantra but was not supportive about my use of Ivomec but put me on to a Permethrin cream for scabies called Lyclear. I've had good results so far but occasionally I have felt the need to use the Ivomec when I can feel excessive mite activity. Cheers, Kate"

(Source) "These pictures take you through the first 6 weeks but I started Soolantra nearly 5 mths ago. I used it every day for 3 months and dropped back to every few days until a recent, low key flare up. So I am currently doing every day. I am nearly at the end of my original tube, so it has lasted quite well! I am so much happier when I look in the mirror! I still have some light redness in my affected patches but I’m comfortable without base makeup again. I did learn some awesome ways to hide the redness with makeup when I choose to, so I will do a follow up post with those tips too. In these pics below I have minimal skin products, perhaps a dusting of powder foundation and maybe bronzer/blush, if anything at all. I really like to show of my new skin and go fairly bare. They are taken in evil supermarket lighting, in the op shop, in natural light, indoor light and even crap selfies. I am so proud of my new skin!!!"

(Source). Caption: "23 days using soolantra. Having less redness but still a lot of bumps. Trying to hang In there hoping it will keep getting better as time goes on."


(Source) "Skin update.  (Using Soolantra) This time last year I was driving back from the doctors crying, with the words "chronic" and "progressive" going round in my head. As OTT as it sounds I will never forget that day and how completely hopeless it all seemed. I haven't done anything different since my last update except I've been out twice this week and had alcohol....I know the hermit has become a social whirlwind lol! ✌️ My face is definitely pinker this week and I have a few new patches of tiny skin coloured bumps on both cheeks but this is a world away from the flare I would have got a few months ago. The only thing that has changed in my life over the last two months is my stress at work is currently zero and this has honestly made me feel like a different person. Perhaps it's a combination of this and my body starting to heal? My main trigger is still the sun and heat and if anything this has got worse, but I live in the UK so I'm not going to worry about again for about eight months lol! (Top) Three weeks ago (Bottom) Today" 

(Source) "Soolantra / heatwave update. I was really nervous about spending a whole day out in the heat yesterday mainly because I've learnt it takes over a week for my skin to recover from a flare. Towards the end of the afternoon my face, neck and arms were beginning to itch like mad and when I got home and took my make up off my skin was quite red with a few new bumps (L). However this morning the redness has gone down a bit and no new bumps so far although it is very blotchy (R). I do feel like I'm now supporting my body in its battle a bit more now and maybe that's starting to show. I obviously wore my SFP50 and my hat when I needed it, but I also stuck completely to my diet and didn't have any alcohol. A few months ago I probably would have thought fuck it and had a few drinks and the wrong food!"

(Source) "Rosacea is a pain in the neck! Finally a medication that works and finished this 6 year saga! [..] Update: I'm still with no more flare ups ever.just that once. I'm everyday grateful for having my skin back and thinking of soon having a little laser tidy up of sub cutaneous burst capillaries which are the ravages of 8 years in hell! I got in just in time people! Only a little orange peel (large open rubbery pores) beginning which is the bodies response to long term skin agro and irreversible!"

(Source) "Die mites ๐Ÿ˜‚ No new bumps since I started using Soolantra and the ones I have are less prominent. My skin is also much softer. Before it was crazy dry and flakey. I am now also taking Olive Leaf Extract and Turmeric capsules. I have absolutely everything crossed right now. Going to try tea tree oil tonight so hopefully I can alternate between the cream and a natural approach long term. (L) Before Soolantra, (M) Day 1, (R) Day 5" 

(Source) "Started Soolantra 3 days ago. Is it normal for things to get worse before they get better?"

(Source) "Severe Oculocutaneous Rosacea in an Adolescent Girl
A, Before treatment with ivermectin. Oral isotretinoin had been discontinued 1 month ago and the patient was using only topical tacrolimus twice daily. B, Resolution of the lesions after a single dose of oral ivermectin. The photograph was taken at the 6-month follow-up visit."

Here are a couple of videos of a lady with rosacea trying out Soolantra, with good results:

Rosacea patients reviews of Soolantra cream and Ivermectin 

There are so many rosacea user posts and questions regarding Ivermectin and Soolantra, that I had to make a small seelection. If you like to really dive into this topic, please go to the site of The Rosacea Forum, make an account and use this search engine to look for posts that deal with either Ivermectin or Soolantra (use both terms as keyword for a post search): https://rosaceagroup.org/The_Rosacea_Forum/search.php

Kayla wrote on March 14th, 2015 about Soolantra: "Miracle cream! Tried everything and this cleared me up in 1 week!"

Dre wrote on July 19th, 2015 about Soolantra: "I don’t have the papules and pustules – just extreme flushing, since I was a teenager. My dermatologist gave me four prescriptions to try and one was soolantra. It has decreased my flushing by 90% and completely changed my life. I was able to start a meetup group (before I avoided social situations) and I no longer flush when I become overheated, anxious, excited, driving in the car, for no reason at all, etc. I think this medicine DOES work with redness – I had no P&Ps at all and I hope they make this forever."

Derik wrote on September 26th, 2015 about Soolantra:
"I agree. I started using just three days ago and was very skeptical. I have the exact same issues as you. No P&P, only extreme flushing and the burning, stinging sensations that comes with. Soolantra has diminished those sensations and my skin feels much less reactive. I still don’t know if this is placebo. I also bought Mirvaso but will not use it if this amazing progress continues."

He updated on November 12th 2015: "I would say I’ve been through about 4 tubes in 6 months. I don’t seem to need or use a full tube per month. The soolantra is still working perfectly for me. If I do miss a day or two I notice it immediately with increased redness. I don’t notice any dryness, peeling or tenderness anywhere. Sometimes if I miss a night I’ll put it on the next morning. I had a *horrible* reaction to the Mirvaso – it turned only the areas I applied ghost-white and then I had even more reactive and extreme flushing in all other areas and rebound redness. I’d say flushing has been a big problem for me for 18 years! There are so many of us out there struggling with this. My life was so different before I started the soolantra!!"

Anthonyavery wrote on March 20th, 2017 about Soolantra: "I love this Soolantra! I’ve been on it for like 6 months and the redness has been reduced by 98%. I still get the weekly pimple so using Accutane. The question is when do I stop using Soolantra?"

Patrick wrote on December 25th, 2014 about Soolantra: "In my experience as a test subject for this compound it significantly reduced redness."

