| TL;DR Soolantra is a once-daily prescription cream containing 1% ivermectin, licensed in the UK since 2015 for the treatment of inflammatory (papulopustular) rosacea in adults. It works through two mechanisms: reducing skin inflammation and killing Demodex folliculorum mites that contribute to rosacea flares. In the largest head-to-head clinical trial, Soolantra produced an 84.9% success rate compared with 75.4% for metronidazole 0.75% cream. Crucially, Soolantra only treats the papules and pustules of rosacea — it does not reduce background redness or flushing, which require different treatments. |
Rosacea is one of those conditions that looks straightforward from the outside — a bit of redness, some spots — but is considerably more complicated to live with and considerably more difficult to treat than most people realise. It is also one of the most commonly mismanaged skin conditions in the UK, partly because many people try treatments aimed at the wrong subtype, and partly because rosacea has no cure, only management. Soolantra is the prescription treatment that, for a specific group of rosacea patients, consistently produces the best results in clinical trials. Understanding whether you are in that group — and how to use it correctly if you are — is what this guide covers.
What Is Rosacea and Why Does the Subtype Matter?
Before getting into Soolantra specifically, the subtype distinction is essential because it determines whether Soolantra will help you at all.
Rosacea is a chronic inflammatory skin condition affecting the central face. It is not a single disease — it presents across a spectrum of subtypes that can occur independently or together. The classic subtypes recognised in UK clinical practice, including by the British Association of Dermatologists (BAD) 2021 guidelines, are: erythematotelangiectatic rosacea (persistent redness, flushing, visible blood vessels), papulopustular rosacea (inflammatory bumps, papules, and pustules resembling acne), phymatous rosacea (skin thickening, most commonly rhinophyma affecting the nose), and ocular rosacea (eye inflammation, lid irritation, recurrent styes).
Soolantra is licensed exclusively for papulopustular rosacea — the subtype characterised by inflammatory bumps and pus-filled spots on the face. Current NICE CKS-aligned guidance lists topical ivermectin as a first-line treatment option for mild to moderate papules and pustules in rosacea. If your rosacea is predominantly background redness, flushing, or prominent facial veins without significant papules and pustules, Soolantra is not the right treatment for you. A different class of medication — such as brimonidine gel for persistent erythema — would be more appropriate.
What Is Soolantra and What Does It Contain?
Soolantra is a prescription-only topical cream manufactured by Galderma and containing 10mg/g (1%) ivermectin as its active ingredient. It was approved through the European Decentralised Procedure and launched in the UK in June 2015. Ivermectin cream is indicated for the topical treatment of inflammatory lesions of rosacea (papulopustular) in adults.
Ivermectin itself is well-established in medicine — it has been used for decades as an antiparasitic treatment for conditions such as river blindness and lymphatic filariasis. Its application in rosacea is different in character, topical rather than systemic, and at a far lower concentration, but the same antiparasitic mechanism is part of why it works on the skin.
Soolantra is a prescription-only medicine (POM) in the UK. It cannot be bought over the counter and requires either an NHS or private prescription from a registered UK prescriber. It is manufactured in a moisturising cream base that is specifically designed to be tolerable on the typically sensitive, reactive skin of rosacea sufferers.
How Does Soolantra Work? The Dual Mechanism
This is the section that most competitor articles handle poorly, and it is genuinely worth understanding — because the dual mechanism of ivermectin is one of the key reasons it outperforms metronidazole, its main topical competitor.
Anti-inflammatory action
Ivermectin has direct anti-inflammatory properties, independent of its antiparasitic activity. The mechanism of action for treating the inflammatory lesions of rosacea is not known, but may be linked to the anti-inflammatory effects of ivermectin, as well as causing the death of Demodex folliculorum mites that have been reported to be a factor in inflammation of the skin. The anti-inflammatory pathway suppresses the immune dysregulation that drives the papules and pustules — reducing their frequency, severity, and duration.
