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Oral Ivermectin for Rosacea


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While it has been reported that topical ivermectin has better results than topical metronidazole for rosacea, there is at least one paper you should consider reading if you are considering taking oral ivermectin and metronidazole for rosacea.  There are other papers showing the safety of using oral ivermectin which has safely been administered to adults and children all over the world. 

Oral Ivermectin for Rosacea
A paper published by the International Journal of Infectious Diseases that compared taking 200 micro-grams Ivermectin per Kilogram of body weight of oral ivermectin once a week in one group (1) of sixty rosacea patients with another group (2) of sixty rosacea patients who received a combined therapy of the same amount of ivermectin along with 250 mg of oral metronidazole three times a day. The results were that the second group (2) improved better than the first group (1).  For more information

There are other papers published mentioning oral ivermectin which are listed below in the subheading, Oral Ivermectin for Demodectic Rosacea, which will be updated as more papers are discovered. If you know of any other papers, please post your findings in this thread. Click the REPLY button and add your finding. 

Ivermectin History
Some may be concerned about taking ivermectin orally. It is interesting to note that ivermectin has been around since the late 1970s and half "of the 2015 Nobel Prize in Physiology or Medicine was awarded jointly to Campbell and Ōmura for discovering avermectin, 'the derivatives of which have radically lowered the incidence of river blindness and lymphatic filariasis, as well as showing efficacy against an expanding number of other parasitic diseases' " Wikipedia

Ivermectin is "a dihydro derivative of avermectin—originating solely from a single microorganism isolated at the Kitasato Intitute, Tokyo, Japan from Japanese soil...originally introduced as a veterinary drug...has led many to describe it as a “wonder” drug....few drugs that can seriously lay claim to the title of ‘Wonder drug’, penicillin and aspirin being two that have perhaps had greatest beneficial impact on the health and wellbeing of Mankind....But ivermectin can also be considered alongside those worthy contenders, based on its versatility, safety and the beneficial impact that it has had, and continues to have, worldwide—especially on hundreds of millions of the world’s poorest people....Despite decades of searching around the world, the Japanese microorganism remains the only source of avermectin ever found. Originating from a single Japanese soil sample and the outcome of the innovative, international collaborative research partnership to find new antiparasitics, the extremely safe and more effective avermectin derivative, ivermectin, was initially introduced as a commercial product for Animal Health in 1981." [1]

While there are no long term clinical studies done on ivermectin use with rosacea, there are papers showing the long term effects of oral ivermectin in school-age and pre-school children treated for helminths. [2] There are also papers written about the long term effects of treating humans with ivermectin on other parasites, i.e., scabies.  

'Intriguingly, IVM has a diverse range of effects in many different organisms, far beyond the endoparasites and ectoparasites it was developed to control. For example, IVM has been shown to regulate glucose and cholesterol levels in diabetic mice, to suppress malignant cell proliferation in various cancers, to inhibit viral replication in several flaviviruses, and to reduce survival in major insect vectors of malaria and trypanosomiasis. Clearly, much remains to be learned about this versatile drug, but the promise of more sustainable strategies for current helminth-control programmes and novel applications to improve and democratise human health, are compelling arguments to pursue this cause." [3]

"Evidence suggests that oral ivermectin may be a safe and effective treatment for scabies". One article says "A Single, Oral Dose of Ivermectin Cures Scabies". [4] Two oral doses of ivermectin was found to be just as effective as a single topical application of permethrin in treating scabies. [5]

"When given orally, ivermectin can be used for treating head or pubic lice and scabies (an itchy, highly contagious skin disease caused by mites burrowing in the skin). Oral ivermectin is useful to control outbreaks of scabies in nursing homes where whole-body application of topical agents is difficult. Ivermectin's greatest impact on human health has been in Africa. Since 1987, in addition to its use for other parasitic infestations, ivermectin has been used extensively to control onchocerciasis with 1.4 billion treatments so far. Onchocerciasis is also called "river blindness" because the blackfly that transmits the disease breeds in fast-moving streams and rivers." [6]

In an article in The New York Times, Scabies Means Misery. This Pill Can End It., it states, "Nonetheless, the drug is considered safe enough to give to almost everyone except the youngest infants and pregnant women."