Ciara wrote on July 9th, 2016: "Hey, the 3rd week with Soolantra was not so successful for me.. More p&ps and overall the face feels less calm than in the previous weeks. But skin is still better than before starting Soolantra."

Hope please...wrote on July 13th, 2016: "So first week done. when I put it on, I don’t know whether it’s a placebo or not for me so far – but it does feel calmer; it doesn’t aggravate at the very least. 2 episodes of bad flushing so far this week. one very bad one. at work there’s a room i have to go into sometimes and it’s very hot – always makes me flush. still made me flush badly, but i’ll see how it goes further on treatment. Other time bad flush was after I washed with sulphur soap after a few hours – which is drying. in the past sulphur has calmed my skin. i’ve had sulphur soap for probably 2 years. back then, i didn’t know about demodex and how the condition gets worse before it get’s better when a correct treatment is hopefully picked, so i gave up on it. i started using sulphur soap on and off again the past month, which has probably altered where i am in the demodex cycle compared to if i had just started soolantra with no sulphur before. i’m going to quit the sulphur for now, and just do soolantra for the course. my gp didn’t want to prescribe the soolantra so i was lucky to get it. i don’t know if she’ll prescribe it again. has anyone else had that problem with gp’s? i’m also coming off sage as it was giving unbearable side effects (thujone free sage doesn’t agree with me either) and starting seabuck thorn oil it’s blurred showing which treatment will work/ not work i know, but i’m just pressing ahead. cheers"

She updated on September 20th, 2016: "11 weeks tomorrow. No difference in flushing than before the start of treatment. I’ll probably only post here again if there is an improvement."

Andrea Newton wrote on September 20th, 2016: "Been using soolantra for nearly six weeks but I’m still getting bumpy skin on my chin, really fed up with it all."

Key69 wrote on April 27th, 2015: "To my best understanding, Soolantra is less like a medication, and more birth control from mites. I believe, if you have a Demodex issue, Soolantra will benefit your condition regardless you have P&P's or not. Some people experience temporary flares when old mites die off, and their bodies leave bacterial, causing added inflammation.  Comparatively speaking, I've found Soolantra to be the lesser of some evils when up against other topicals.
I've been e-mailing, and researching, and in most cases, if you use Soolantra, you'll see "something" around day 24, and 45 of use, due to the life cycles of the mites (although different species of mites can survive different durations).  Now, I'm not saying this is "how it is", this is just what some of my conclusions are. Best wishes too all.

Well, I'm on my final week of Soolantra, and I'm unimpressed. The red spots that came up have faded a lot, but are still kind of there, who knows when another will arise...The reason I began this cream is to try and mitigate my redness, which it hasn't done ANYTHING for. From many peoples experiences, Soolantra worked great; their condition reacted within the first couple weeks. Mine hasn't. I believe my condition isn't linked with Demodex (obviously), but maybe by some miracle this week, the Soolantra will kick in ): I've been putting it on after my nightly shower, if that makes any difference or not... I hope I'm not discouraging anyone against trying soolantra, but in my case, it has been more hurt then help thus far."

RedRecluse wrote on August 19th, 2017: "I am 99% convinced that Rosacea Subtype 2 is Demodectic Rosacea, caused by Demodex Mites. The 'traditional' and commonly known Rosacea, Subtype 1, is not caused by Demodex Mites. It is a 'vascular' and caused by mostly unknown reasons, not Demodex Mites. Please read here. If you still have pustular breakouts, then you really ought to move onto ZZ Cream (correctly at night)."

Kfranke wrote on August 19th, 2017: "As far as I've read, we still don't actually know for sure if subtype 2 is caused by demodex mites or not. I think the theory seems pretty promising, though, as I am one of the many on here who has had success treating my subtype 2 with Soolantra. I believe it has helped with the redness on my cheeks, too. Of course, I'm using red/amber light in conjunction with Soolantra, so the improvement in redness may be due to the light, but I think that in general, decreasing inflammation in your face will at least somewhat bring down redness. Personally, I never experienced the "die off" that you all refer to. My condition seems to ebb and flow. One week I'll have no pustles, NONE, and my face will look freaking fantastic. Then sometimes I wake up and there they are, starting up again. Then they'll go away, then they'll come back...it's quite annoying. ๐Ÿ˜’"

Sks42 wrote on August 19th, 2017: "My experience with Soolantra was that it moved really fast with me also. Things would be night and day different sometimes from day to day. It's an interesting experience! I had an obvious increase of pustules within the first 24 hours. I think "dontgiveup" experienced the same thing as far as a very quick increase of symptoms. My first week started with increased pustules within 24 hours and then it peaked at day 6 and 7. My worst weeks on Soolantra were week 1 and week 3."

MariaSt wrote on August 19th, 2017: "I am back after 5 months of using Soolantra. I didn't experience any die-offs. My "healthy" skin areas became even more white, but the problematic areas didn't change. I still had to stick with my diet not to get new p&ps and I even developed one new food sensitivity, to nuts. The good thing with this cream is that it doesn't sting, doesn't smell at all, it isn't drying, hydrates the skin and doesn't clog the pores. But clearly it wasn't the ultimate solution for me. I still encourage anyone with rosacea to try Soolantra as the first line therapy, because of all the pros I mentioned before."

Hls1209 wrote on August 20th, 2017: "I am so on the fence with using the soolantra. I have been using sulfur wash with pretty good results, but it seems like just when I think things are getting under control, I wake up with spots that appeared overnight! If sulfur really does kill mites, then why am I still flaring? It makes me leery to use soolantra when I do have some good days compared to 12 weeks (or more) of die off symptoms that I know I would have to muddle through with the soolantra. Can I assume if I am still having breakouts while using the sulfur wash consistently that I may not have demodex?? Also, is flushing a response to die off or killing the mites? I had flushed more last week than usual, actually for the first time in a while, and sure enough, the breakouts follow, but just on one cheek."

AlbaVF wrote on August 27th, 2017: "Hello,  I also used Soolantra and my face is worse than ever... before I only had a little red zone on my right cheek and now is all over my right side of the face and it is itching a lot, included my neck... I really don't know what to do."

QTee wrote on August 2nd, 2017: "I have been using Invermection cream (aka Soolantra or Rosaver in Canada) for a month. Initially had very good results then a major breakout. Invermectin is very drying. My skin tends to be dry so I need to do some extra hydration to ensure I don't have a problem."

