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Dual anti-inflammatory and antiparasitic action of topical ivermectin 1% in papulopustular rosacea.

J Eur Acad Dermatol Venereol. 2017 Jun 27;:

Authors: Schaller M, Gonser L, Belge K, Braunsdorf C, Nordin R, Scheu A, Borelli C

Abstract
BACKGROUND: Recently, therapy of rosacea with inflammatory lesions (papulopustular) has improved substantially with the approval of topical ivermectin 1% cream. It is assumed to have a dual mode of action with anti-inflammatory capacities and anti-parasitic effect against Demodex, which however has not yet been demonstrated in vivo.
AIM: To find scientific rationale for the dual anti-inflammatory and anti-parasitic mode of action of topical ivermectin 1% cream in patients with rosacea.
METHODS: A monocentric pilot study was performed including 20 Caucasian patients with moderate to severe rosacea, as assessed by investigator global assessment (IGA score ≥ 3) and a demodex density ≥ 15/cm(2) . Patients were treated with topical ivermectin 1% cream once daily (Soolantra(®) ) for ≥12 weeks. The density of Demodex mites was assessed with skin surface biopsies. Expression of inflammatory and immune markers were evaluated with RT-PCR and by immunofluorescence staining.
RESULTS: The mean density of mites was significantly decreased at week 6 and week 12 (p<0.001). The gene expression levels of IL-8, LL-37, HBD3, TLR4 and TNF-α were downregulated at both time points. Reductions in gene expression were significant for LL-37, HBD3 and TNF-α at both follow up time points and at week 12 for TLR4 (all p<0.05). Reduced LL-37 (p<0.05) and IL-8 expression was confirmed on the protein level by immunofluorescence staining. All patients improved clinically and 16 out of 20 patients reached therapeutic success defined as IGA score ≤ 1.
CONCLUSION: Topical ivermectin 1% cream acts by a dual, anti-inflammatory and anti-parasitic mode of action against rosacea by killing Demodex spp. in vivo, in addition to significantly improving clinical signs and symptoms in the skin. This article is protected by copyright. All rights reserved.

PMID: 28653460 [PubMed - as supplied by publisher]

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