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Ivermectin paralyzes and eliminates Demodex mites in hair follicles by binding to glutamate-gated chloride channels in invertebrate nerve and muscle cells. Additionally, it exerts anti-inflammatory effects on keratinocytes and neutrophils, independently reducing rosacea inflammatory lesions.
Commercial Soolantra (1% ivermectin cream) costs $300–$500/month and is often not covered by insurance for rosacea. Compounded 1% ivermectin cream provides the same active ingredient at $30–80/month. Compounding also allows combination formulas with metronidazole or azelaic acid.
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Ivermectin 1% cream is FDA-approved for inflammatory lesions of rosacea (Soolantra) and has become a standard treatment after evidence emerged that Demodex folliculorum mite overpopulation is a significant contributor to papulopustular rosacea.
Compounded ivermectin provides the same therapeutic benefit as Soolantra at a fraction of the cost, making long-term treatment financially sustainable. It can also be combined with other anti-rosacea agents in custom formulations.
Papulopustular rosacea, Demodex folliculorum overpopulation, seborrheic dermatitis with Demodex component, blepharitis (ocular rosacea)
1% cream: Apply pea-sized amount to entire face once daily in PM
Allow 3 months of consistent use to assess full efficacy
Generally very well tolerated. Mild skin dryness or irritation. Unlike oral ivermectin, no systemic effects at standard topical doses.
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