MissM wrote on August 19th, 2017: "I started Soolantra last night. My skin seemed to tolerate the application well...no burning, stinging or flushing. Today I woke up with a bunch (more than usual) of new pustules in my usual breakout spots. Is it possible to have a die off within 24 hours or is this a fluke?"

MissM updated on August 25th, 2017: "Hi Everyone, I just wanted to give an update on being on Soolantra for the past 7 days. Again, I don't have the usual pustules and papules associated with subtype 2 (more of an inflammatory response to demodex), but instead, I believe I have a demodectic condition called pityriasis folliculorum, which symptoms include: dry flaky skin, folliculur scales, and dead skin build up, along with very superficial pustules here and there (maybe like 1-2 on my face at any given time).
I really can't believe what has happened to my skin in the last 7 days. I actually don't want to post this because I'm afraid I'm going to "jinx" my progress. After a year of dealing with flaky, dead skin build-up and sandpaper like texture of the skin.....my skin is FREAKING SMOOTH!!!!! There is still minor white flakes coming out of my pores in some places, but my skin overall has down a 165 degree turn around. I keep running my hands on my cheeks and I can't believe how smooth they feel. I thought my skin barrier was shot due to my subtype 1 rosacea, but it may have been demodex the whole time!!!!  This past week, I still have gotten my usual 1-2 pustules at a time, but they are much less inflamed and go away in record speed (like within 4-6 hours). I have not yet had a major "die-off", but I'm heading into week 2 and 3, so things may change.
Overall, my skin has tolerated Soolantra very well (my skin is SO extremely sensitive that I had big concerns about this). Soolantra seems to actually sooth my skin.  Anyway, I will be posting weekly. I really hope my skin stays this smooth and doesn't build-up again....this is a dream come true, seriously."

MissM updated on September 1st, 2017: "Hi All, I just wanted to post my 14 day update! My skin is completely smooth. All the follicular scaling is gone now. I haven't had a single pustule this week. I don't think I had an initial die-off...at least not yet. The first week I seemed to have more pustules within the first 24 hours of application and then usual breakouts all week, but this week has been smooth sailing. I still experience flushing (I have subtype 1), but the irritation I have experienced in the past has markedly decreased over the course of this past week, and the overall quality of my skin is unbelievably better---it's like my skin barrier is healing. I still have some skin "peeling" or "rolling off" my face around my nose and chin after I wash my face...but not all over my face like before. Anyway, I'll be back to report next week! -M."

MissM. allowed me to post these close-ups of her skin, before (top 2) and after Soolantra use (bottom 2 picture close ups):

MissM updated on September 9th, 2017: "Things are still good! One little pustule at the beginning of this week. It's such a relief to wake up every morning and not be scared to look in the mirror. My skin is smooth and no more flakes at all! Here are some before and after pics (unfortunately, you can't see the flakes in these photos. I tried to take pictures of them, but they just don't show up on my cell phone. However, you can see...no more pustules, yay!).
[..] As I'm typing this, I'm sitting in front of the fan with a monster flush.   If there was only a cream that took away the flushing too!!"

MissM updated on September 19th, 2017: "I only wash my face once per day and then put the Soolantra on in the evening afterward and keep it on until I wash my face again the next evening. Do you wash your face in the evening as well? I'm wondering if there is something in your face wash?? From what I understand, a flare-up from a die-off reaction would be an increase in pustules and papules, not necessarily increase in redness and burning..."

Dontgiveup wrote on August 20th, 2017: "So if I get more pustules vs papules ratio now, it means I am effectively mass murdering my mites? Before treatment I had, like you say, good and bad days. Like 1-2 good days every 3-4 weeks and then BAM they come back.. and I was NEVER able to figure out my triggers, my p&p are really random so, yeah, I'm pretty sure my problem is mites. I just gotta keep myself from putting soolantra twice a day.. Maybe my skin will heal better if I let it breathe. I just want them gone as fast as possible so that i can think of other things than my skin and like, enjoy life.."

Dontgiveup updated on September 11th, 2017: "I completed a month (started on august 10) and I do NOT see improvement yet.. some days I am presentable, but most days i am WORSE than before. I am getting more and more discouraged as it is hard for me to get out of the house when I feel so ugly. The only reason I continue is because I read success stories that took a long time to see results (like Angela in this thread).. but it's soooo hard and I try to avoid mirrors  Ok now i am crying. Soooo fed up i feel like a monster."

Dontgiveup updated on September 11th, 2017"I have papules and pustules mostly on my cheeks and sometimes on chin/nose and rarely on forehead. It is worse on one cheek than the other and its completely different patterns on each sides which makes me think its demodex. And i cant find out my triggers except heat. By worse i mean WAY more spots, and on one cheek they seems to be spreading?! While the other cheek is more stable. On some days they seem more inflamed and lots of white liquid tips (sorry for details) I flush too but i dont mind flushing if i can get rid of the damn p&p. I really don't know if i sould continue, because since i started i feel like crap and dont want to go out in public. I dont know if i can tolerate it much longer  it has negatively impacted my quality of life. But who knows, maybe its just constant die off and i will look normal soon?"

Dontgiveup updated on September 12th, 2017: "What scares me is that i seem to be on a CONSTANT mite die off since i started. This does not follow the regular pattern! I may have had like 3 or for "not so bad" days since i started on august 10. And these days were BY NO MEAN an improvement from before soolantra. I'm getting paranoid now that i am putting myself through this for nothing!! Conceiler might be a really good idea, but i am too scared to make things worse by putting on makeup. And wayyy too embarrassed to go makeup shopping with the state of my skin
Oh and, when did you start to notice initial improvement? After 1 month + 2 days it would have been encouraging to at least see a small improvement. I'm going crazy staying 24h a day in the house. Lucky to be on maternity leave right now and not work for another 5 months!"

Dontgiveup updated on September 12th, 2017: "Only thing I use right now is Soolantra, and i wash my face twice a day with dove sensitive just like before. I dont know why my face is so ITCHY today, normally it just itches briefly in the afternoon on areas i will get new p&p. Some days i don't itch at all and still get p&p. I don't know what kind of die off i am having but it it surely not an allergic reaction because on SOME days i get zero new p&p and the ones i already have flatten. Sunday morning my face was okay, i wasnt embarrassed to go grocery shopping, and then i got a big flare up at maybe 4-5pm... and it got worse on monday, and then worse today. With all that itching i am scared of what i might look like tomorrow.. and i have to get out of the house tomorrow. My SO is not supportive at all, he just came home for his lunch hour and said something about my cheeks. I know he didn't choose me like that 8 years ago, but it's not like it's my fault.. this is life. Things happen!"

