Aczone vs Soolantra

Aczone: An anti-inflammatory gel for red, tender acne. It is not a retinoid and not a standard antibiotic, so it suits skin that cannot tolerate either. Soolantra: A once-daily cream for the bumps and pustules of rosacea. It calms inflammation and reduces the mites that live in facial follicles, but it does not treat flushing or fixed redness.

Reviewed by Dr. Schwarz, Board-Certified Dermatologist

Which one?At a glance What it treats Diagrams How you take it Results Side effects Safety Cost When you stop Questions

Which one is right for you?

Choose Aczone if…

Choose for red, tender acne when skin can't tolerate a retinoid or you want to avoid a standard antibiotic.

Inflamed spots rather than blackheads
Sensitive skin that reacts to retinoids
You want a morning step that sits well under makeup

Choose Soolantra if…

Choose for rosacea bumps and pustules as a once-daily cream that often clears them — it doesn't treat flushing or fixed redness.

Rosacea bumps and pimples
You want once-daily use
You'll give it 12–16 weeks

Fine together

Can you take them together?

They treat different conditions and can share a routine if you have both acne and rosacea bumps. Apply at different times of day if your skin is sensitive.

At a glance

● Aczone

● Soolantra

Type

Topical anti-inflammatory (dapsone gel)

Topical antiparasitic and anti-inflammatory (ivermectin 1%)

What it does

Calms red, tender acne spots

Calms inflammation and reduces Demodex mites

Best for

Inflamed acne

Rosacea bumps and pustules

Prescription

Yes

Form

Gel, 5% or 7.5%

Cream

How often

7.5% once daily; 5% twice daily

Once daily

Course length

Ongoing

Time to results

4–12 weeks

4–16 weeks

Main side effect

Mild dryness

Mild burning or dryness

Blood tests

None for the gel

None

Pregnancy

Check with your clinician

Cost

Moderate; generic available

What it treats

Compare uses by strength of evidence. Evidence level describes confidence in a benefit, not its size.

Evidence level

Aczone

Soolantra

Strong evidenceMost established uses

Acne

Reduces inflamed breakouts in large trials.

Redness and fine superficial vessels across a light-skinned cheek and nose.

Rosacea

Reduces bumps and pimples.

Limited evidenceEarly or small studies

Rosacea

Small studies show fewer bumps.

—

Little evidence

dark keratin plugs in dilated pores on the nose and adjacent left cheek, with the face turned to the person’s right on light skin.

Blackheads

Weaker on clogged pores than retinoids.

The finger webs and wrist on fair light skin, with small red bumps, several thin gray burrow lines a few millimetres long, and scratch marks across the area.

Scabies

Scabies needs permethrin or ivermectin tablets.

Not effective

Acne Scarring

Doesn't change scars.

Acne

Not an acne treatment.

Post-Inflammatory Redness

Doesn't fade redness alone.

How it works

Aczone. Dapsone gel helps calm inflammatory acne. 1. May calm neutrophil activity: Can reduce some inflammatory actions of these immune cells. 2. May reduce inflammatory oxidants: Can limit release of tissue-irritating molecules. 3. Reduces inflamed acne spots: Red bumps and pimples can improve over time. — Open full-size diagram
Diagram explanation and sources
May calm neutrophil activity: Can reduce some inflammatory actions of these immune cells. May reduce inflammatory oxidants: Can limit release of tissue-irritating molecules. Reduces inflamed acne spots: Red bumps and pimples can improve over time.
The acne mechanism is unknown. Neutrophil and oxidant explanations are proposed based on experimental studies, not established as the cause of topical clinical benefit.
Source 1 · Source 2 · Source 3

Soolantra. Ivermectin helps settle rosacea bumps and pimples. 1. Reduces Demodex mites: Kills mites that may contribute to rosacea inflammation. 2. May calm immune signals: Anti-inflammatory effects may also help skin settle. 3. Reduces bumps and pimples: Inflammatory rosacea lesions gradually improve. — Open full-size diagram
Diagram explanation and sources
Reduces Demodex mites: Kills mites that may contribute to rosacea inflammation. May calm immune signals: Anti-inflammatory effects may also help skin settle. Reduces bumps and pimples: Inflammatory rosacea lesions gradually improve.
The label states that the rosacea mechanism is unknown. Anti-parasitic and anti-inflammatory actions are supported by a small in-vivo pilot; clinical efficacy has randomized-trial support. Demodex is not the sole cause of rosacea.
Source 1 · Source 2 · Source 3

How you take it

Treatment plan

When to Apply: Clean dry skin, whole affected area. The 7.5% gel once a day, the 5% gel twice, usually in the morning so the night is free for a retinoid.

How to Start: Full strength from day one. It dries clear and sits well under makeup and sunscreen.

If It Irritates: Uncommon — usually mild dryness a moisturizer settles. With benzoyl peroxide at the same moment it can turn skin temporarily orange-brown, which is harmless and avoided by using the two at different times of day.

If It’s Not Working: Give it twelve weeks. There is no step up in strength, so the next move is adding or changing a drug.

When to Apply: Once a day, usually at night, on clean dry skin. A pea-sized amount for the whole face, spread thinly rather than dabbed on bumps. Keep it off the eyes, lips and inside of the nose. Moisturizer and sunscreen go on top once it has dried.

How to Start: Once daily from day one. No build-up schedule, and twice a day speeds nothing up.

If It Irritates: Mild burning, stinging or dryness early on is common; moisturizer before or after usually settles it. A flare of bumps in the first two to four weeks happens and passes. It does not mean the cream is wrong.

