Rosacea After Stopping Ivermectin: The Relapse Study

When a prescription has helped your face, the next appointment needs a stopping plan as well as a refill decision. Ask what to photograph, which changes should trigger contact and whether another course would need a new assessment.

Who entered follow-up

ATTRACT followed 757 responders after 16 weeks: 399 previously using ivermectin 1% daily, 358 using metronidazole 0.75% twice daily. Entry required clear or almost-clear skin; 692 completed follow-up.¹

These were selected responders, not all 962 originally randomized. Almost everyone was White. More ivermectin participants entered completely clear: 41.6% versus 29.1%. That imbalance complicates attributing later differences solely to the cream.¹

Bring the clinician your starting photograph and the latest one. Name what changed: the number of bumps, their location, burning or visible color. Our rosacea prescription comparison separates treatment targets.

What stopping meant

Treatment stopped. Visits occurred every four weeks for 36 weeks; the same cream restarted at relapse, defined as at least mild disease on the investigator’s scale.¹

Median time to first relapse was 115 days (95% CI 113–165) versus 85 (85–113); estimated relapse rates were 62.7% versus 68.4%.¹

This was not continuous maintenance or proof of cure. Withdrawal without relapse was censored; visits limited timing precision. Galderma funded the study; two authors were employees.¹

A median is not a date to put beside your own name. Ask for an individual instruction: “If bumps return after I stop, should I contact you before restarting, and how soon should you see my face?” Write the answer beside the prescription name and strength.

Which instructions apply now

The US Soolantra label covers rosacea’s inflammatory bumps and pimples. It directs once-daily facial application, avoiding eyes and lips; burning, irritation and allergic dermatitis are possible. Pregnancy data are insufficient, and milk exposure after topical use has not been evaluated.²

That indication does not promise control of every episode of flushing. Show the prescriber any symptoms that persisted while the bumps improved, rather than assuming another course will address them.

UK product information specifies daily treatment for up to four months, permits repeat courses and advises discontinuing if there is no improvement after three months. Severe worsening with a strong skin reaction requires discontinuation.³ Follow the plan for your prescribed product and country; the trial’s restart rule is not a personal prescription.

Prepare the review

Before the appointment, put the tube name, start and stop dates, photographs and any reactions in one note. Ask what would count as recurrence, what to do if a reaction develops and whether the next course changes your other facial products.

Skin, Head to Toe includes “Describe Your Own Face,” which organizes location, appearance and sensation, timing, and other symptoms. Use those descriptions when you report a change. See the book.