Ivermectin 1% cream, sold as Soolantra and as a generic, is a prescription cream for the bumps and pimples of rosacea. Its label approves it for the inflammatory lesions of rosacea, applied once a day, and it was tested in adults. In two large trials, about 4 in 10 people using it were rated clear or almost clear after 12 weeks, compared with about 1 in 10 to 2 in 10 on the plain cream base. Side effects were uncommon: burning and skin irritation, each in 1% of people or fewer. It’s often linked to Demodex, the tiny mites that live on everyone’s face, but the label says nobody knows exactly how it works on rosacea. It isn’t approved for flushing or visible blood vessels, and you’ll need a dermatologist to prescribe it.
Ivermectin cream at a glance
| Detail | Ivermectin cream, 1% |
| Brand name | Soolantra; generic versions are also approved |
| What it is | Prescription cream, 10 mg of ivermectin per gram |
| Approved for | Inflammatory lesions of rosacea, the red bumps and pus-filled spots |
| How often, per the label | Once a day |
| Most common side effects | Skin burning sensation and skin irritation, each in 1% of people or fewer |
| Children | Not established as safe or effective |
The mite question
Demodex mites live in the hair follicles and oil glands of human skin. Two species live on people, and one of them also lives in the oil glands of the eyelids. They’re too small to see without a powerful microscope, and they live on nearly everyone’s skin.
What’s different in rosacea is the number. The American Academy of Dermatology says researchers often find more of these mites on people with rosacea, and that the larger numbers may set off an immune response that leads to inflammation. The National Rosacea Society notes a long debate over whether the extra mites are a cause or a result of rosacea, with more evidence suggesting they may help cause it.
Ivermectin is an antiparasitic drug, which is why the mite link comes up so often, and it’s also described as anti-inflammatory. Its label, though, makes no claim about mites at all. It says the way the cream treats rosacea is unknown. So “it works by clearing the mites” is a reasonable theory, not an established fact, and it isn’t a reason to go hunting for mite cures online.
What the trials found
The approval rests on two identical 12-week trials in 1,371 adults with moderate or severe rosacea. About two-thirds were women, and 96% were white, which is a real limit on what the results can tell people with darker skin.
The gap over the base cream was wide. In the first trial, 38% of people on Soolantra were rated clear or almost clear at 12 weeks, against 12% on the plain cream. In the second, 40% against 19%. Bumps and pimples fell by about 65% on the cream and 42% to 43% on the base. The cream pulled ahead of the base from week 4 in both trials.
The base cream helped a fair amount by itself, and nothing here was compared head-to-head against other rosacea medicines. The National Rosacea Society lists ivermectin with azelaic acid and metronidazole as the topicals its expert committee considers very effective for bumps and pimples.
Who it’s usually for
The trials enrolled people whose rosacea showed up as red bumps and pus-filled spots across the face, rated moderate or severe. That’s the label’s territory. It goes on the parts of the face that are affected, and the label’s instructions break the face into five areas: forehead, chin, nose and each cheek.
If what bothers you is a constant flush, or the fine red lines of broken capillaries, this isn’t aimed at that. Persistent redness has its own prescriptions, and visible blood vessels usually call for light or laser treatments. Our guide to a flushing red face covers the everyday side.
A dermatologist matters here for diagnosis as much as for the prescription. Rosacea can look like acne, a reaction to a product or something rarer, and the National Rosacea Society notes that a heavy mite overgrowth can mimic rosacea without responding to rosacea treatment.
Side effects and safety
The label lists no contraindications, meaning no group of people it says must never use it. In the trials, 2,047 people with rosacea used the cream, more than 1,500 of them for over 12 weeks and 519 for around a year. Skin burning and skin irritation were the reactions reported, each in 1% of people or fewer. Since approval, contact dermatitis and allergic skin reactions have been reported.
Very little ivermectin reaches the bloodstream from the cream, and in the long trials it didn’t build up over a year of use. It does stay in the body a while: the label puts its average half-life at about 6.5 days. In lab tests it didn’t block or boost the liver enzymes that many other drugs depend on.
The tube has a child-resistant cap, and the leaflet says to call a doctor or go to an emergency room if anyone swallows it. The cream is for the face only, and the label says to keep it away from the eyes and lips.