"This meta-analysis gives strong evidence that IVM 1% cream is the most effective topical treatment above other alternatives and it satisfies the impairment of social and working life with a sustained better QoL." [13]

A brand name for ivermectin is Stromectol. "Never take ivermectin in larger amounts, or for longer than recommended by your doctor. Follow all directions on your prescription label. Take ivermectin on an empty stomach, at least 1 hour before or 2 hours after a meal. Ivermectin is usually given as a single dose. Take this medicine with a full glass of water. To effectively treat your infection, you may need to take ivermectin again several months to a year after your first dose." [15]

"Studies conducted in children or infants have shown good tolerance of ivermectin." [17]

"Presently ivermectin is used to treat strongyloidiasis, scabies, pediculosis, gnathostomiasis, myiasis, and leishmaniasis. In addition, other studies have shown that ivermectin can be used to reduce the prevalence and spread of other infectious diseases linked to a helminthic parasites transmitted through soil such as strongyloidiasis, ascariasis, trichuriasis, and enterobiasis hookworm, Trichuris and Ascaris. These diseases have been identified as major cause of death for underdeveloped children with poor nutrition and retarded growth. Topical administration of ivermectin to children also reduced the prevalence of head lice and scabies. Moreover, ivermectin has also been shown to be effective in the treatment of Papulopustular rosacea (PPR), a human skin disease characterized by transient pustules and facial erythema." [19]

"Treatment with oral ivermectin and topical metronidazole cream resulted in a symptom-free period of 22 months. This case represents an unusual presentation of symptomatic Demodex infestation." [20]

Oral Ivermectin for Demodectic Rosacea

"A diagnosis of Demodex folliculitis was made, and the patient was prescribed 2 doses of oral ivermectin, 200 μg/kg, spaced 1 week apart. All pustules, swelling, and erythema resolved 2 weeks after the start of the first dose of ivermectin (Fig 3), and all scaling resolved after an additional week without further treatment. She did not require use of any topical medications and did not have any further facial rashes after treatment." [9]

"We report the case of a 12-year-old girl who presented with severe ocular and cutaneous rosacea unresponsive to oral doxycycline, oral isotretinoin, and topical tacrolimus. A biopsy specimen showed numerous mites within the folliculosebaceous unit. Treatment with a single dose of oral ivermectin achieved resolution of her symptoms." [10]

"The aim of this retrospective study was to assess the benefit and tolerability of oral and topical ivermectin therapy in pediatric PPR and POD....In conclusion, both oral and topical ivermectin were well tolerated and beneficial for treatment of both PPR and POD in this small group of children." [11]

"Ivermectin, both oral and topical, has been effective in treating rosacea of various subtypes. In particular, a case of recalcitrant oculocutaneous rosacea in an immunocompetent patient with Demodex folliculorum colonization achieved resolution with a single dose of oral ivermectin. An individual with recalcitrant papulopustular rosacea and evidence of numerous Demodex organisms on histologic examination benefited from oral ivermectin and topical permethrin cream.34 Gnatophyma, a rare variant of phymatous rosacea involving the chin, was treated with oral ivermectin, oral tetracycline, and metronidazole cream with satisfactory results (Table 1)." [12]

"All patients were treated with 50% tea tree oil lid scrubs and two doses of oral ivermectin (200 mcg/kg)." [14]

One paper in noting the efficacy of oral ivermectin alone in comparison with oral ivermectin-metronidazole combined therapy in the treatment of ocular and skin lesions of demodex folliculorum concluded the oral ivermectin-metronidazole combined therapy was superior. [16]

"However, this patient still had a very good response to oral ivermectin and metronidazole gel, and all clinical symptoms disappeared within 4 weeks after treatment." [21]

Oral Ivermectin Safely Administered

"Over one billion treatments of ivermectin alone or co-administered with albendazole have been delivered in large-scale preventive chemotherapy programmes against lymphatic filariasis and onchocerciasis since 2000." [18]

"The wholesale cost in the developing world for the tablets is about US$0.12 for a course of treatment. In the United States, the costs is less than US$50." Wikipedia

"The direct cost of a pack of 100mg tablets of ivermectin is approximately $2.90 with a unit price of 0.029 per tablet. These costs are subject to variations in different countries." [18]

The above facts show there are a substantial number of humans globally who have taken oral ivermectin, including children.  

