A 45-year-old woman presents with persistent central facial erythema, flushing triggered by hot beverages and sun exposure, papules and pustules on the cheeks and nose, and telangiectases. She has no comedones. Demodex mite density is elevated on skin scraping. Which topical agent directly targets Demodex folliculorum and is approved for rosacea?
- A Ivermectin 1% cream ✓
- B Azelaic acid 15% gel
- C Metronidazole 0.75% gel
- D Topical brimonidine 0.33% gel
Correct answer: A. Ivermectin 1% cream
Explanation
Topical ivermectin 1% cream (Soolantra) is the only approved topical agent with direct anti-Demodex activity. Since Demodex folliculorum infestation plays a pathogenic role in papulopustular rosacea, ivermectin addresses both inflammation and the mite burden. Trials show superior efficacy to metronidazole 0.75% for papulopustular rosacea with lower relapse rates. Azelaic acid 15% gel has anti-inflammatory and keratolytic effects but limited anti-Demodex activity. Brimonidine targets erythema via alpha-adrenergic vasoconstriction — no anti-Demodex effect.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.