Topical ivermectin, particularly the 1% cream formulation (commonly known as Soolantra), is a well-documented treatment option in dermatology. Approved by the FDA in 2014 specifically for the inflammatory lesions of papulopustular rosacea, it works through a dual mechanism: reducing Demodex mite populations on the skin (a factor implicated in rosacea) and exerting direct anti-inflammatory effects by downregulating pro-inflammatory pathways like IL-8, cathelicidin, and TNF-α.
Multiple randomized, double-blind, vehicle-controlled phase 3 trials demonstrated its efficacy, with significantly higher rates of “clear” or “almost clear” skin (around 38-40% vs. 11-19% for vehicle) and greater reductions in inflammatory lesion counts (around 75-76% vs. 50%). It often outperforms alternatives like metronidazole 0.75% cream in head-to-head studies, with good tolerability and improvements in patient quality of life. Recent research also suggests it may indirectly benefit rosacea by positively altering the skin microbiome.
Beyond rosacea, evidence for other inflammatory skin conditions remains more limited but promising in smaller studies and case series:
- Perioral/periorificial dermatitis, seborrheic dermatitis, and acne vulgaris — Small case series (e.g., 15-20 patients) have reported high response rates (often 90%+ clearance or major improvement) with topical ivermectin, sometimes faster onset (as early as 2 weeks) and better outcomes than traditional options.
- Atopic dermatitis/eczema — Preclinical murine models show anti-inflammatory properties relevant to T-cell-mediated conditions, but human data is sparse.
- Psoriasis — Emerging anecdotal reports and case collections (including some shared by physicians like Dr. William Makis) describe improvements, potentially linked to anti-inflammatory and mite-related effects, though no large-scale trials exist yet.
- Cystic acne — Some testimonials highlight relief where standard treatments failed, likely due to its anti-inflammatory and antibacterial actions.
For skin cancers (e.g., basal cell carcinoma, squamous cell carcinoma, melanoma), the picture differs sharply. Preclinical lab and animal studies have explored ivermectin’s potential anti-tumor mechanisms (e.g., inducing apoptosis, disrupting mitochondrial function, inhibiting angiogenesis, or affecting pathways like PAK1 in various cancers including melanoma). However, these are mostly in vitro or rodent models—no robust human clinical trials support topical (or oral) ivermectin as an effective treatment for skin cancers.
Dermatology guidelines and oncology sources emphasize that skin cancers require proven interventions like surgical excision (often Mohs for basal/squamous cell), topical agents such as 5-fluorouracil or imiquimod (for select superficial cases), radiation, or systemic therapies for advanced disease. Claims of topical ivermectin causing skin cancers to “fall off” or resolve stem largely from patient testimonials and anecdotal reports circulated online (often involving horse paste formulations mixed with castor oil or similar for better absorption). While some individuals report dramatic improvements in lesions (including basal cell carcinomas or suspicious moles), these lack biopsy confirmation, controlled follow-up, or peer-reviewed publication. Oncology experts note that interest in repurposed drugs like ivermectin for cancer has grown, but human evidence remains absent or negative in early trials (e.g., no benefit in a phase 1/2 study for metastatic triple-negative breast cancer when combined with immunotherapy).
Dr. William Makis, a radiologist and cancer researcher, has prominently shared numerous patient testimonials (via X posts, Substack articles, and interviews) describing successes with topical ivermectin (1% cream or higher-concentration veterinary pastes) for inflammatory skin issues and skin cancers, as well as combinations with fenbendazole/mebendazole for broader cancers. These stories are compelling to many and highlight off-label experimentation, but they represent uncontrolled, self-reported outcomes rather than scientific evidence.
In summary:
- Strong evidence — Rosacea (FDA-approved, multiple RCTs/meta-analyses).
- Moderate/preliminary evidence — Certain inflammatory dermatoses like perioral dermatitis, seborrheic dermatitis, acne (small studies/case series).
- Weak/anecdotal evidence — Eczema, psoriasis, cystic acne, skin cancers (testimonials dominate; no high-quality human trials for oncology uses).
Anyone considering topical ivermectin—especially for non-approved uses like skin cancer—should consult a dermatologist or oncologist first. Self-treatment with veterinary formulations carries risks (e.g., inconsistent dosing, skin irritation, delayed proper care). While repurposed drugs hold exciting potential, claims far outpace current proof in many areas. Ongoing research may clarify more roles in the future.