Causes of inflammation
It has been speculated that Demodex , a parasitic mite normally found in and around the hair follicles, could be partly responsible for rosacea flares; specifically, Bacillus oleronius—the bacteria that live inside Demodex. According to Dr. Baldwin, ivermectin, commonly used to treat Demodex infestation, is now also available in a new topical formulation (Soolantra, Galderma) that is proving to be effective in the treatment of rosacea as well, lending credence to Demodex and the inflammation that it causes being at least partly responsible for the disease.
According to Dr. Baldwin, the current conventional wisdom for rosacea is that the innate immune system, which is supposed to tell the difference between foreign and self, is possibly not working as well as it should be in terms of appropriately recognizing the commensal organisms that live and breed naturally on the skin such as P. acnes, S. epidermidis, and perhaps Demodex. The result is an inflammatory response to these organisms by the innate immune system, translating clinically into rosacea.
In addition to killing Demodex, Dr. Baldwin says that ivermectin is a very good anti-inflammatory drug and the new topical formulation of ivermectin also has a very good moisturizing base, which acts as an excellent barrier repair cream. It still remains unclear however in which capacity these therapeutic effects of topical ivermectin are responsible for the improvement of rosacea symptoms, a question that would be a potential focus for future clinical studies.
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“I believe that there should be a definite shift away from using antibiotics at antibiotic doses for the treatment of rosacea. We are in a good position now where we have a lot of good medications that we can use that are not antibiotics and it is my opinion that we should not be using antibiotics for the treatment of rosacea until all other avenues have been exhausted,” Dr. Baldwin says.