Horse Paste
With the craze of rosaceans using horse paste to treat rosacea topically (containing 1.87% ivermectin), there is at least one report of oral horse paste treatment for Lyme disease in Facebook by a poster. [7] Another website suggests taking oral ivermectin and using topical horse paste to treat scabies. [8]

Anecdotal Reports
ElaineA has a post worth reading on this subject, Oral Ivermectin, getting diagnosed and a prescription. Another poster, eringael, reports success using oral ivermectin/metronidazole. She also has some incredible photos in this thread worth looking at. She has updated her results in this post

BPRMFC at RF started a thread of using oral Ivermectin and Moxidectin

More information on oral ivermectin.

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End Notes

[1] Proc Jpn Acad Ser B Phys Biol Sci. 2011 Feb 10; 87(2): 13–28.
doi: 10.2183/pjab.87.13
PMCID: PMC3043740; PMID: 21321478
Ivermectin, ‘Wonder drug’ from Japan: the human use perspective
Andy CRUMP and Satoshi ŌMURA

"When doctors in the USA prescribe ivermectin for scabies that is called an "off-label" use. This is not unusual and it is generally legal.   Once a drug has been FDA approved for one disease or use, a doctor can prescribe it for any other use they choose to. Read more about "off-label use" in Wikipedia here. Wikipedia says "Off-label use is generally legal unless it violates specific ethical guidelines or safety regulations, but it does carry health risks and differences in legal liability." In other words, if the doctor thinks it is unethical to prescribe ivermectin or that he might get sued for prescribing it, he probably won't." In Depth Information On Ivermectin, MaximPulse, Green Dept

[2] PLoS Negl Trop Dis. 2008 Sep; 2(9): e293.
Published online 2008 Sep 10. doi: 10.1371/journal.pntd.0000293
PMCID: PMC2553482; PMID: 18820741
Impact of Long-Term Treatment with Ivermectin on the Prevalence and Intensity of Soil-Transmitted Helminth Infections
Ana Lucia Moncayo,  Maritza Vaca,  Leila Amorim,  Alejandro Rodriguez,  Silvia Erazo,  Gisela Oviedo,  Isabel Quinzo,  Margarita Padilla,  Martha Chico,  Raquel Lovato,  Eduardo Gomez,  Mauricio L. Barreto,  and Philip J. Cooper  

[3] Trends in Parasitology
Volume 33, Issue 6, June 2017, Pages 463-472
Ivermectin – Old Drug, New Tricks?
Roz Laing. Victoria Gillan. Eileen Devaney

[4] CDC, Scabies, Medications

A Single, Oral Dose of Ivermectin Cures Scabies
NEJM Journal Watch, September 1, 1995

[5] Ann Parasitol. 2013;59(4):189-94.
The efficacy of permethrin 5% vs. oral ivermectin for the treatment of scabies.
Ranjkesh MR, Naghili B, Goldust M, Rezaee E.

Difficult-to-treat scabies: oral ivermectin

[6] Oops! I Just Took My Dog's Heartworm Medicine
Ivermectin Safety, National Capitol Poison Control 

[7] Post number five in this thread (posted May 2, 2019)

[8] Ivermectin to cure scabies, Maximpulse, Green Dept

[9] JAAD Case Rep. 2019 Jul; 5(7): 639–641.
Perioral Demodex folliculitis masquerading as perioral dermatitis in the peripartum period
Dema T. Alniemi, MD and David L. Chen, MD

[10] JAMA Dermatol. 2014 Jan;150(1):61-3. doi: 10.1001/jamadermatol.2013.7688.
Severe demodexfolliculorum-associated oculocutaneous rosacea in a girl successfully treated with ivermectin.
Brown M, Hernández-Martín A, Clement A, Colmenero I, Torrelo A.

