COMPARITIVE EFFICACY AND SAFETY OF TOPICAL IVERMECTIN 1% CREAM VERSUS TOPICAL METRONIDAZOLE 1.5% GEL IN STEROID-INDUCED ROSACEA: A PROSPECTIVE RANDOMIZED COMPARITIVE STUDY

Abstract

Introduction

Steroid-induced rosacea is an increasingly recognized inflammatory dermatosis resulting from prolonged or inappropriate use of topical corticosteroids on the face. It presents with persistent erythema, papules, pustules, telangiectasia, and burning sensation, often causing significant cosmetic and psychological distress. In India, misuse of topical steroid-containing creams for cosmetic purposes has led to a rising incidence of steroid-induced rosacea. Although topical metronidazole has long been used as a first-line therapy, ivermectin has recently gained attention due to its dual anti-inflammatory and acaricidal effects against Demodex mites. However, comparative data specifically evaluating these two agents in steroid-induced rosacea remain limited.

Methods: A prospective randomized comparative study was conducted in the Dermatology outpatient department of Rajshree Medical Research Institute, Bareilly, from March 2024 to April 2025. A total of 160 patients aged above 18 years clinically diagnosed with steroid-induced rosacea were enrolled and randomly divided into two groups of 80 each. Group 1 received topical ivermectin 1% cream once daily, while Group 2 received topical metronidazole 1.5% gel twice daily. Patients were evaluated at baseline and at 4, 8, and 12 weeks. Treatment efficacy was assessed using inflammatory lesion count, Investigator Global Assessment (IGA), Rosacea Area and Severity Index (RASI), and Visual Analogue Scale (VAS). Adverse effects such as burning, stinging, dryness, and irritation were recorded during follow-up visits.

Results: Both groups were comparable in baseline demographic and clinical characteristics. Progressive improvement was observed in both treatment groups during the study period. However, patients treated with topical ivermectin demonstrated significantly greater reduction in inflammatory lesion count compared to the metronidazole group at 4, 8, and 12 weeks (p<0.001). Mean IGA scores also decreased significantly in the ivermectin group (0.95±0.50) compared to the metronidazole group (1.45±0.58) at 12 weeks. IGA treatment success (score 0 or 1) was achieved in 72.5% of patients receiving ivermectin compared to 50.0% in the metronidazole group (p=0.004). Similarly, RASI and VAS scores showed greater improvement in the ivermectin group. Local adverse effects such as burning, stinging, dryness, and irritation were more frequently observed in patients treated with metronidazole, while ivermectin demonstrated better tolerability.