Topical Ivermectin, Encapsulated Benzoyl Peroxide More Efficacious Than Metronidazole for Rosacea

TUESDAY, July 7, 2026 (HealthDay News) — Topical ivermectin and encapsulated benzoyl peroxide are more efficacious than metronidazole for adults with rosacea, according to a review published online July 1 in JAMA Dermatology.

Anissa Valentina Amstutz, from Brigham and Women”s Hospital in Boston, and colleagues conducted a systematic review and network meta-analysis of randomized clinical trials (RCTs) to compare the efficacy and tolerability of topical treatments for moderate-to-severe rosacea. Thirty-two RCTs met inclusion criteria and included 11,399 adults treated with 10 topical interventions.

The researchers found that ivermectin and encapsulated benzoyl peroxide demonstrated greater reductions in lesion count compared with metronidazole (mean differences, 4.17 and 4.14, respectively) and had a higher likelihood of Investigator Global Assessment success (mean differences, 10.31 and 15.51, respectively). Between treatments, there was a similar frequency of discontinuation due to adverse events; discontinuation was more frequent with encapsulated benzoyl peroxide than metronidazole (mean difference, 8.33). Robust quantitative synthesis of patient-reported outcomes and erythema outcomes was precluded by limited data.

“These findings provide comparative evidence to inform initial topical treatment selection but are limited to short-term outcomes,” the authors write.

One author disclosed ties to the biopharmaceutical industry.

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