[11] JAAD, March 2017, Volume 76, Issue 3, Pages 567–570
Ivermectin therapy for papulopustular rosacea and periorificial dermatitis in children: A series of 15 cases
Lucero Noguera-Morel, MD, Paula Gerlero, MD, Antonio Torrelo, MD, Ángela Hernández-Martín, MD

[12] Clin Cosmet Investig Dermatol. 2016; 9: 71–77.
Published online 2016 Mar 18. doi: 10.2147/CCID.S98091
PMCID: PMC4807898
PMID: 27051311
New developments in the treatment of rosacea – role of once-daily ivermectin cream
Leah A Cardwell, Hossein Alinia, Sara Moradi Tuchayi, and Steven R Feldman

[13] Dermatol Ther. 2019 Dec 20;:e13203
Efficacy of topical ivermectin and impact on quality of life in patients with papulopustular rosacea: A systematic review and meta-analysis.
Husein-ElAhmed H, Steinhoff M

[14] Indian J Ophthalmol. 2020 May;68(5):745-749
Demodex blepharokeratoconjunctivitis affecting young patients: A case series.
Patel NV, Mathur U, Gandhi A, Singh M

[15] Ivermectin, drugs.com

[16] Int J Infect Dis. 2013 May;17(5):e343-7. doi: 10.1016/j.ijid.2012.11.022.  Epub 2013 Jan 5.
Evaluation of the Efficacy of Oral Ivermectin in Comparison With Ivermectin-Metronidazole Combined Therapy in the Treatment of Ocular and Skin Lesions of Demodex Folliculorum
Doaa Abdel-Badie Salem , Atef El-Shazly, Nairmen Nabih, Youssef El-Bayoumy, Sameh Saleh

[17] Arch Pediatr. 2016 Feb;23(2):204-9.  doi: 10.1016/j.arcped.2015.11.002. Epub 2015 Dec 14.
Safety of Oral Ivermectin in Children
A Chosidow, D Gendrel 

[18] WHO Expert Committee on the Selection and Use of Essential Medicines: Application for inclusion of ivermectin on the WHO Model List of Essential Medicines (EML) and Model List of Essential Medicines for Children (EMLc)for the indication of Scabies
Submitted: December 2018

[19] Pharmaceuticals (Basel). 2020 Aug; 13(8): 196.
Avermectin Derivatives, Pharmacokinetics, Therapeutic and Toxic Dosages, Mechanism of Action, and Their Biological Effects
Gaber El-Saber Batiha,1, Ali Alqahtani, Omotayo B. Ilesanmi, Abdullah A. Saati, Amany El-Mleeh, Helal F. Hetta, and Amany Magdy Beshbishy

[20] J Cutan Pathol. 2020 Nov;47(11):1063-1066
Aymptomatic vulvar demodicosis: A case report and review of the literature.
Hedberg ML, Chibnall RJ, Compton LA

[21] PubMed RSS Feed - -Demodicosis Imitating Acne Vulgaris: A Case Report

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"Oral ivermectin (200 micrograms/kg/day) is also a treatment alternative for PPR although it is supported with level D evidence. In patients with treatment resistant rosacea, combination of oral ivermectin and permethrin 5% cream can be considered since this combination was found to be effective in decreasing demodex density in immunocompromised patients as well."

Clin Cosmet Investig Dermatol. 2020; 13: 179–186.
Published online 2020 Feb 20. doi: 10.2147/CCID.S194074
PMCID: PMC7039055
PMID: 32110082
Conventional and Novel Treatment Modalities in Rosacea
Burhan Engin, Defne Özkoca, Zekayi Kutlubay, and Server Serdaroğlu

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