Compare · Medications

Rhofade vs Soolantra

Rhofade: A once-daily cream that narrows facial blood vessels to reduce rosacea redness for most of a day. Like brimonidine it treats color only, and the effect ends when it wears off. 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
Existing illustration of a plain white tube labeled Cream, with a cream swatch; no medicine name or strength is shown.Soolantra — Header Image
Which one?At a glanceWhat it treatsDiagramsHow you take itResultsSide effectsSafetyCostWhen you stopQuestions

Which one is right for you?

Choose Rhofade if…

Choose to fade rosacea redness for most of the day — it treats color only, not bumps.

  • Background redness bothers you most
  • You want a once-daily morning cream
  • You'll test it first for rebound

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
Often combined

Can you take them together?

They treat different parts of rosacea: Soolantra for bumps, Rhofade for redness. Apply Soolantra at night and Rhofade in the morning.

At a glance

● Rhofade
● Soolantra
Type
Topical vessel-narrowing cream (oxymetazoline 1%)
Topical antiparasitic and anti-inflammatory (ivermectin 1%)
What it does
Temporarily shrinks facial blood vessels
Calms inflammation and reduces Demodex mites
Best for
Persistent rosacea redness
Rosacea bumps and pustules
Prescription
Yes
Yes
Form
Cream
Cream
How often
Once daily, usually morning
Once daily
Course length
As needed
Ongoing
Time to results
1–2 hours; lasts about 12
4–16 weeks
Main side effect
Application-site irritation
Mild burning or dryness
Blood tests
None
None
Pregnancy
Check with your clinician
Check with your clinician
Cost
High; brand only
Moderate; generic available

What it treats

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

Evidence level
Rhofade
Soolantra
Strong evidenceMost established uses
—
Redness and fine superficial vessels across a light-skinned cheek and nose.

Rosacea

Reduces bumps and pimples.
Moderate evidenceSome supportive research
Redness and fine superficial vessels across a light-skinned cheek and nose.

Rosacea

Reduces persistent redness.
—
Little evidence
—
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
Fine branching superficial spider veins on the lower leg.

Spider Veins

Doesn't remove vessels.
Inflamed acne on light skin. The spots sit in a patch of pink, and the ring of redness around each one is easy to see. A few have a yellow-white head, and the skin between them is dry and flaking.

Acne

No role in acne.
Inflamed acne on light skin. The spots sit in a patch of pink, and the ring of redness around each one is easy to see. A few have a yellow-white head, and the skin between them is dry and flaking.

Acne

Not an acne treatment.
Post-Inflammatory Redness.

Post-Inflammatory Redness

Doesn't fade redness alone.
How it works

Rhofade

Rhofade. Oxymetazoline temporarily reduces rosacea redness. 1. Activates vessel receptors: Stimulates alpha-1A receptors in skin blood vessels. 2. Narrows blood vessels: Vessel walls contract and reduce local blood flow. 3. Reduces visible redness: The effect is temporary and wears off.
Open full-size diagram
Diagram explanation and sources

Activates vessel receptors: Stimulates alpha-1A receptors in skin blood vessels. Narrows blood vessels: Vessel walls contract and reduce local blood flow. Reduces visible redness: The effect is temporary and wears off.

Oxymetazoline is an alpha-1A agonist and vasoconstrictor. This is temporary control of persistent facial erythema, not vessel destruction or cure.

Source 1

Soolantra

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: Once a day on clean dry skin, usually morning so the effect covers the day. A pea-sized amount spread thinly over forehead, nose, chin and both cheeks. Wash your hands afterwards. Sunscreen and makeup go on once it has dried.

How to Start: Test one small area for a few days first. A small amount, never more than once a day. There is no build-up schedule and no benefit to using more.

If It Irritates: Mild stinging, dryness or itching early on usually settles. If redness gets worse rather than better, or worsens as the cream wears off, stop and call your doctor.

If It's Not Working: Nothing to increase — there is one strength. If a few weeks of daily use has not helped, the options are brimonidine gel, which works through a different receptor, or laser and light treatment for the vessels themselves.

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. Monitoring is visual — does the redness reduce, does it worsen, does your skin tolerate the cream.

A small amount is absorbed, so the class effects — lower blood pressure, a slow heart rate, dizziness — are theoretically possible. They are rare on intact skin, but they are why heart problems, low blood pressure, circulatory disease and certain psychiatric medicines are worth raising first.

Review a few weeks in, and the only question is whether the result justifies continuing.

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.

● Rhofade
● Soolantra
First hour

First hourStarting: Redness begins to fade. Mild tingling or dryness is common.

Hours 3 to 8

Hours 3 to 8Peak: Least red through most of the working day.

Around 12 hours

Around 12 hoursWearing off: Color returns, usually to where it started.

Weeks 1 to 4

Weeks 1 to 4Watching: A few people find redness or flushing gets worse instead of better, as it wears off or over the first weeks. Stop and review.

Ongoing

OngoingNo build-up: No accumulation. Month three looks like day one.

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.

Rhofade

Soolantra

Common
Common
  • Redness, itch or pain where applied
  • Rebound redness in some people
Common
  • Mild burning or stinging
  • Dry skin
Tell your doctor
Tell your doctor
  • Rosacea bumps worsening
Tell your doctor
  • Rosacea worsening
Stop and get care
Stop and get care
  • Dizziness or chest pain
Stop and get care
  • Swelling or trouble breathing

Safety and who should avoid it

Pregnancy
Use care
Ask the doctor managing your pregnancy.
Use care
Ask the doctor managing your pregnancy.
Breastfeeding
Use care
Discuss with your clinician.
Use care
Discuss with your clinician.
Children
Not used
Adults only.
Not used
Adults only.
Monitoring
None
—
None
Judge at 12–16 weeks.
Key interactions
Check
MAOI antidepressants; blood pressure drugs.
None known
—
Other cautions
Use care
Heart disease, narrow-angle glaucoma, Raynaud's.
Use care
Keep out of eyes.

Cost and getting it

Getting it and cost

Brand priced, and coverage is inconsistent because insurers often treat facial redness as cosmetic. Prior authorization is common.

A pump lasts a while if you stick to the pea-sized rule. Manufacturer savings offers exist and change often.

Where cost rules it out, price generic brimonidine gel where available, green-tinted makeup, and — if you want a lasting change rather than a daily one — laser or light treatment.

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?
Redness returns each day as it wears off.
Bumps can return months after stopping.
Taper needed?
No.
No.
After the last dose
Nothing lasting.
Restarting usually works.

Common questions

Rhofade:How is this different from brimonidine gel?

Both narrow facial vessels, through different receptors. Brimonidine works faster and wears off sooner; oxymetazoline covers more of a working day and rebound redness is reported less often. Neither treats the condition.

Rhofade:Can I use decongestant nasal spray on my face instead, since it has the same ingredient?

No. Different concentration, different base, different intended surface. It is not a cheaper version of this medicine.

Rhofade:Will it help my bumps and pustules?

No. Blood vessels only. Bumps need their own treatment, and the two are often used together.

Rhofade:Will it stop me flushing when I drink wine or eat something spicy?

Not reliably. It reduces fixed background redness. Flushing is a faster, different response, and some people report more of it on this cream.

Rhofade:How long before I know whether it works?

A single application shows the same day. Give it a few weeks to judge whether it is worth continuing.

Rhofade:Can I wear sunscreen and makeup over it?

Yes, once it has dried. Keep the daily sunscreen either way — sun is a common rosacea trigger.

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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