A systematic review and meta-analysis conducted by Anissa Valentyna Amshtutz and her colleagues from Harvard Medical School demonstrated the superiority of ivermectin and encapsulated benzoyl peroxide over metronidazole in the topical therapy of rosacea.
The researchers searched databases CENTRAL, MEDLINE, Web of Science, and Embase up to August 2025, including references from published works. Thirty-two randomized controlled trials involving 11,400 adult patients were included in the analysis. These data were pooled using a network meta-analysis with mixed effects, and the results were published in the journal JAMA Dermatology.
Most of the studies examined lasted from eight to sixteen weeks. The use of ivermectin and encapsulated benzoyl peroxide showed a more significant reduction in the number of eruptions compared to metronidazole (the average difference was 4.17 versus 4.14). Furthermore, therapy with these drugs showed a higher probability of success according to the IGA scale (average difference of 10.31 and 15.51, respectively).
Despite their effectiveness, the frequency of treatment discontinuation due to adverse events was higher when using encapsulated benzoyl peroxide than when using metronidazole (the average difference was 8.33). Of particular note is a study by Swedish physicians concerning persistent eye symptoms after COVID. They described manifestations such as near vision impairment, strabismus, weakened pupillary reflex, corneal neurodegeneration, and chronic activation of dendritic cells, which are also associated with changes in tear film protein composition. This work was published in Nature Communications.