Demodex mite eradication
This is the mechanism that sets Soolantra apart from every other topical rosacea treatment. Demodex folliculorum are microscopic mites that live in the hair follicles of human facial skin. Virtually everyone has some Demodex present, but people with rosacea — particularly papulopustular rosacea — consistently show significantly higher Demodex densities than those without the condition. The mites and their waste products trigger immune responses that contribute to the characteristic inflammation of papulopustular rosacea. Ivermectin kills these mites, removing a chronic trigger of the inflammatory cycle that other topical treatments simply leave intact.
This is also why some patients experience a temporary worsening of their rosacea in the first week of Soolantra treatment. Soolantra may cause a worsening of rosacea for up to a week when initially starting. This may be due to a reaction to dying Demodex mites in the skin. Any worsening should settle after the first week — if it doesn’t settle, or is very severe, stop using Soolantra. This die-off reaction is rarely mentioned by prescribers or in competitor articles, which leads patients who experience it to stop treatment prematurely under the false impression that the cream is making things worse. In most cases, pushing through the first week — unless the reaction is severe — allows treatment to proceed to the point where improvement becomes visible.
Why does this matter versus metronidazole?
Metronidazole, the most established topical treatment for papulopustular rosacea, works as an antimicrobial and anti-inflammatory. It has no antiparasitic activity. This means metronidazole addresses the inflammatory component of rosacea but does nothing about Demodex density — a significant driver in many patients. Soolantra addresses both.
What Does the Clinical Evidence Actually Show?
Versus placebo
Two Phase 3 randomised controlled trials, each of identical design, compared Soolantra against a vehicle cream (placebo) over 12 weeks in 1,371 adults with moderate to severe papulopustular rosacea. Both randomised clinical trials demonstrated that ivermectin 1% cream was more effective than the vehicle cream based on the co-primary efficacy endpoints — IGA success and absolute change in inflammatory lesion counts. These were not marginal differences. The trials established unequivocally that Soolantra produces clinically meaningful reductions in rosacea papules and pustules beyond what would occur with a placebo cream.
Versus metronidazole — the ATTRACT trial
The most clinically significant study for UK patients is the ATTRACT trial — a Phase 3, investigator-blinded, randomised study comparing Soolantra once daily against metronidazole 0.75% cream twice daily in 962 patients with moderate to severe papulopustular rosacea over 16 weeks. The percentage reduction of inflammatory lesions from baseline was 83.0% for ivermectin 1% cream and 73.7% for metronidazole 0.75% cream. IGA success rates, defined as ‘clear’ or ‘almost clear’, were 84.9% for ivermectin 1% cream and 75.4% for metronidazole 0.75% cream.
Soolantra was not only more effective — it was administered once daily rather than the twice-daily regimen required for metronidazole, which is a meaningful practical advantage for long-term adherence.
Long-term results and relapse
Results improve further with sustained use beyond 12 weeks. In the 52-week extension study, the percentage of patients with an IGA score of ‘clear’ or ‘almost clear’ increased from 38.4% at week 12 to 71.1% at week 52 in study 1, and from 40.1% to 76.0% at week 52 in study 2. This is an important finding that many patients are not told: the cream continues improving results well beyond the initial treatment period.
The ATTRACT relapse extension study is equally significant. The median time to first relapse was significantly longer for patients initially successfully treated with ivermectin 1% compared with metronidazole 0.75% — 115 days versus 85 days — and relapse rates at the end of the study period were significantly lower at 62.7% versus 68.4%. In practical terms, patients treated successfully with Soolantra stayed clear for about a month longer before needing retreatment, compared with those treated with metronidazole.
How to Use Soolantra Correctly
This is where a lot of patients go wrong, and incorrect application significantly undermines results.
Dose and timings
Ivermectin cream should be applied once daily for up to 4 months. If there is no improvement after 3 months, the treatment should be discontinued. The treatment course may be repeated. Apply it at the same time each day — either morning or evening consistently — to maintain a steady level of the medication in the skin.
How to apply Soolantra?
A pea-sized amount of ivermectin cream can be applied to each of the five areas of the face: forehead, chin, nose, and each cheek. The cream should be spread as a thin layer across the entire face, avoiding the eyes, lips and mucosa. Ivermectin cream should only be applied to the face and hands should be washed after application.
