What it is

➝ Azelaic acid and ivermectin are two topical treatments commonly prescribed for rosacea, especially when used together as part of a combined management strategy.

➝ Azelaic acid (usually in 15% gel/foam or 20% cream) works as an anti-inflammatory and keratolytic agent. It reduces swelling, redness, and papules while also improving skin texture.

➝ Ivermectin (1% cream) is an anti-parasitic and anti-inflammatory medication. It targets Demodex mites, which are often more abundant in rosacea patients, and reduces skin inflammation.

➝ When used together, these two agents provide dual benefits:

• Azelaic acid reduces inflammation and pigmentation.
• Ivermectin addresses inflammation caused by Demodex and reduces papules and pustules.

Why it’s done

→ To treat papulopustular rosacea, characterized by bumps, pustules, and background redness.

→ To reduce persistent inflammation and improve skin barrier health.

→ To offer an effective non-antibiotic topical therapy, avoiding long-term oral antibiotics.

→ To manage rosacea safely in patients who cannot tolerate or prefer to avoid systemic treatments.

→ In Korea, dermatologists often recommend azelaic acid + ivermectin therapy as part of a stepwise approach, starting with topicals before considering oral doxycycline or laser treatments.

Alternatives

→ Other topical treatments:

• Metronidazole cream or gel.
• Brimonidine or oxymetazoline cream (for redness only).
• Sulfur-based washes.

→ Oral treatments:

• Low-dose doxycycline (anti-inflammatory dose).
• Minocycline or isotretinoin (for resistant cases).

→ Laser and light-based therapies:

• Intense Pulsed Light (IPL).
• Pulsed Dye Laser (PDL).
• Nd:YAG laser for persistent redness and visible vessels.

→ Lifestyle measures: Avoiding triggers (alcohol, spicy food, extreme temperature, stress).

Preparation

→ Dermatologist consultation to confirm rosacea type and severity.

→ Patients are advised to:

• Start slowly (every other day) with azelaic acid to minimize irritation.
• Apply ivermectin once daily, usually at night.
• Use gentle cleansers and moisturizers to support skin barrier.
• Avoid harsh exfoliants and alcohol-based skincare products.

→ In Korea, patients often receive skincare counseling along with prescriptions to ensure compliance and minimize irritation.

How it’s Done

→ Azelaic acid is applied once or twice daily in a thin layer on affected areas.

→ Ivermectin is applied once daily (usually at night), covering the entire affected area.

→ The two can be alternated (morning and evening) or layered, depending on tolerance and dermatologist guidance.

→ Combination therapy is often continued for 12–16 weeks, with long-term maintenance as needed.

→ In Korean clinics, dermatologists sometimes pair these topicals with procedural treatments (IPL, PDL) for maximum results.

Recovery

→ Early improvement (less burning, fewer bumps) is often seen within 3–4 weeks.

→ Significant reduction in papules, pustules, and background redness usually occurs by 8–12 weeks.

→ Skin texture becomes smoother, and patients often notice fewer flare-ups over time.

→ With consistent use and avoidance of triggers, many patients maintain long-term control without requiring oral medications.

Complications

→ Azelaic acid may cause mild stinging, burning, or dryness at the beginning.

→ Ivermectin is generally well tolerated, but some patients may experience mild itching or skin irritation.

→ Both treatments are considered safe for long-term use and do not carry the systemic risks of oral medications.

→ Rare cases of hypersensitivity may occur, requiring discontinuation.

Treatment Options in Korea

→ Widely used in dermatology clinics and aesthetic centers as part of rosacea management.

→ Korean dermatologists often prescribe azelaic acid in the morning and ivermectin in the evening, combined with gentle K-beauty moisturizers to reduce irritation.

→ Clinics may integrate topical therapy with laser treatments (IPL, PDL, Nd:YAG) for persistent redness and visible blood vessels.

→ Patient education is a priority: Korean doctors often provide step-by-step skincare routines, teaching patients how to apply products in the correct sequence for best results.

→ This combination is highly valued in Korea for its dual mechanism, allowing patients to control inflammatory rosacea effectively without relying on long-term antibiotics.