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If you’re dealing with rosacea, you know how frustrating it can be. Redness, bumps, burning - it doesn’t just affect your skin, it affects your confidence. Soolantra, the brand name for topical ivermectin, has become a go-to for many people. But is it the best option? And are there cheaper, equally effective alternatives out there? Let’s cut through the noise and compare what actually works.
What is Soolantra, and how does it work?
Soolantra is a 1% topical cream containing ivermectin, approved by the TGA and FDA for treating inflammatory lesions of rosacea in adults. It was first introduced in 2014 and quickly became one of the most prescribed treatments for papulopustular rosacea. Unlike antibiotics or steroids, ivermectin doesn’t just kill bacteria - it targets the Demodex mites that live in your skin follicles. Research shows people with rosacea often have higher numbers of these mites, and their immune response to them triggers inflammation.
Most users start seeing results in 4 to 8 weeks. In clinical trials, about 40% of patients saw a 75% or greater reduction in lesions after 12 weeks. It’s not a quick fix, but for many, it’s a game-changer - especially when other treatments like metronidazole failed.
Top alternatives to Soolantra
There are several other topical and oral options for rosacea. Not all work the same way, and not all are suitable for everyone. Here are the most common alternatives.
Metronidazole (MetroGel, Rosadan)
Metronidazole is a topical antibiotic that’s been around for decades. It’s available as a gel, cream, or lotion, and is often the first-line treatment for mild to moderate rosacea. It reduces inflammation and kills bacteria, but it doesn’t directly target Demodex mites. Studies show it reduces lesions by about 30-50% over 9-12 weeks - less effective than ivermectin in head-to-head trials.
Pros: Cheaper, widely available, gentle on skin. Cons: Slower results, higher relapse rate after stopping. Many people switch to Soolantra after metronidazole stops working.
Azelaic Acid (Finacea, Skinoren)
Azelaic acid is a naturally occurring dicarboxylic acid derived from grains. It’s available as a 15% gel or 20% cream. It works by reducing inflammation, killing bacteria, and slowing down excess skin cell production. It’s also safe during pregnancy, which makes it a top pick for women.
In trials, azelaic acid reduced lesions by about 45% after 15 weeks. It’s slightly less effective than ivermectin but better tolerated by sensitive skin. Side effects? Mild stinging or redness at first - but it usually fades.
Brimonidine (Mirvaso)
Brimonidine is a topical alpha-2 agonist that temporarily shrinks blood vessels. It’s not for treating bumps or pimples - only for flushing and redness. It works in as little as 30 minutes and lasts up to 12 hours.
It’s great for quick fixes before events or photos. But it doesn’t treat the root cause. Rebound redness is common after stopping, and some users report worsening symptoms over time. It’s often used alongside Soolantra or azelaic acid for a two-pronged approach.
Oral Antibiotics (Doxycycline, Minocycline)
Low-dose doxycycline (40 mg delayed-release, sold as Oracea) is FDA-approved for rosacea. It’s an anti-inflammatory, not an antibiotic at this dose. It’s used for moderate to severe cases, especially when there’s widespread inflammation or eye involvement.
Results show 50-70% improvement in lesions after 12 weeks. But long-term use raises concerns about antibiotic resistance and gut health. Most dermatologists recommend it for short-term control, then switching to topical treatments like Soolantra for maintenance.
Isotretinoin (Accutane)
Isotretinoin is a powerful oral retinoid, usually reserved for severe acne. But it’s sometimes used off-label for severe, treatment-resistant rosacea. It reduces oil production and inflammation dramatically. Some patients see near-complete clearance.
But the side effects are serious: dry skin, lips, eyes; mood changes; liver stress; and it’s strictly off-limits during pregnancy. It’s not a first choice - only for extreme cases under close medical supervision.
Comparison: Soolantra vs Alternatives
| Treatment | Active Ingredient | Targets | Time to See Results | Effectiveness (Lesion Reduction) | Side Effects | Cost (AUD/month)* |
|---|---|---|---|---|---|---|
| Soolantra | Ivermectin 1% | Demodex mites, inflammation | 4-8 weeks | 70-75% | Mild burning, dryness | $80-$120 |
| Metronidazole | Metronidazole | Bacteria, mild inflammation | 6-12 weeks | 30-50% | Stinging, redness | $20-$40 |
| Azelaic Acid | Azelaic acid 15-20% | Inflammation, skin cells, bacteria | 8-12 weeks | 40-50% | Stinging, peeling (early) | $60-$90 |
| Brimonidine | Brimonidine tartrate | Redness only | 30 minutes | Redness: 50-60% | Rebound redness, flushing | $100-$140 |
| Low-dose Doxycycline | Doxycycline 40mg | Inflammation | 4-8 weeks | 50-70% | GI upset, sun sensitivity | $40-$70 |
| Isotretinoin | Isotretinoin | Oil glands, inflammation | 3-6 months | 70-90% | Severe: dryness, mood, liver | $50-$100 |
*Approximate out-of-pocket cost in Australia after PBS subsidy where applicable. Prices vary by pharmacy and brand.
Who should use Soolantra?
Soolantra shines for people with persistent inflammatory rosacea - the kind with red bumps and pustules that don’t respond to antibiotics or gentle creams. If you’ve tried metronidazole and it stopped working, Soolantra is often the next logical step.