Dontgiveup updated on September 13th, 2017: "Little update since my "worst day ever" yesterday: I woke up with NO new p&p, and my face doesn't feel inflamed and itchy anymore. Of course I still have yesterday's p&p, but half of the inflamed papules have shrunk and now have a white liquid tip.
So i still look like a monster, but at least i don't feel like scratching my face off anymore.. i'm REALLY surprised to look a bit better than yesterday, because normally the more it itches, the bigger the flare up. Oh well maybe it's delayed until tomorrow.."

Dontgiveup updated on September 19th, 2017: "Argh this is SO frustrating. Last week's massive angry flare up cleared in a few days, and i had skin better than before during the weekend. And now, another flare up since monday evening. Not as bad as last week (for now) but still, I don't know what to think anymore.. i thought i finally got rid of the bad skin. Should i continue? Thursday i will be starting my 7th week of diligent use and i still flare.. i'm going crazy over this! I actually had hope with the "great" skin i had during the weekend."

Rosacea patients reviews of Ivermectin (Soolantra's active ingredient) 

All the way back in 2008, there was already an Ivermectin trial. Forum member Rachzon wrote about the participation in an IVERMECTIN trial, all the way back on October 4th, 2008: "I have been on an Ivermectin trial for just over a week now with quite positive results. I have moderate Rosacea with frequent papules and pustules. My most recent flare up started in July and had continues until this week when I started the topical Ivermectin. My skin had improved a little after I started applying Megan Gales Invisable Zinc about a month ago but the change in the last week has been quite dramatic. My skin is still far from perfect but as the trial goes for about a year I hope it continues to improve. Initially I was getting about 20 papules on EACH cheek, forehead and even on my neck, so it was pretty ugly, the inflammation was not pleasant either. I have the occasional papule left, the worst place is still on my neck but the texture of my skin is soft, no burning or itching and life is a hell of a lot more pleasant. My 3 year old son hasn’t been patting my cheek and asking me if it still hurts this week either. Looks like those beastly mites have a lot to answer for in my case.

Rachzon updated: "It is a 30 gram tube with what I presume is 1% Ivermectin. [..] I asked about other peoples experiences, they have about 10 on the trial at the Coast and all but one have had results similar to mine. The Derm mentioned that up to this point it has been very hard to treat Papular Pustule Rosacea so is very pleased with these results. [..] 10 weeks I have been on the trial now and my face continues to be fantastic. I get the very occasional bump but it is gone within a few days."

Rachzon updated on October 9th, 2008: "I know this sounds very vain but I can not stop looking at my skin in the mirror. If my skin could stay this fabulous I will be eternally ecstatic. It is smooth, even the pores seem to be smaller. I'm not at all red. I had a stressful shift at work the other day, I felt myself flush but it seemed to settle very quickly. There are still a couple of papules on my neck but my face is completely clear. I will stand by the Megan Gales Invisible Zinc and say it is the best product EVER and that in combination with the Ivermectin cream is for me an absolute Godsend. I stopped my Doxy and Rosex (had not done a thing in 2 months) 2 weeks ago and my face has stopped flaking. I hope that this cream is on the market soon as I will hate to have to stop it after the trial. I have also started using an Avene moisturiser in the morning before the Invisible Zinc which is really soothing. It seems like a really nice product."

Mistica replied on October 9th, 2008: "Hi Rachel, That is indeed great news! And I totally understand about wanting to check your face in the mirror. Just to clarify about the redness. Are you talking about permanent background redness you had, or the inflamed areas caused by the outbreaks? The former is so hard to treat."

Rachzon replied on October 13th, 2008: "Mistica, I think I am lucky and at this point don't seem to have permanent redness. It was always hard to tell as the same spots seem to have been constantly inflamed. But now as my face is completely clear I couldn't have had any permanently red spots. I still have a few broken capillaries around my nose but I'm sure laser is the only way to get red of them. And I plan to put off that path as long as I possibly can. Face is getting better every day. My husband can't believe the difference, he has never seen my skin like this (wish I had this on my wedding day). So for those of us with papules and pustules caused by mites it looks like there may be a solution. I just hope that my skin continues to stay this good and doesn't relapse for any reason. Will let you all know if it does.
I asked about other peoples experiences, they have about 10 on the trial at the Coast and all but one have had results similar to mine. The Derm mentioned that up to this point it has been very hard to treat Papular Pustule Rosacea so is very pleased with these results. I haven't taken any Doxy, Propanolol or used any Rosex now for 3 weeks. The only think I'm taking is mutivitamins, flaxseed, fishoils, grapeseed and probiotics.  Supose it is hard to know intil more studies are done what comes first. Do the mites in the case of papular Rosacea cause or mimic the rosacea or do they just make the symptoms of Rosacea worse."

Rachzon last updated on December 5th, 2008: "Sorry my face is looking sooooo good that I haven't been on here for a while. 10 weeks I have been on the trial now and my face continues to be fantastic. I get the very occasional bump but it is gone within a few days. The bumps aren't red, itchy or scaly either. I have no flushing, burning or stinging. We are in the height of summer here with 32 degree days and I look just like anyone else. I have been spending a lot of time with the kids in the pool as well (the sun was my worst enemy). I really could not be happier. I am very thankful for the day I spent on Google looking for a "Cure" and came up with this trial.

But two years later Rachzon wrote again, on July 5th, 2010: "Has anyone tried Ivermectin in a cream that they have made up themselves? I have been doing lots of reading about Ivomec and its use on Dermodectic Mange in dogs and scaley face in budgies and wondered if anyone has been game to try it themselves. I have been waiting in vain for the trial of Ivermectin to recommence but it has almost been 2 years and I am ready to give up hope. Even for over a year after finishing the trial my skin was wonderful. My face has been a constant battle since Christmas. I have managed to keep it under reasonable control with Manuka honey and Tea Tree in coconut oil but it is so much work in comparison to the Ivermectin Cream that I used on the trial."