Pregnancy and breastfeeding
The label says there isn’t enough data on ivermectin in pregnancy to establish a risk. In animal studies, oral ivermectin caused harm to developing young, but at doses hundreds to thousands of times higher than the cream’s maximum human dose. On breastfeeding, nobody has measured whether ivermectin reaches breast milk after use on the skin, and the leaflet asks you to talk with your provider about how to feed your baby while using it.
What to keep in the rest of your routine
The AAD says every rosacea treatment plan includes a gentle cleanser, a moisturizer and sunscreen. None of these products contains a strong active. Each one is fragrance-free or has no fragrance in its ingredient list. They’re the kind of plain basics that let a prescription do its job without extra irritation.
Aveeno Calm + Restore Redness Relief Moisturizing Cream
About $20
Prices move constantly, so we link to live listings instead of printing a number that is wrong by the time you read it. Links go to Amazon, which is where a referral gets credited.
CeraVe Hydrating Facial Cleanser is about $15, though the price changes often. It has three ceramides and hyaluronic acid, no added fragrance, and it’s non-comedogenic. CeraVe makes it for normal to dry skin, so if yours runs very oily, a lighter gel wash may suit you better.
Vanicream Daily Facial Moisturizer is a light lotion built on squalane, hyaluronic acid and five ceramides, with no botanical extracts or essential oils. It’s non-comedogenic and light enough to wear under makeup. Our skin barrier repair guide explains why ceramides keep coming up.
Aveeno Calm + Restore Redness Relief Moisturizing Cream has oat, feverfew, ceramide and vitamin B5. It’s fragrance-free, non-comedogenic and has a richer texture than the Vanicream. Aveeno says it visibly soothes the look of facial redness. That’s a cosmetic claim about appearance, not a rosacea treatment, but it’s a sensible night cream for dry, reactive skin.
Vanicream Facial Moisturizer SPF 30 uses 19.5% zinc oxide as its only sunscreen filter, with ceramides and squalane in the base. It’s broad spectrum and non-comedogenic, and at about $14 it covers two steps at once.
EltaMD UV Clear SPF 46 combines 9% zinc oxide with 7.5% octinoxate, so it’s a hybrid rather than pure mineral. It’s fragrance-free, oil-free and has 5% niacinamide, and EltaMD says it’s designed for sensitive, rosacea-prone and acne-prone skin. It costs about three times as much as the Vanicream, so it’s the pick if you want a lightweight sunscreen with niacinamide built in. More options are in our moisturizers for sensitive skin roundup.
How we picked
Nothing here treats rosacea or stands in for ivermectin. These are the three basics a rosacea plan rests on, cleanser, moisturizer and sunscreen, chosen fragrance-free and made for sensitive skin, with a budget and a pricier option for sunscreen and a light and a richer option for moisturizer.
If I Were You
If you’ve just been prescribed ivermectin cream, keep everything else to cleanser, moisturizer and sunscreen for the first three months, so you know what the cream is doing.
If you’ve read that rosacea is “caused by mites,” treat that as one theory among several. Skip the DIY mite remedies and let a dermatologist decide what your skin needs.
If it burns or stings, tell your prescriber. It’s uncommon with this cream, and they’ll want to know.
If you’re pregnant, trying or breastfeeding, raise it before you start. The label doesn’t have enough data to reassure you either way.
If your rosacea is mostly redness without bumps, ask about treatments aimed at redness. That isn’t what this cream was tested on.
FAQ
Is this the same ivermectin as the pills?
Same active ingredient, very different product. Soolantra is a 1% cream for the skin, and its label says it isn’t for use by mouth, in the eyes or in the vagina.
Does ivermectin cream kill Demodex mites?
Ivermectin is an antiparasitic drug, and that’s the popular explanation. The label doesn’t say so; it lists the mechanism as unknown.
How long does it take to work?
In the trials it beat the base cream from week 4, and results were measured at 12 weeks.
Can I use it with metronidazole or azelaic acid?
Rosacea is often treated with more than one medicine, but whether to combine them is your dermatologist’s call.
Is there a generic?
Yes. Generic ivermectin cream, 1% is approved for the same use.
Bottom line
Ivermectin 1% cream is a once-a-day prescription for the bumps and pimples of rosacea, with strong trial results and few side effects. The mite story behind it is plausible but unproven, so don’t let it send you down a DIY path. Keep the rest of your routine plain, give it about three months, and raise pregnancy or breastfeeding with your dermatologist. Our guide to calming rosacea redness and the skin archive have more.