The five pea-sized amounts instruction is worth following precisely. Using too little means inadequate coverage of active inflammatory areas; using too much risks the product reaching the eyes or lips. The cream is not applied only to visible spots — it is spread as a thin layer across the whole face, as you would apply sunscreen. This whole-face approach matters because Demodex mites are distributed across the face, not concentrated only at the visible lesion sites.
What to expect in the first weeks?
Improvement in visible papules and pustules typically begins around two weeks into treatment for many patients, though the full effect builds over three to four months. Do not assess whether Soolantra is working at the two-week mark — if you have pushed through the potential initial die-off reaction, continue as prescribed and review at the three-month point. Up to 8 in 10 people find significant benefit after 4 months of use.
What Soolantra will not do?
This is the single most important expectation-management point. Soolantra treats the papules and pustules of rosacea. It does not reduce background redness, flushing, or telangiectasia — these are features of erythematotelangiectatic rosacea that require different treatments. Many patients start Soolantra expecting all their rosacea symptoms to improve, and when their background redness persists, they conclude the cream is not working. If persistent redness is also present, your GP may consider adding brimonidine gel alongside Soolantra.
Side Effects — What to Know?
Soolantra is generally very well tolerated, which contributes to its strong clinical profile. Most of the patients who received ivermectin 1% cream in clinical studies denied stinging, burning, dryness, or itching associated with the medication, whereas more subjects who received azelaic acid 15% gel twice daily reported these symptoms.
The most common side effect is a mild burning or stinging sensation on application, reported in fewer than 1 in 10 users. The temporary initial flare described above, related to Demodex die-off, should resolve within a week. Genuine ongoing skin irritation, persistent burning, or worsening beyond the first week warrants stopping the cream and discussing with your prescriber.
Who should not use Soolantra?
Soolantra should not be used in pregnancy or breastfeeding — if you are pregnant or planning a pregnancy, discuss this explicitly with your prescriber before starting. Caution is warranted with warfarin or other coumarin-type blood-thinning anticoagulants. Soolantra is not suitable for children and should only be applied to the face — never used in or around the eyes, on the lips, inside the nose, or on other body areas. If you are allergic to ivermectin or any other component of the cream, do not use it.
Soolantra’s Place in the UK Rosacea Treatment Ladder
Understanding where Soolantra sits within NHS prescribing guidance helps clarify when and why a GP might prescribe it.
The strongest evidence supports the use of 0.75% metronidazole, topical azelaic acid, or topical ivermectin for inflammatory rosacea. In practice, this means all three are appropriate first-line topical options for papulopustular rosacea in primary care, with the choice guided by patient preference, skin sensitivity, and previous treatment history. Soolantra is not a last resort for treatment failures — it is an appropriate starting point.
For moderate to severe papulopustular rosacea, oral doxycycline (Efracea 40mg modified-release) is often added alongside topical treatment rather than used sequentially. Soolantra and low-dose oral doxycycline can be used in combination for patients whose disease is not adequately controlled by topical therapy alone.
Where rosacea does not respond to 12 weeks of combined oral and topical treatment, referral to dermatology is indicated. At that point, oral isotretinoin under specialist supervision becomes an option, alongside light-based treatments for persistent erythema and telangiectasia.
Getting a Prescription for Soolantra in the UK
NHS prescription
Soolantra is available on NHS prescription. Your GP can prescribe it following a clinical assessment of your rosacea type and severity. It is generally prescribed for patients with moderate papulopustular rosacea, though GPs have clinical discretion to prescribe it for milder disease where previous treatments have been insufficient or poorly tolerated.
Private prescription
Private prescriptions for Soolantra are available through registered UK online pharmacies and private GPs following a brief clinical consultation. This route is useful for people who want faster access, prefer not to see their GP in person, or whose NHS surgery has declined to prescribe it. At Star Pharmacy, our skin condition treatments are available through a confidential online consultation with our registered prescribers, with discreet delivery to your door.