Wistar replied on July 6th, 2010: "Hi Rachzon, you have probably already read about my comments on it in this other thread. It is the best stuff out there for papules. I have used it for over 12 months on a frequent basis. Go with the ivermectin 1% sterile liquid. You shouldn't need a syringe. Peel off the foil surrounding the cap and the rubber bung underneath is removable. Dab some on cotton wool and rub onto face. Lightly glaze the face with it. Let it air dry. After 2 hours a calm feeling will happen to the face. Two days later you will notice no new papules. Any existing papules will clear in their own sweet time as normal. After two weeks, still no new papules. By then you should maybe be clear of the old papules. Repeat every 3-4 weeks for as long as necessary. If you don't use enough, it won't have the clearing effect and you will have to repeat again a few days later. If you use too much you may feel restless for a couple of hours or even notice a little muscle twitching.  It is the total amount absorbed into the skin that determines the effectiveness as it works systemically (like taking a tablet). As you become familiar with applying the liquid, you will discover the right amount. Plan on using it for at least 6-12 months to prevent any relapse.
Here you go. Search for ivermectin on amazon for more choices." 
I have used Eurax intermittently for 6 months. Still not sure if it make a difference. If anything sort of works it would be Tea Tree oil. It only sort of controls it, I still got new papules, just not as many."

Rachzon updated on July 24th, 2010: "Pleasing results. Initially I bought Ivomec in the form of the dip which is what they used on cattle topically. After the initial chemical smell I was very reluctant to use it on my face and bought the Ivomec injection. Here in Australia I could order it on a pet on line store. I could only buy it in 200mls so hesitated until my face got so bad I was desperate.
I started using it 3 days ago and I have already noticed a difference. I have also been taking antihistamines, anti inflammatories and propanaol so something is working. I found when I was on the Ivermectin trial I could stop everything else that I was taking. My face went into a remission for about 18 months. When I was using the 1% cream we were using it every night before bed as that was when the mites were supposed to be more active. 
Today no new papules have arrived and my face has stopped peeling, the redness has also diminished. I have been using the Ivomec sparingly as I still have some fears as it hasn't really been used on humans. This solution is also 1% Ivermectin. My mother used to have a lot to do with animals and even though the use of Ivermectin is not FDA approved on dogs they used it to treat demodectic mange with good results. Dogs are very sensitive to many things, but I am still very much aware of long term effects that we can't know about. I also am aware of how I feel when I have a bright red peeling face full of papules and my children are patting my skin and asking me if my face hurts. So at the moment I am prepared to take a little risk and hope that I can put my face back into remission for another 18 months."
(Note; this Ivermectin is the exact same Ivermectin that is used in Soolantra).

She updated on September 5th 2010: "I have been using the Ivermectin 1% Injection topically now for a month and a half. Results are good, not quite perfect but I will never have perfect skin, The odd papule but they only last a day or two. My pore size seems to have reduced too. I can not tell you the last time I flushed either. I have come home from work with a redish nose on occasion but that seems to decrease once I am out of the airconditioning. I have even stopped wearing make up."

Flying_er also started an Ivermectin trial as a result, and wrote  on August 7th, 2010: "I've1% topical ivermectin 2 nights per week and Eurax all other nights. I'm on day 11 and have some observations. My skin does seem calmer using these products but it also seems to be getting a bit dry. I'm trying to not use moisturizer as I've heard the ingredients in the moisturizers may feed the mites, not sure if that's true or not. In the last couple of days I've been getting some new red bumps on my forehead. These bumps have a white center and look a bit like a whitehead but the center is hard and can't be squeezed. I'm wondering if these new bumps are mite die-off related and I'm also wondering how bad the breakout will get. I guess I'll just have to wait and see. I'll continue to post results. -Dave-
started down the demodex treatment path. I'm currently using
I'm definitely breaking out more than normal since starting the mite killer routine. It's either from mite die-off or my skin doesn't like the topicals and is reacting to that. Either way I'm going to stick to this routine long enough to either kill off the mites or prove that mites are not my problem. I'm using the Ivomec 1% 50ml bottle, same as what you found on Amazon. I wet a cotton ball with the ivermectin and dab it on my forehead/scalp/cheeks until all areas are wet, not dripping wet but clearly wet. The liquid almost beads up on the skin. I just let it sit like that and it eventually dries up or gets absorbed. I'm currently doing this 2 times per week."

Flying_er updated on August 29th, 2010: "I'm now 30 days into the mite killing routine. I'm using topical Ivermectin every other night and sulphur cream the other nights. I stopped using Eurax, and replaced with sulphur cream. I figure the sulphur adds some healing properties to the equation. My skin is still up and down, a few days of clearing followed by a few days of breakouts, mostly in the form of papules. I feel like my skin is trending towards improving but time will tell. My Dr. also gave me some new shampoo to use 2x per week. It's called Aliclen, so far I like it, seems to be helping my scalp. [..] we are not injecting the the liquid, we are just applying it to our face using a cotton ball. -Dave-"

Flying_er updated again on November 18th, 2010: "I used Ivermectin once or twice a week for around 3 months. I never saw a total clearing of my P&Ps but it did seem to help calm my skin and reduce the breakouts. About 3 weeks ago I stopped using the Ivermectin to see what would happen. At first no difference was noticed but during the last week I've noticed that a lot of the little bumps I had previously are starting to return. I had forgotten how many of these little bumps I had before using Ivermectin and now they are returning. I'm going to start using the ivermectin again tonight and see if the issue clears up. I'll report back when I have more info. [..] I find it to be harsh on my skin, it dries it out and irritates it. -Dave-"

Michael_V wrote on September 1st, 2010: "I also tried oral ivermectin in the past without success, although I realize now how optimistic that approach is. While it likely did eradicate or at least substantially thin my resident demodex population for a couple of weeks, the continued dermal inflammation, increased facial blood flow, and enlarged follicles (these things take time to resolve) left my face like a freshly painted and swept waterfront condo with plenty of new tenants eager to move in. Remember that the demodex (or their commensals) are only part of the problem. For most of us, a large part is also our own dermal immunity, which either (1) reacts too easily, (2) reacts too strongly, (3) reacts for too long, or (4) all of the above. Any successful approach will require a sustained, multipronged approach that includes some combination of ongoing demodex and/or commensal bacterial control, trigger avoidance, improved general health and immune function, and the promotion of dermal healing."

Michael_V updated on September 5th, 2010: "5 weeks so far using topical Ivomec twice daily with excellent results and no side effects. Will continue for one more week and then go down to once weekly for maintenance. I also took oral ivermectin (stromectol), two doses five days apart, and the benefits seemed additive and synergistic."

