Rosacea — SCE Dermatology MCQ

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ModerateInflammatory DermatosesRosaceaSCE Dermatology

A 40-year-old woman with rosacea has been using topical Metronidazole for 3 months with partial response. She has moderate papulopustular rosacea. According to BAD guidelines, what topical agent has shown superiority to Metronidazole in head-to-head trials?

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Correct answer: A — Topical Ivermectin 1% cream

Topical Ivermectin 1% cream (Soolantra) has shown superiority to topical Metronidazole 0.75% in head-to-head trials for papulopustular rosacea (ATTRACT study). Ivermectin has both anti-inflammatory and anti-parasitic properties (targeting Demodex folliculorum mites, which are implicated in rosacea pathogenesis). It is applied once daily and can be used long-term. Topical Azelaic acid 15% is another effective option but has not shown superiority to Metronidazole. Oral Doxycycline (modified-release 40 mg) is recommended for moderate-to-severe papulopustular rosacea unresponsive to topical therapy.

Reference: BAD 2021 Rosacea Guidelines; ATTRACT trial BJD 2015