> ## Documentation Index > Fetch the complete documentation index at: https://docs.hi-doctor.ai/llms.txt > Use this file to discover all available pages before exploring further. # Topical ivermectin — Demodex and rosacea > Ivermectin 1% cream acts on both the Demodex mite and the inflammatory response around it. How it works in papulopustular rosacea and what it does not treat. Ivermectin is an avermectin, originally developed as an anti-parasitic. Applied to the face at 1% it has become one of the better-supported treatments for the papulopustular phenotype of rosacea, and it appears to work through two mechanisms rather than one. ## What it is Active ingredient: **ivermectin 1%**. On this service it is prescribed as a component of the compounded papulopustular gel on the [rosacea](/library/conditions/rosacea) pathway, alongside [metronidazole](/library/medicines/metronidazole-topical) 0.75% and [niacinamide](/library/medicines/niacinamide) 2%, supplied as a 30 g preparation prepared by a pharmacy against the prescription. ## How it works Ivermectin binds to glutamate-gated chloride channels in invertebrate nerve and muscle cells, causing paralysis and death. *Demodex folliculorum* density is higher in rosacea-affected skin than in unaffected skin, and reducing that density reduces the immune stimulus. Independently of any effect on mites, ivermectin suppresses the production of inflammatory cytokines and modulates neutrophil activity. This second mechanism is part of why it acts on the inflammatory lesions rather than only on the mite population. Everyone carries *Demodex*. The mites are normal residents of the pilosebaceous unit, and their presence is not a disease. What appears to differ in rosacea is both the density and the way the skin's innate immune system responds to them — which is why "rosacea is caused by mites" is a simplification that does not survive contact with the evidence. Ivermectin acts on the papules and pustules. It does not remove telangiectasia, does not reverse phymatous change, and does relatively little for fixed background erythema. Those features are handled with vascular laser, intense pulsed light or surgery in person, and no topical substitutes for them. ## What has been reported Topical ivermectin is generally well tolerated, and most reported effects are local and mild. | Reported effect | Character | | ---------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------- | | Burning or stinging on application | Common early; usually settles | | Dry skin and itching | Common; a bland moisturiser is the usual answer | | Erythema at the application site | Common; disproportionate or spreading redness is a reason to stop and seek advice | | Transient worsening of rosacea | Reported in the first weeks. A flare that starts after a new product and does not settle is worth messaging the doctor about rather than pushing through | | Contact dermatitis | Uncommon; distinguished by intense itch and spread beyond the treated area | ## Realistic timelines Local tolerance is established. A transient early flare is reported by some people and usually settles. Inflammatory papules and pustules typically begin to reduce. The fair point of assessment for the inflammatory component. Background redness is usually little changed, which is expected. Rosacea relapses when treatment stops. Maintenance at a reduced frequency is the usual approach, and the reviewing doctor decides what that looks like. ## Who it is not suitable for Anyone with known hypersensitivity to ivermectin or to an excipient in the formulation. It is kept away from the eyes, and eye symptoms in rosacea — grittiness, burning, recurrent styes, lid margin inflammation — need an eye assessment rather than a facial treatment; any change in vision is an urgent in-person matter. Suitability in pregnancy and breastfeeding is a decision for the reviewing doctor, who needs to know before prescribing. ## How Hi-Doctor handles it The review is fully asynchronous — no video call, no telephone consultation. You complete the twelve-step rosacea questionnaire, upload the mandatory photograph, and a registered doctor establishes which phenotype is present and decides whether a compounded topical is appropriate. A prescription is never guaranteed; if one is not issued, the consultation fee is refunded in full. The preparation is dispensed and paid for at a pharmacy — the [pricing page](/essentials/pricing) covers what the consultation fee includes. ## Related reading * [Rosacea](/library/conditions/rosacea) * [Metronidazole](/library/medicines/metronidazole-topical) · [azelaic acid](/library/medicines/azelaic-acid) · [niacinamide](/library/medicines/niacinamide) * [How to apply a prescription topical](/library/guides/how-to-apply-topicals) * [Side effects of dermatology topicals](/library/guides/side-effects-dermatology) * [Taking your dermatology photos](/library/guides/dermatology-photos) * [Safety and eligibility](/essentials/safety) ## Start a consultation Answer the rosacea questionnaire and upload the required photograph. A registered doctor reviews the case and decides whether a topical treatment is appropriate — declining is a normal outcome. See [what it costs](/essentials/pricing) and [how the review works](/essentials/how-it-works). This page is reference information, not medical advice and not a prescription. Whether a medicine is appropriate for you is decided by a registered doctor after reviewing your consultation.