ArticleClinical, cosmetic and investigational dermatology2026
Dermoscopic Response Predictors in Papulopustular Rosacea Treated with Topical Ivermectin and Metronidazole: A Prospective Observational Comparative Study.
Article in Clinical, cosmetic and investigational dermatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Over recent years, dermoscopy has proven useful not only for diagnosing skin conditions but also as a tool for predicting treatment response in inflammatory dermatoses. However, no data are available on dermoscopic predictors in papulopustular rosacea (PPR). Objective: To evaluate whether certain clinical and dermoscopic findings serve as positive or negative predictors of response to topical ivermectin or metronidazole in PPR. Methods: Twenty-three patients with moderate-to-severe PPR were enrolled. Ten patients received ivermectin 10 mg/g cream and 13 received metronidazole 1% gel (non-randomized, based on physician preference), applied once daily for 8 weeks. Inflammatory lesion counts and key clinical/dermoscopic features were assessed at baseline and after 8 weeks by two independent, blinded physicians. Post-treatment clinical outcomes (optimal response: >75% lesion reduction; partial response: 50-75% reduction) were correlated with baseline features. Results: Both treatments significantly reduced inflammatory lesion counts (p<0.001 for both). Any response (optimal or partial) occurred in 7/10 (70%) ivermectin-treated and 8/13 (62%) metronidazole-treated patients. Optimal response occurred in 5/10 (50%) ivermectin-treated and 4/13 (31%) metronidazole-treated patients. In the ivermectin group, all patients who achieved optimal response had baseline protruding follicular plugs (PFPs) (5/5, 100%) in dermoscopy, which are indicators of demodex tails. Those with partial or minimal/no response in the ivermectin group did not have baseline PFPs (0/5). Baseline PFPs were significantly associated with optimal response to ivermectin (p=0.004). In the metronidazole group, all 4 optimal responders did not have baseline PFPs. All the 4 patients in the metronidazole group with baseline PFPs showed minimal/no response, though this was not statistically significant (p=0.176). No other baseline features significantly predicted response in either treatment group. Conclusion: PFPs in dermoscopy of moderate-to-severe PPR serve as positive predictors for optimal response to topical ivermectin, but not metronidazole. This observation warrants validation in larger controlled trials.
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