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Ivermectin + metronidazole is a topical combination medication that works through dual mechanisms to treat inflammatory skin conditions, particularly rosacea and Demodex-related disorders. Ivermectin functions as both an anti-inflammatory agent and an antiparasitic that targets Demodex mites, which have been implicated in rosacea pathophysiology. Metronidazole reduces reactive oxygen species, decreases oxidative tissue injury by inhibiting neutrophil-generated cytokines, and provides additional anti-inflammatory and antimicrobial effects. Clinical studies have shown this combination to be more effective than either agent alone, with superior efficacy in reducing inflammatory lesions, eradicating Demodex mites, and improving overall skin condition. The combination has demonstrated complete Demodex eradication, improved tear film parameters in patients with meibomian gland dysfunction, and reduced ocular symptoms.
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