Skincare Alongside Soolantra — What Helps and What Hurts
This is an area most prescribers cover inadequately at the point of prescription, and it makes a real difference to outcomes.
Rosacea skin is chronically sensitised and has a compromised barrier function. Many standard skincare products — particularly those containing fragrances, alcohol, witch hazel, menthol, and common preservatives — can trigger or worsen flares. The basic framework for skincare alongside Soolantra is: a gentle, fragrance-free cleanser used with lukewarm (not hot) water; a simple, non-comedogenic moisturiser to support barrier function; and a broad-spectrum SPF 30+ sunscreen every morning, applied after Soolantra has been absorbed.
Sun exposure is one of the most consistent rosacea triggers, and daily SPF is one of the most evidence-based lifestyle interventions available. The BAD 2021 guidelines list sun exposure among the best-supported environmental triggers. Using SPF every day also helps limit the erythema that Soolantra does not directly treat.
Topical steroids should be specifically avoided on the face in rosacea. They cause short-term improvement in redness but exacerbate rosacea in the longer term and can induce a steroid-dependent rosacea variant that is considerably more difficult to manage.
Final Thoughts
Soolantra is one of the most well-evidenced topical treatments in dermatology for its licensed indication — and for the right patient, it genuinely delivers on that evidence in real-world use. The clinical trials show clear superiority over both placebo and the previous standard of care, metronidazole, with better clearance rates, longer remission, and fewer side effects than many alternatives.
The key to using it successfully is realistic expectations: it treats papules and pustules, not background redness. It takes weeks to months to show its full effect. The first week may be slightly worse before it gets better. Used consistently, as prescribed, over a full treatment course, the majority of patients with papulopustular rosacea will see meaningful, sustained improvement.
If you think Soolantra might be right for your rosacea, our team at Star Pharmacy can help. Complete a confidential online consultation, and our registered prescribers will assess your symptoms, confirm whether Soolantra is clinically appropriate, and arrange a prescription with discreet delivery to your door. You can also browse our broader range of skin condition treatments for further guidance on what is available for rosacea and related conditions.
FAQs
How long does Soolantra take to work?
Many patients notice some improvement in their papules and pustules within two weeks of starting treatment, but the full effect builds over three to four months. Up to 8 in 10 people find significant benefit after 4 months of use. The licensed duration of a treatment course is up to four months, after which the course may be repeated if rosacea returns. Clinical studies showed that results continued to improve at 52 weeks — so sustained use beyond the initial course is appropriate for many patients. If there is no meaningful improvement after three months of consistent daily application, discuss with your prescriber whether an alternative or additional treatment is needed.
Is Soolantra better than metronidazole for rosacea?
For most patients with moderate to severe papulopustular rosacea, the clinical evidence favours Soolantra. The percentage of patients achieving success without relapse requiring retreatment was 33% greater in the ivermectin versus the metronidazole group. Soolantra also has the practical advantage of once-daily rather than twice-daily dosing. That said, both are appropriate first-line topical options for papulopustular rosacea in UK guidelines — individual skin sensitivity, tolerability, and personal preference are legitimate factors.
Can Soolantra reduce facial redness in rosacea?
Only to the extent that reducing active inflammation reduces some associated redness. Soolantra treats the papules and pustules of papulopustular rosacea — it is not licensed or clinically effective for the background persistent redness, flushing, or telangiectasia of erythematotelangiectatic rosacea.
Can I use Soolantra long-term?
The licensed treatment course is up to four months per cycle. The treatment course may be repeated. There are no published studies assessing safety and efficacy beyond 12 months, so long-term continuous use beyond repeated four-month courses has not been formally evaluated. In practice, many patients use repeated courses successfully over several years.
Will Soolantra make my rosacea worse before it gets better?
Possibly in the first week, and this is something your prescriber should warn you about. A temporary flare of papules and pustules in the first few days is thought to reflect the inflammatory response to dying Demodex mites — a die-off effect. This is not a sign that the cream is wrong for you. It typically settles within a week. If it persists beyond a week, or if the initial worsening is severe rather than mild, stop the cream and speak to your prescriber.