Mrsmoof wrote on September 1st, 2010: "I am curious if anyone also took an antibiotic while taking Ivermectin as in the patent? I wonder if the antibiotic would add or enhance the effects of Ivermectin?"

Betise wrote on August 20th, 2010: "Hi there everyone - I was recently diagnosed with Rosacea (2 days ago) and discovered this forum today. I have been reading your posts in regards to Ivermectin with great interest. I am a veterinary nurse and am very familiar with Ivomec - it is a product we use off label routinely to treat Demodex in not only dogs - but also Guinea pigs, rats and mice (one tends to think if it is safe for them, us humans should be ok <lol>). Before my diagnosis I kind of suspected I had rosacea and had wondered if mites could be involved. I did consider using Ivomec so was absolutely delighted to find out others have done so with some success. I have redness across my nose and both checks, probably on average once a week I get small papules and pustules. Sometimes my face feels like it is sunburnt and it does get itchy every now and then (hence my thinking along the lines of mites). My nose is the worst affected area."

Supramom2000 wrote on October 13th, 2010: "It was really working well for me! I did it for 4 weeks. But after talking to Auburn, I am trying the honey mask route for 4-6 weeks and then seeing if I need the Ivermectin as maintenance."

Bambi wrote on February 13th, 2011: "Haven't been on the forum for a long, long time and just tried to ignore my rosacea. However, about 2 months ago I did some lurking on this thread and ordered ivomec just in case it would help. Well, it made a big difference. I'm so very grateful to all you rosacean pioneers who led the way. I use 3-4 small drops on a wet cotton disk every night before bed. I also change my pillow case every night. I'm not going to claim that I now have a peaches and cream complexion, but the redness has faded to an acceptable pink. It's true that it's a bit itchy when you apply it, but for me it calms down pretty quickly. Now if someone could come up with a way to take the dye out of my hair I'd be in heaven!! [..] Ivomec is helping with both, more so with the redness, but also with P&Ps. Thanks to you all, Jodi"

Gumbo wrote on March 28th, 2011: "Since the majority in this thread are using Ivermectin and treat for demodex I thought I should just make a note here in regard to treatment. The dermatologist I saw in Europe has published extensively on demodex and rosacea, and outlined a treatment for me. The interesting thing to note though is the need to treat the scalp, as my dermatologist has noted that most heavy infestations on the face will most likely have a lot of demodex on their scalp. I was given a scalp solution to use twice a week in my treatment. Further, after treating for 2 months, a recent biopsy showed 20 mites in a small section of my cheek. The deeper the biopsy went, the more mites. I mention this because I don't believe people get re-infested by their pillow, dog, cat, neighbor or whatever the excuse is. It is best to treat the entire head, and for many many months. I do believe this sterile liquid is effective. I also like the fact it lasts a long time and only requires dabbing a bit on the face every couple of days."

Here is an entire section of posts on where to buy Ivermectin.

Bob4324 wrote on May 22nd, 2015: "4 days ago, I decided to experiment with invermectin. I bought the little bottle with a rubber lid intended for cattle injection, and applied it topically using a dropper and my fingers. I was very liberal with application, spreading it all over my face and scalp and re-applying multiple times throughout the night. I hadn't really intended to apply so much, but after the first application there was such an immediate visual improvement that excitement got the best of me. For several hours, my face was better than I've seen it in years (maybe ever). It just looked like a normal person's face who doesn't have Rosacea. It's surreal to look at a mirror and see that. Well, it didn't last unfortunately. About 4-5 hours later, I started to have some sort of a reaction where the skin became very red. Over the next few days, I methodically tried all of my old standbys to reduce the redness back down to baseline. Of course, living with rosacea for so long, there are plenty of things in my bag of tricks. But oddly, none of the usual treatments were helping. There was clearly something "different" about this reaction.

Having read a fair bit about demodex all over the internet (including this forum and this thread in particular), I've noticed that this sequence of "Holy crap I'm cured" turning to "Holy crap my face is on fire" fits in with the theories about a demodex holocaust being proceeded by die off symptoms caused by dead demodex and their associated bacteria etc. With that in mind, I did something which I'd never dream of doing otherwise -- I applied antibacterial hand sanitizer directly to my face. After an hour, checking up and reapplying. I ended up applying quite a bit, and it's the first thing which has reduced the redness back to baseline since the invermectin. So now my skin looks about how it was 4-5 days ago before the experiment, maybe a bit better. The quick return to baseline via antibacterial hand santizer gives me hope that it's worth another attempt. Next time, I'll respond to any die-off symptoms immediately with antibacterial. If the two can work together, one productively flushing demodex and the other fending off die-off symptoms, then there's a comfortable route forward with invermectin."

As many people who started with Soolantra/Ivermectin noticed, it can take up to 6 to 8 weeks before your skin sees the benefit of this treatment. Especially those with skin outbreaks can notice a worsening of their skin for the first month at least, which can be very frightening and discouraging. The mites have a life cycle of around 2 weeks however, and when they die off, their 'corpses' release substances in the skin that can cause an extra inflammatory response, before things are cleared up and improved. Some people try to ease this phase with oral or topical antibiotics.

CD wrote on January 25th, 2017: "I started 8 days ago. It got worse initially. The first week was really bad with bumps all over my face, particularly around my nose, cheeks, and forehead. Now things seem to be improving. I’m cautiously optimistic. It was helpful for me to read the advice of others to stick with it. I’ll keep it up and report back."

Ayesha wrote on February 1st, 2017: "Hey, I have been prescribed soolantra for papillae rosacea. I have been using the cream once a day for only 5 days. My face is bad. It has brought out red spots all over my face and nose. Before they were just bumps in the skin now they are showing on the outside. Not sure if it is meant to get worse before it gets better. I am getting married in 7 months and do not want to look like this."

Stuart wrote on February 1st, 2017: "In 7 months time your skin will be better than its ever been believe me. 5 days is nothing. You will have weeks worse than others as the mite kill off happens until the mites are gone.but you will be happy. About 12 weeks plus you should be clear but in the weeks leading up to that your skin will continually improve dramatically."

Ayesha wrote on February 3rd, 2017: "Thank you for your advice Stuart. I have an appointment with the dermatologist tomorrow so will show him my face and see what he says. I was hoping someone would say it gets worse before it gets better. Today the redness is not to bad and the bumps are not as bad as yesterday. Not sure if that is because I have been in bed all day due to a sickness bug and not had the opportunity to go out and about. Hope soolantra works for me. I honestly do not know how I have developed papular rosacea. I have Asian skin, I am pretty fair in colour may be that’s why. Thank you for your support. Your words give me hope."

