Efficacy of single-dose oral ivermectin in treatment of rosacea in relation to demodex mites

Background Rosacea is a common chronic inflammatory cutaneous disease. Demodex mites play an important role in the etiology and pathogenesis of rosacea. Despite the various therapeutic options available, rosacea can be difficult to treat in some patients. Topical Ivermectin is approved for the treatment of rosacea. However, oral Ivermectin has not been extensively studied in the treatment of rosacea. This study aimed to (a) evaluate the efficacy, safety, adverse effects, and patient satisfaction of a single 250 µg/kg dose of oral ivermectin in the treatment of different subtypes of rosacea and (b) correlate its efficacy to different clinical variables. Also, it aimed to (c) clarify the possible role played by demodex mites in the pathogenesis of rosacea and the effect of oral Ivermectin on demodex mite count change after treatment, and its possible mechanisms in the treatment of rosacea. Methods This study included 45 rosacea patients; demodex mite count using standardized skin surface biopsies was done before and after receiving a single dose of 250 µg/kg oral Ivermectin. Disease severity was assessed at baseline and after treatment using the 5-point Global Investigator Assessment IGA scale. Patients were followed up every 4 weeks for 3 months. Results The results revealed significant Global Investigator Assessment improvement in included patients and high patient satisfaction rate. This was consistent with Demodex mites count that showed a significant decrease after treatment. A low relapse rate and few side effects were recorded. Conclusion A single 250 µg/kg dose of oral ivermectin is effective, safe, and tolerable in the treatment of different subtypes of rosacea. It exerts its action through both anti-inflammatory and antiparasitic roles.