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Dual anti‐inflammatory and anti‐parasitic action of topical ivermectin 1% in papulopustular rosacea
Author(s) -
Schaller M.,
Gonser L.,
Belge K.,
Braunsdorf C.,
Nordin R.,
Scheu A.,
Borelli C.
Publication year - 2017
Publication title -
journal of the european academy of dermatology and venereology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.655
H-Index - 107
eISSN - 1468-3083
pISSN - 0926-9959
DOI - 10.1111/jdv.14437
Subject(s) - ivermectin , medicine , demodex , rosacea , papulopustular , dermatology , mite , biology , veterinary medicine , botany , acne
Abstract Background Recently, therapy of rosacea with inflammatory lesions (papulopustular) has improved substantially with the approval of topical ivermectin 1% cream. It is assumed to have a dual mode of action with anti‐inflammatory capacities and anti‐parasitic effects against Demodex , which however has not yet been demonstrated in vivo . Aim To find scientific rationale for the dual anti‐inflammatory and anti‐parasitic mode of action of topical ivermectin 1% cream in patients with rosacea. Methods A monocentric pilot study was performed including 20 caucasion patients with moderate to severe rosacea, as assessed by investigator global assessment ( IGA score ≥3) and a Demodex density ≥15/cm 2 . Patients were treated with topical ivermectin 1% cream once daily (Soolantra ® ) for ≥12 weeks. The density of Demodex mites was assessed with skin surface biopsies. Expression of inflammatory and immune markers was evaluated with RT ‐ PCR and by immunofluorescence staining. Results The mean density of mites was significantly decreased at week 6 and week 12 ( P < 0.001). The gene expression levels of IL ‐8, LL ‐37, HBD 3, TLR 4 and TNF ‐ α were downregulated at both time points. Reductions in gene expression were significant for LL ‐37, HBD 3 and TNF ‐ α at both follow‐up time points and at week 12 for TLR 4 (all P < 0.05). Reduced LL ‐37 expression ( P < 0.05) and IL ‐8 expression were confirmed on the protein level by immunofluorescence staining. All patients improved clinically, and 16 of 20 patients reached therapeutic success defined as IGA score ≤1. Conclusion Topical ivermectin 1% cream acts by a dual, anti‐inflammatory and anti‐parasitic mode of action against rosacea by killing Demodex spp. in vivo, in addition to significantly improving clinical signs and symptoms in the skin.