Stuart wrote on February 3rd, 2017: "Its fine. I had antibiotics to combat the mite die off for the 1st few weeks. Its 3 weeks, 6 weeks , 9 weeks that u will most probs have further mite die off. But you have to stick with it. That's the number 1 rule."

Carrie wrote on February 3rd, 2017: "Your face will get soooooo bad before it gets better. Once it gets better though, it will be better than it’s ever been. I look totally different than I did 18 months ago. V Beam Laser helps a lot too. Don’t give up. The only reason I got past day 3 was because I saw a man on here begging people to just keep going. You will feel like a monster for several days, but don’t stop! All the bumps are the mites dying and you have to kill them all before you clear up. Good luck!"

MT wrote on February 4th, 2017: "I suggest to keep more moderate words than “better than it’s ever been” mate. Soolantra is quite good, but not magic, and not for everyone. Worse before it gets better overall, we all know that now. But after about 2 years of Soolantra medicine, I can say it’s not always for the best in a pink glasses tinted world. Soolantra isn’t THE miracle product for all rosacea pathologies. Regards."

Claude caron wrote on February 19, 2017: "Hi I hope you enjoyed the magnificent results that I did. I had terrible papules diffuse over my forehead chin and cheeks after 4 weeks of soolantra I found an improvement of 70%. 3-4 weeks beyond this my condition cleared, amazing!!"

Chris wrote on February 3, 2017: "Doxycycline is a life saver. I got big red bumps after a few weeks on ivermectin cream. Doxycycline made them disappear within a week. It means I need to stay on an antibiotic for a while, but I don’t notice any side effects from it during the 6 months. Now that my skin is much improved from the combination of ivermectin and doxy – much less flushing, burning, inflammation and swelling – I decided I’m ready for IPL. So far I’ve had one light treatment with small but noticeable improvement. I’m going back next week for the next one, which will be stronger. I figure once my skin improves enough, I’ll be able to go off the doxy (does anyone have experience with this?)."

Susan wrote on April 20th, 2017: "My dermatologist ordered a Rx. for Soolantra and ordered it to be compounded. Soolantra averages about $350.00 and compounded Soolantra is $35.00 The people suffering with Rosacea and Demodex mites need to know this."

Irene McDonald wrote on July 3rd, 2017: "I have just finished my first tube of Soolantra and am delighted with the results. When I used it first I though it didn’t work well but now think I didn’t persevere long enough. I now use Soolantra every night and my skin hasn’t looked this good or clear for 15 years. Finally there seems to be a solution. I first heard of Soolantra at a Beauty Therapists seminar. A dermatologist gave a great talk on Rosacea and was convinced the demadox mite was to blame for the pustules. Now I agree, having been a sceptic for years. Irene"

Dorota wrote on July 4, 2017: "Hi, I have rosacea for about 20 years. But it was never as bad as last. I started with soolantra and for about 2 days nothing changed so on third day I started Oxytetracycline as well. And then it began. For a couple of days my skin was getting swollen, red and bumpy and then literally peeled off in chin area. I couldn’t leave the house. I was sure it was antibiotic, After about five days I went back to GP and they told me to stop using cream, that is highly possible that the cream was causing these reaction. I stopped using Soolantra and I’m on antibiotics now. I was prescribed Metrogel last month. Although my face looked a lot better I had to stop using it as I couldn’t get out when sun was out. I was wearing Spf 50+ but my face was burning and I need to be out with my son.My face looks a lot better now, no pimples only redness although it tends to be dry and itchy around chin where was pilling off. I don’t know what to do. Maybe someone can help?"
two years after I gave birth. It was so bad that I developed blepharitis, I had always very sensitive skin so I couldn’t use any cosmetics as I ended up with very red itchy face. I was waiting with treatment until I stopped breastfeeding and about two months ago I went to GP to ask for treatment. I got Soolantra and Oxytetracycline

Carrie wrote on July 4th, 2017: "Your face has to get really really bad on Soolantra before it gets better. Most people get very red and bumpy for days. This is the mites dying off. I looked like a monster, but you have to let the whole cycle finish or you will never get better. Go back to some comments that I and others made on this page from 2015 and 2016. Everyone explains the process they went through."

It seems that some people really cannot tolerate Soolantra. Maybe some of its inactive ingredients cause a bad rosacea skin reaction for some people, or perhaps the Ivermectin is the culprit. For the majority of people who post about the worsening of skin after starting Soolantra/Ivermectin, however, the skin improves after the first 5 weeks or so of instability. 

Effie wrote on March 22nd, 2014: "I'm a newbie here, first post, but I've been following this thread ever since reading that there was another new study recently affirming that demodex mites cause rosacea, and when I was searching for information I came across this thread about Ivermectin and the Ivermectin FDA trials that sound so promising. I took a chance and ordered some of the Ivermectin 1% from Amazon and have been using it for 5 days. The first two days I used it straight and it burned and stung for about 30 minutes before calming down, and in addition it seemed like it was drying my skin out a lot, so then I mixed it with CeraVe cream, two parts cream to 1 part Ivermectin and that worked fine. I've been gradually increasing the Ivermectin and am now using about 2 parts Ivermectin and one part cream with no burning or stinging. At first it didn't seem like it was doing much, but the past two days I've begun to notice that my pores are actually decreasing in size, sort of working in from the outer edges of my face towards the center (where it's worse) and my skin is looking a little more normal! This morning my skin looks and feels more "normal" than it has in years and years.

I have had Rosacea for a LONG time, probably 20 years or more -- I have the type without pustules or papules, but my face is reddened and my pores are huge, and my skin seems to thicken overnight to the point that my face looks like an orange peel every morning with puffy thickened red skin and huge pores, especially on my nose, cheeks and chin. I have to dermabrade my face every morning just to get it to look a little normal before applying my makeup. My dermatologist started me on Noritate years ago, and the first time I used it, it was like a miracle, my skin cleared up, my pores all shrank down to almost invisible and all the redness went away. I actually cried I was so happy. But my dermatologist neglected to tell me that the effect wouldn't last, and eventually it just stopped working for me. In addition, I have sebaceous gland hyperplasia, which my derm told me was caused by my rosacea, and the Noritate seems to make that a lot worse when I use it. I've found that dermabrasion works best for me, along with Prosacea when I have flare-ups, but sometimes nothing works and I just have to keep trying different approaches until the flareup goes away.