If It's Not Working: Give it twelve weeks before judging, up to sixteen for the full effect. There is one strength, so the next step is adding something else, often azelaic acid or an oral antibiotic, not more cream.

Monitoring

No routine blood tests for the gel. Unlike dapsone tablets, you do not need G6PD testing first, because so little is absorbed.

You can stay on this for years, and nothing accumulates. Review is clinical, at about twelve weeks and then yearly.

No blood tests or laboratory monitoring. Very little is absorbed through intact skin, far below the amounts involved with the tablets.

Monitoring is a conversation at around twelve weeks: have the bumps reduced, is the cream comfortable, is anything separate needed for redness. People stay on it for years without a dose change, because nothing accumulates.

Irritation after months of comfortable use usually points to a change in the routine or a second problem such as contact dermatitis, worth reviewing rather than pushing through.

When you’ll see results

Approximate windows, not promises.

● Aczone

● Soolantra

Weeks 1 to 4

Weeks 1 to 4Red, tender spots calm down. Blackheads and whiteheads look unchanged.

Weeks 4 to 8

Weeks 4 to 8Fewer new inflamed spots.

After 12 weeks

After 12 weeksIf inflamed acne has not improved, move on. Judge it on red spots only — it was never going to fix clogs.

First few minutes

First few minutesApplying it: A pea-sized amount once a day, thinly over the whole face.

Weeks 1 to 2

Weeks 1 to 2Adjusting: Mild burning, dryness or itching. Some get a short flare as mite numbers drop. Little visible change yet.

Weeks 2 to 4

Weeks 2 to 4First change: Fewer new pustules, which clear before the firm red bumps. The face looks calmer before the count is obviously lower.

Weeks 4 to 12

Weeks 4 to 12Working: Steady reduction in bumps and pustules. Most of the gain happens here, and background pink fades as the inflammation settles.

Weeks 12 to 16

Weeks 12 to 16Judge it here: The point the trials measured, where most people were rated clear or almost clear.

Side effects

Sorted by what to do about them.

Aczone

Soolantra

Common

Mild dryness or oiliness
Orange tint if used with benzoyl peroxide at the same time

Common

Mild burning or stinging
Dry skin

Tell your doctor

Irritation that doesn't settle

Tell your doctor

Rosacea worsening

Stop and get care

A spreading rash or blisters
Breathlessness, pale skin or blue-tinged lips

Stop and get care

Swelling or trouble breathing

Safety and who should avoid it

Pregnancy

Ask first

Discuss with your clinician.

Use care

Ask the doctor managing your pregnancy.

Breastfeeding

Ask first

Discuss with your clinician.

Use care

Discuss with your clinician.

Children

9 and older

Approved from age 9 (7.5%) or 12 (5%).

Not used

Adults only.

Monitoring

None routine

Unlike dapsone tablets, no blood tests.

None

Judge at 12–16 weeks.

Key interactions

Check

Benzoyl peroxide at the same time (orange tint); oral dapsone.

None known

—

Other cautions

Avoid

Allergy to dapsone or sulfones.

Use care

Keep out of eyes.

Cost and getting it

Getting it and cost

Generic dapsone gel comes in both strengths and costs far less than it used to, though still more than generic clindamycin or benzoyl peroxide. Some plans want prior authorization, usually after a retinoid.

Sold as Soolantra, with generic ivermectin 1% cream now available in some markets. Price varies widely between pharmacies and plans, and many plans want metronidazole or azelaic acid tried first.

A tube lasts a while, since a pea-sized amount covers the whole face once a day. If cost is the barrier, price generic ivermectin cream, a pharmacy discount card, or generic metronidazole or azelaic acid.

When you stop

Comes back?

Yes. Red spots come back within weeks to a couple of months.

Bumps can return months after stopping.

Taper needed?

No rebound and no taper.

No.

After the last dose

Inflammation returns to its old level.

Restarting usually works.

Common questions

Aczone:Why did my face turn orange?

Benzoyl peroxide and dapsone applied together can leave a temporary orange-brown tint on skin and light-colored facial hair. It washes off and is harmless. Use them hours apart.

Aczone:Do I need a G6PD test first?

Not for the gel. That belongs to dapsone tablets, where far more of the drug reaches the bloodstream.

Aczone:Will it clear my blackheads?

No. It works on inflammation. Blackheads need a retinoid.

Aczone:Is it an antibiotic?

No. It is a sulfone with anti-inflammatory action, which is why resistance is not the same concern.

Soolantra:Does it get rid of the redness in my face?

Not the kind most people mean. It reduces redness from inflamed bumps, so the face looks calmer. It does not stop flushing or remove visible vessels; those need brimonidine or oxymetazoline, or laser and light.

Soolantra:Why did my rosacea get worse in the first two weeks?

A short early flare is common, probably because dying mites release material the immune system reacts to. It settles within a few weeks.

Soolantra:Is this the same as taking ivermectin tablets?

Same drug, completely different medicine. The cream goes on the face, almost none enters the bloodstream, and it treats skin only.

Soolantra:How long will I need to use it?

Rosacea is managed, not cured, so most people use it long term. Bumps return within a few months of stopping.

Soolantra:Can I use it alongside other rosacea treatments?

Yes, and combinations are common: a redness treatment in the morning and ivermectin at night, or ivermectin with oral doxycycline.

Soolantra:Do I need to change my pillowcases because of the mites?

No. These mites live in the follicles of nearly every adult face. They are not caught from bedding, pets or people, and cleaning does not change their numbers.

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