Medication

Ivermectin Cream (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.
Dr. Schwarz, MD · Board-certified dermatologistLast reviewed September 8, 2026
16:9 hero for Ivermectin Cream (Soolantra). Never cropped: the tone strip and the corner logo depend on the full frame.

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Ivermectin cream is my first prescription when rosacea shows up as bumps and pustules rather than color: once a day, better tolerated than metronidazole gel, and it cleared more spots in head-to-head trials. It will not touch flushing, the fixed pink background or visible vessels, so I sort out which problem we are treating before I write anything. Some people flare early on. That settles, and it is not a reason to stop.

— Dr. Schwarz, Board Certified Dermatologist

Key Facts

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Also calledSoolantra, ivermectin 1% cream
Drug classTopical antiparasitic with anti-inflammatory action
Applied as1% cream
Typical courseLong term, while rosacea is active
Time to workEarly change by 4 weeks, full effect around 12 to 16 weeks
Prescription onlyYes

What It Is

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Ivermectin 1% cream is a prescription treatment approved in 2014 for the inflammatory bumps and pustules of rosacea, which doctors call papulopustular rosacea. Ivermectin is an old drug, used for decades as a tablet against parasites. On skin it does two things: calms inflammation, and reduces Demodex, the microscopic mites that live in hair follicles. It goes on the whole face once a day. Almost none reaches the bloodstream, so it does not behave like the tablet.

How It Works

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Demodex folliculorum lives in the follicles of nearly every adult face. In rosacea the numbers are higher, and the immune system appears to react to the mites and the bacteria they carry. That reaction is part of what produces papules and pustules. Ivermectin paralyzes the mites through glutamate-gated chloride channels, nerve channels people do not have, so mite numbers fall.

It also damps down inflammatory signaling in the skin directly, which is why improvement often begins before mite numbers could have changed much.

Nothing here narrows blood vessels. Flushing and the fixed pink of rosacea come from how facial blood vessels behave, so this cream barely touches them. That explains most of the disappointment people report.

Here is where Ivermectin Cream (Soolantra) acts in the skin, and what the others do instead.

About Ivermectin Cream (Soolantra)
Compare
Skin basics
BARRIEREPIDERMISDERMISPOREOILGLANDKILLS MITESCROSSES EASILYSTOPS PLUGS FORMINGUNCLOGS THE POREKILLS BACTERIAKILLS YEASTLOWERS OIL PRODUCTION

Everyone carries these mites in their follicles. In some people the immune system reacts to them, and reducing their number reduces the bumps and the redness that come with them. For rosacea: it lowers the mites and calms the inflammation.

Ivermectin cream crosses to the follicle where the mites live. Very little reaches the bloodstream.

Retinoids change how the lining of the pore sheds its cells, so the plug that starts a spot stops forming in the first place. That is why they prevent spots rather than treat the ones already there, and why the first weeks can look worse before they look better.

Salicylic acid dissolves in oil, so it gets down inside the pore rather than sitting on the surface, and loosens the plug of dead skin and sebum blocking the way out.

This works on the bacteria growing in an inflamed pore. Less bacteria means less for the immune system to react to, which is what takes the redness and soreness out of a spot.

The yeast involved here lives on everyone's skin and only causes trouble when it overgrows in oil. This reduces it, which is why the flaking and itching settle and why it comes back if treatment stops for good.

This works upstream of the spot, on the gland itself. Less oil means fewer plugs, less for bacteria to feed on and less inflammation, which is why it changes the pattern rather than clearing one spot.

The outer film of dead cells and oil. It holds water in and keeps irritants out, and it is thinner than a sheet of paper. Almost every dry, itchy, stinging skin problem starts here.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

What It Treats

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Close-up of a cheek with pink flushing and fine visible red blood vessels beside the nose
Rosacea
Strong evidence
Often the best single treatment for the bumps and pus-filled spots, because it works on the Demodex mites and on the inflammation at the same time. Once a night, a pea-sized amount for the whole face. It usually beats metronidazole head to head, and it does nothing at all for flushing or visible vessels.

Not the Best For

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Close-up of small pink bumps and flaky skin clustered on the chin below the lower lip
Perioral Dermatitis
Limited evidence
Used when Demodex mites around the hair follicles are thought to be part of the picture, which is more likely in a stubborn case with a lot of small pus-filled heads. Most of its evidence comes from rosacea rather than this condition. It is a second or third choice, not a starting point.
Flushing episodes
Doesn't work
Ivermectin works on the mites and the inflammation around them. Flushing comes from blood vessels widening, so it carries on unchanged.
Visible broken vessels
Doesn't work
No cream removes a capillary you can see. Those need laser or intense pulsed light.
Fixed background redness
Doesn't work
Some pink fades because the inflammation behind it settles, but steady redness that is always there is a different problem and is treated separately.