So far, the results I'm having with the Ivermectin/CeraVe mixture remind me of my first trial of Noritate, the results are just slower, but I'm cautiously optimistic that this might work! I just hope the results last. I have been so hoping that my rosacea was NOT caused by demodex mites, I was having a really hard time accepting that, but so far the Ivermectin is working so I'm having to start accepting that maybe it is. Anyway, just wanted to share my results, say thanks to all who shared their experiences"

Bumps wrote on March 22nd, 2014: "I did see a benefit, even when self-medicating with the bovine ivermectin. Within 2 weeks or so, my skin had cleared. I have been using Ivermectin since then--about 18 months or so. Now I am using the medication prescribed by my doctor and compounded at the pharmacy. I use it no more than twice per week--Wednesday and Sunday. Some weeks I forget and don't use it at all, but generally I try to keep up with the therapy. My skin looks completely normal at all times. You could never tell I had trouble with Rosacea. I hope this works for others, because I remember how much discomfort and embarrassment this condition caused for me. Try it for yourself if you have P&P Rosacea. I'm confident it will help. I'd like to know whether it helps people with redness only."

You can read (a lot) more on Ivermectin used by rosacea patients here:

-Ivermectin for demodex


-Topical ivermectin (Soolantra) vs permethrin vs crotamiton (Eurax)

-Stromectol (Ivermectin) for Demodex Rosacea

-Less Expensive Alternative To Soolantra

-Sulfur vs. soolantra?

-Bad reaction to Soolantra?


-Demodex unresponsive to oral ivermectin and topical permethrin

-Eyebrow loss, seb derm or demodex?

About oral Ivermectin for rosacea:

Nbapoker wrote on January 28th, 2008: "Ivermectin (Stromectol)- To kill the mites. My derm prescribed me Ivermectin (Stromectol) 6 mg a night (an hour before dinner, w/ water), to attempt to kill the mites. But I have not started it yet.... anybody have any experience with this med?
p.s.- I have seb derm/rosacea/acne. And I am taking low dose accutane which has helped with my skin texture.

Mistica replied on August 14th, 2009: "I used topical Ivermectin for about two or three months and it had no impact whatsoever upon my severe vascular rosacea.
The formula I used was very similar to the one used by Rachzon ( same derm). She had a complete resolution of her type of rosacea. P&P with associated redness and some flushing. It appears that ivermectin is only affective in her type. What type do you have, Colander?"

Colander wrote on August 15th, 2009: "I have just ordered this (60 pills). I will take one pill in the morning and one before I go to sleep. Maybe this dosage is too small to help, but if I just see any little improvement I will tell my doctor and demand prescription."

Beth83 wrote on January 28th, 2014: "HI. My doctor prescribe Stromectol to me because I was having issues with Rosacea and skin mites. I was getting certain type of acne (that really wasn't acne and something to do with the skin mites) that had a hard and deep cylindrical center that needed to be removed with tweezers to be able to heal. I took 3 pills, then a week later 3 more. It was an instant help with those hard bumps. They were gone after a few weeks and no new ones for about 8-9 months.  i still got some regular acne but I could deal with that. Those hard/deep bumps were horrible. I went about 9 months without any of those. i started to get a few small ones lately so I ran back to the doctor and an currently taking a second dose."

Davem81 wrote on January 28th, 2014: "Very much my thinking too for my P&P rosacea. I think the consensus now is that topical ivermectin is likely to be more help than the tablet form. Phase 3 clinical trials for a human licensed version have just completed on this product."

In this scientific article, three cases of rosacea are described, where oral ivermectin treatment cleared the rosacea symptoms;

"Three adult rosacea patients with varied clinical presentations and with varied disease durations are
selected to illustrate the disclosed invention. These patients' cases illustrate the effectiveness of ivermectin treatment on the different clinical manifestations of the disease.

Patient 1
This 44-year old Caucasian female had exhibited clinical evidence of rosacea for 1-2 years and had been treated with limited success with oral tetracycline, topical and oral metronidazole, and cortisone creams. Her facial skin exhibited mid-facial erythema and flushing with papule and pustule formation. In addition, her eyelids exhibited chronic blepharitis and repeated loss of eyelashes, which is quite typical of rosacea. She was treated with ivermectin, 200 micrograms per kilogram of body weight in each of two oral doses with an interval of four days between doses. Oral tetracycline was continued at a dose of 500 milligrams per day for the first 30 days after ivermectin was given and then was discontinued. After a mild initial flareup of mid-facial papules, the condition improved rapidly to the point that by 60 days no papules were present, all eyelashes were growing back, and she had no more flushing with heat or spicy foods. Symptoms had not returned after three months.

Patient 2
This 33-year old Caucasian female had the acute onset of papular and pustular rosacea involving nearly all of her cheeks and chin two months prior to her evaluation. Marked itching and redness were present, but no eye symptoms were noted. Ivermectin in two 200 microgram per kilogram oral doses given three days apart was administered along with a four-week course of oral tetracycline. The clinical signs abated quickly, with itching being gone after one week and papular lesions clearing by three weeks. At two months from the onset of treatment and one month after cessation of tetracycline, no clinical signs or symptoms of rosacea remained.

Patient 3
This 65-year old African-American female had suffered from severe papular and pustular rosacea of the mid-face and nose for 15 years. Tetracycline, in doses of 500-1000 mg per day had proven to be the only partially-effective medication for her. Oral ivermectin was administered in two 200 microgram per kilogram doses given four days apart and tetracycline was continued for one month in a dose of 500 mg per day. Followup at three months from the start of ivermectin therapy revealed only mild hyper-pigmentation at the sites of previous inflamed papules and pustules. The patient reported that no new lesions had been noted for six weeks prior to that 3-month evaluation.

While these examples illustrate the preferred embodiment of this invention, the treatment of rosacea using oral ivermectin, exposure of Demodex mites to ivermectin from any route of administration will result in the elimination of the organisms and secondary amelioration of the signs of inflammation that are typical of rosacea. Therefore, the topical use of ivermectin in any vehicle that allows it to adequately penetrate into skin follicles to reach the level occupied by Demodex folliculorum will be an effective treatment for rosacea and is considered to be entirely within the scope of this invention. Changes of dosages, dosing schedules, concentrations, vehicles, and frequency of repetition of ivermectin regimens are also not considered to be outside the scope of this invention."