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Original Article

Papulopustular rosacea treated with ivermectin 1% cream: remission of the Demodex mite infestation over the time and evaluation of clinical relapses

Author Affiliation(s)

Abstract

Background: Topical ivermectin is an anti-inflammatory and anti-Demodex drug for papulopustular rosacea. Rosacea is a relapsing disease and the time between recurrences should be considered alongside efficacy


Objectives: The aims of this study were to assess the time of first relapse and relapse rates of Demodex mite infestation and papulopustular rosacea


Methods: We conducted a prospective study of subjects affected by different degrees of papulopustular rosacea. Patients that achieved a complete response after treatment were monitored every 4 weeks and up to 32 additional weeks. For each patient, we evaluated recording the time to first relapse and relapse rate of Demodex mite infestation and rosacea.


Results: The overall success rate on Demodex infestation was 87.5%. only 12.5% relapse. Ivermectin leads to complete response in 70% of patients. Median time to relapse was 140 days, the mean time was 152 days. The global success rate was 54.76%.


Conclusions: Topical ivermectin keeps a remission of Demodex infestation and clinical remission for long time. We proposed a twice-weekly ivermectin maintenance therapy to reduce recurrences.

Keywords : Ivermectin, rosacea, papulopustular rosacea

References

1. van Zuuren EJ. Rosacea. N Engl J Med. 2017; 377:1754-1764. 2. Wilkin J, Dahl M, Detmar M, Drake L, Feinstein A, Odom R, et al. Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. J Am Acad Dermatol. 2002; 46:584-587. 3. Taieb A, Khemis A, Ruzicka T, Barańska-Rybak W, Berth-Jones J, Schauber J,et al. Ivermectin Phase III Study Group. Maintenance of remission following successful treatment of papulopustular rosacea with ivermectin 1% cream vs. metronidazole 0.75% cream: 36-week extension of the ATTRACT randomized study. J Eur Acad Dermatol Venereol. 2016; 30:829-836. 4. Schaller M, Almeida LM, Bewley A, Cribier B, Dlova NC, Kautz G, et al. Rosacea treatment update: recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol. 2017; 176:465-471. 5. Steinhoff M, Vocanson M, Voegel JJ, Hacini-Rachinel F, Schäfer G. Topical Ivermectin 10 mg/g and Oral Doxycycline 40 mg Modified-Release: Current Evidence on the Complementary Use of Anti-Inflammatory Rosacea Treatments. Adv Ther. 2016; 33:1481-501. 6. Mendieta Eckert M, Landa Gundin N. Treatment of rosacea with topical ivermectin cream: a series of 34 cases. Dermatol Online J. 2016; 22:13030. 7. Trave I, Merlo G, Cozzani E, Parodi A. Real-life experience on effectiveness and tolerability of topical ivermectin in papulopustular rosacea and antiparasitic effect on Demodex mites. Dermatol Ther. 2019;32: 13093. 8. Forton F, Seys B. Density of Demodex folliculorum in rosacea: a case-control study using standardized skin-surface biopsy. Br J Dermatol 1993; 128:650-659. 9. Alniemi DT, Chen DL. Perioral Demodex folliculitis masquerading as perioral dermatitis in the peripartum period. JAAD Case Rep 2019; 5: 639–641. 10. Friedman P, Sabban EC, Cabo H. Usefulness of dermoscopy in the diagnosis and monitoring treatment of demodicidosis. Dermatol Pract Concept 2017; 7:35–38. 11. Lee JY, Hsu CK. Granulomatous rosacea-like demodicidosis. Dermatol Online J 2007; 13: 9. 12. Dall'Oglio F, Lacarrubba F, Luca M, Boscaglia S, Micali G. Clinical and erythema-directed imaging evaluation of papulo-pustular rosacea with topical ivermectin: a 32 weeks duration study. J Dermatolog Treat. 2019; 30:703-707. 13. Drago F, Ciccarese G, Herzum A, Rebora A, Parodi A. Rosacea and alcohol intake. J Am Acad Dermatol. 2018;78: e25. 14. Gallo RL, Granstein RD, Kang S, et al. Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol 2018; 78:148-155. 15. Hopkinson D, Moradi Tuchayi S, Alinia H, Feldman SR. Assessment of rosacea severity: A review of evaluation methods used in clinical trials. J Am Acad Dermatol 2015; 73:138-143. 16. Laing R, Gillan V, Devaney E. Ivermectin - Old drug, new tricks? Trends Parasitol. 2017;33:463–472. 17. Forton F, Germaux MA, Brasseur T, De Liever A, Laporte M, Mathys C, et al. Demodicosis and rosacea: epidemiology and significance in daily dermatologic practice. J Am Acad Dermatol. 2005; 52:74-87. 18. Forton F, De Maertelaer V. Erythematotelangiectatic rosacea may be associated with a subclinical stage of demodicosis: a case-control study. Br J Dermatol. 2019; 181:818-825. 19. Forton FMN. The Pathogenic Role of Demodex Mites in Rosacea: A Potential Therapeutic Target Already in Erythematotelangiectatic Rosacea? Dermatol Ther (Heidelb). 2020; 10:1229-1253. 20. Trave I, Micalizzi C, Gasparini G, Cozzani E, Parodi A. Dermoscopy of papulopustular rosacea and comparison of dermoscopic features in patients with or without concomitant Demodex folliculorum. Clin Exp Dermatol. 2021; 46: 1434-1440. 21. Schaller M, Gonser L, Belge K, et al. Dual anti-inflammatory and anti-parasitic action of topical ivermectin 1% in papulopustular rosacea. J Eur Acad Dermatol Venereol. 2017; 31:1907–1911. 22. Thibaut de Ménonville S, Rosignoli C, Soares E, et al. Topical treatment of rosacea with ivermectin inhibits gene expression of cathelicidin innate immune mediators, LL-37 and KLK5, in reconstructed and ex vivo skin models. Dermatol Ther (Heidelb). 2017; 7:213–225.

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