Background: Rosacea lessens patients’ quality of life not only by visible symptoms like erythema, papules, and pustules but also by invisible symptoms like stinging, burning and dryness. Ivermectin 1% cream has recently been introduced as an efficient therapy for papules and pustules in rosacea patients. Objectives: To investigate the potential of ivermectin 1% cream to improve rosacea- associated erythema and invisible symptoms by combining established questionnaires with the novel photography and analysis tool Scarletred® Vision. Methods: We performed an open monocentric pilot study including 25 Caucasian patients presenting with moderate to severe rosacea with erythema, less than 10 papules and/or pustules, and ≥15 Demodex mites/cm2. Patients applied 1 g of ivermectin 1% cream (Soolantra®) once a day for ≥ 16 weeks. Skin symptoms were recorded at baseline, week 8 and ≥ week 16. Grade of erythema was determined by clinician erythema assessment (CEA) and patient self-assessment (PSA). Severity of invisible skin symptoms (stinging and/or burning, dryness, itching) were assessed by questionnaire. Erythema and skin texture were additionally quantified using Scarletred® Vision. Results: Ivermectin 1% cream significantly reduced invisible symptoms of rosacea (stinging and/or burning, dryness: p<0.0001; itching p<0.001; at ≥ 16 weeks). Analysis with Scarletred® Vision confirmed CEA and PSA results for improvement of erythema (p<0.0001; at ≥ 16 weeks) and skin roughness (p<0.001; at ≥ 16 weeks). Conclusions: Treatment with ivermectin 1% cream is efficient in treating not only rosacea- associated papules and pustules but also erythema and invisible skin symptoms.
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