Forms

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Ivermectin for rosacea comes in one form.

1% cream:

Oral ivermectin:

Strengths

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One strength only.

The only strength
1%
Nothing weaker to start on, nothing stronger to move up to. If it is not enough, add a second treatment rather than more cream.

Basics

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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.

Sample Routine

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Here is where Ivermectin Cream (Soolantra) sits in a day, and what goes around it. Pick what you are treating and what your skin is like, and the rest of the routine changes to suit.

What to Expect

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First few minutes | Applying it
A pea-sized amount once a day, thinly over the whole face.
Weeks 1 to 2 | Adjusting
Mild burning, dryness or itching. Some get a short flare as mite numbers drop. Little visible change yet.
Weeks 2 to 4 | First 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 | Working
Steady reduction in bumps and pustules. Most of the gain happens here, and background pink fades as the inflammation settles.
Weeks 12 to 16 | Judge it here
The point the trials measured, where most people were rated clear or almost clear.

What to Avoid

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  • Spot-treating A whole-face treatment — the follicles that have not flared yet are the point.
  • The eyes, lips and inside of the nose Keep the cream off these. Rinse with water if it gets in the eyes.
  • Scrubs and grainy exfoliants Rosacea skin is already reactive; scrubbing adds irritation without benefit.
  • Stopping in week three because of a flare Early worsening is common and settles. Stopping then means never finding out whether it works.
  • Your own rosacea triggers Heat, sun, alcohol and spicy food still set off flushing. The cream does not protect against them.

Monitoring

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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.

If You Stop

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No taper, no withdrawal. Bumps and pustules generally return over one to four months, because mite numbers rebuild and the underlying tendency has not changed. Studies found a longer gap before relapse with ivermectin than with some alternatives, but relapse was still the usual outcome. Rosacea is managed, not cured. Most people continue or step down to a few applications a week, worth planning with a doctor rather than by drift.

Cost

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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.

Ask Your Doctor

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If you are pregnant or breastfeeding
Including planning a pregnancy. Ask the doctor managing your pregnancy first.
If you have reacted to ivermectin before
In any form, tablet or cream.
If your skin is broken or weeping
Badly inflamed skin too, since more is absorbed through skin that is not intact.
If the burning has not settled
After a month it should be easing, not building.
If your eyes are gritty or sore
Or crusted at the lash line. Rosacea can involve the eyes and needs its own treatment.
If nothing has changed by sixteen weeks
Twelve to sixteen weeks is a fair trial. There are other options, including oral treatment.

How It Compares

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Metronidazole cream or gel
Worse
The older standard. In head-to-head trials ivermectin cleared more bumps, but metronidazole is cheaper and more widely covered.
Azelaic acid 15%Diagram: how Azelaic Acid 15% (Finacea) works in the skin
Azelaic acid 15%
The same
For the same bumps. Twice a day rather than once, and it stings more for many people, but it also fades the marks spots leave behind and is usually cheaper.
Oral doxycycline
Different job
Faster. Works from the inside for more widespread or stubborn disease, and is often added to a cream rather than replacing it.
Brimonidine or oxymetazoline
Different job
A different target altogether. Those narrow blood vessels for redness and do nothing for bumps.
Laser and intense pulsed light
Different job
The option for visible vessels and fixed redness, which no cream addresses.
Where ivermectin fits
Different job
It is once daily, generally well tolerated, and the strongest of the creams for bumps and pustules.

Myths

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  • "It is the same as ivermectin tablets people took for other reasons." Same drug, different medicine. This is a cream for the face and almost none reaches the bloodstream.
  • "Rosacea means my face is infested with mites." Demodex mites live in the follicles of nearly every adult. In rosacea there are more of them and the immune system reacts. Not an infestation, not a hygiene problem.
  • "It treats rosacea redness." It treats bumps and pustules. Redness from flushing and visible vessels needs a different approach.
  • "You can just dab it on the spots." Whole-face use is what was studied. Spot-treating leaves the follicles about to flare untreated.
  • "An early flare means I am allergic to it." A short worsening in the first weeks is common and settles. A true allergy spreads, swells and itches, and gets worse.
  • "I should wash my bedding differently because of the mites." Cleaning routines do not change mite numbers, and the mites are not caught from bedding, pets or other people.

Questions Patients Ask

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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.

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.

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.

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.

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.

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.

References

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