Ivermectin Therapy for Rosacea: Software Platform to Quantify Changes in Erythema and Skin Texture

Introduction: Rosacea’s impact on quality of life comes from both visible and subjective symptoms. Ivermectin 1% cream has demonstrated efficacy and safety as a rosacea therapy, with both anti-inflammatory and acaricidal mechanisms of action. Objectives: Investigate the potential of ivermectin 1% cream to improve rosacea-associated erythema and invisible symptoms by combining established questionnaires with the photography and analysis platform Scarletred® Vision. Materials and Method: Single-center, open-label study of subjects (N=25) with moderate-severe rosacea (erythema, <10 papules/pustules, ≥15 Demodex mites/cm2) treated with ivermectin 1% cream once-daily for ≥16 weeks. Skin symptoms assessed at baseline, week 8 and ≥week 16; erythema assessed by clinician erythema assessment (CEA) and patient self-assessment (PSA); stinging, burning, dryness, itching severity assessed by questionnaire. Standardized digital skin images captured using a smartphone with Scarletred Vision App plus a Scarletred Skin Patch. Standard Erythema Value (SEV) algorithm used to quantify erythema, Gray Level Co-occurrence Matrix to quantify skin texture. Results: At baseline, mean CEA or PSA score was 3.6 with 44% score 3 and 56% score 4; subjects also had severe or moderate subjective symptoms. Ivermectin 1% cream significantly improved CEA and PSA, reduced lesions, and reduced Demodex counts (P<.0001 for all). Stinging, burning, dryness significantly reduced at 16 weeks (P<.0001) as was itching (P<.001). Scarletred Vision showed significant improvement of erythema (P<.0001) and skin roughness (P<.001) at ≥16 weeks, which agreed with CEA and PSA findings. Conclusions: Ivermectin 1% cream was efficacious in treating rosacea papules, pustules, and erythema; reducing Demodex counts, and improving subjective skin symptoms.