It’s also a good choice if you want to avoid long-term antibiotics. Because it targets mites, not bacteria, there’s less risk of resistance. Many patients use it long-term with no loss of effectiveness.
It’s not ideal for pure redness without bumps. If your main issue is flushing, brimonidine or laser treatments might be better. And if you’re pregnant or breastfeeding, azelaic acid is safer.
Who should avoid Soolantra?
Soolantra is generally safe, but not for everyone. Avoid it if you:
- Have a known allergy to ivermectin or any ingredient in the cream
- Are using other strong topical treatments like retinoids or benzoyl peroxide at the same time - they can irritate skin further
- Have very sensitive or broken skin - apply only to intact skin
Some people report a temporary flare-up in the first 2 weeks. That’s normal - your skin is reacting to the mite die-off. Don’t stop unless it becomes unbearable.
Real-world experience: What patients say
One woman in Brisbane, 42, tried metronidazole for 8 months with little improvement. She switched to Soolantra and saw her bumps reduce by 80% in 10 weeks. She still uses it twice a week for maintenance.
A man in Melbourne, 58, had rosacea for 15 years. He tried everything - lasers, antibiotics, herbal creams. Soolantra was the first thing that gave him lasting relief. He says, "It didn’t cure me, but it gave me back my confidence."
On the flip side, some users find it too expensive. Others say it doesn’t touch their redness. That’s why combination therapy is often the key.
Combination therapy: The smart approach
Most dermatologists don’t rely on just one treatment. A common plan:
- Start with Soolantra to target mites and bumps
- Add brimonidine in the morning for redness
- Use gentle, fragrance-free moisturizers daily
- Avoid triggers: spicy food, alcohol, extreme heat, harsh cleansers
Some patients add azelaic acid at night if they still have lingering inflammation. Others use low-dose doxycycline for 3 months, then taper off to topical-only.
The goal isn’t perfection - it’s control. Rosacea can’t be cured, but it can be managed.
What about natural remedies?
Tea tree oil, aloe vera, green tea extracts - they’re popular online. But here’s the truth: there’s no strong evidence they work better than placebo for moderate to severe rosacea.
Some people swear by diluted tea tree oil (5%) for mites, but it can irritate skin. A 2023 study in the Journal of Clinical and Aesthetic Dermatology found tea tree oil was less effective than ivermectin and caused more irritation.
Don’t replace proven treatments with unproven ones. Natural doesn’t mean safe or effective. Use them only as gentle supports - not as primary therapy.
How to get Soolantra in Australia
Soolantra is available on the Pharmaceutical Benefits Scheme (PBS), so if you have a Medicare card, you pay around $30 per tube (or $7.70 for concession holders). Without PBS, it can cost over $150.
You need a prescription from a GP or dermatologist. Bring photos of your skin and a list of what you’ve tried. If your doctor says no, ask for a referral - dermatologists have more experience with rosacea treatment protocols.
Final thoughts: Is Soolantra worth it?
Soolantra isn’t the cheapest option. But it’s one of the most effective for inflammatory rosacea. If you’ve tried other treatments and they didn’t stick, it’s worth a shot.
It’s not magic. It takes time. It requires consistency. But for many, it’s the difference between hiding your face and living without fear.
Work with your doctor. Don’t give up after one failed treatment. And remember - rosacea isn’t your fault. You’re not broken. You just need the right tools.
Is Soolantra better than metronidazole for rosacea?
Yes, for inflammatory rosacea with bumps and pustules. Clinical trials show Soolantra (ivermectin) reduces lesions by 70-75% after 12 weeks, compared to 30-50% for metronidazole. Soolantra also targets Demodex mites, which metronidazole doesn’t. If metronidazole stopped working for you, Soolantra is the next step.
Can I use Soolantra every day?
Yes. Soolantra is designed for daily use - once a day, applied to the entire affected area. Most people use it long-term. Studies show no loss of effectiveness over 52 weeks. Some switch to every other day or 3 times a week after achieving control, but daily use is standard.
Does Soolantra help with redness?
Not directly. Soolantra targets inflammation caused by mites, which can reduce redness over time. But if your main symptom is persistent flushing or visible blood vessels, you’ll need something like brimonidine or laser therapy. Many people use Soolantra and brimonidine together for full coverage.
How long does it take for Soolantra to work?
Most people see improvement in 4 to 8 weeks. Full results usually take 12 weeks. Don’t stop early if you don’t see instant results. The mites die slowly, and inflammation fades gradually. Some see a temporary flare-up in the first 2 weeks - that’s normal and means it’s working.
Is there a generic version of Soolantra?
No, not yet. Ivermectin 1% cream is still under patent protection in Australia. Generic versions may become available after 2027. Until then, you can save money by using the PBS subsidy - pay only $30 per tube with a prescription.
Can I use Soolantra with other skincare products?
Yes, but be careful. Avoid strong actives like retinoids, glycolic acid, or benzoyl peroxide on the same area - they can cause irritation. Use Soolantra at night, and in the morning stick to gentle cleansers and moisturizers. Always patch test new products.
Next steps if you’re considering Soolantra
- Take clear photos of your skin - before and after any treatment
- Keep a trigger journal: what you eat, where you go, what you use on your face
- Ask your doctor for a referral to a dermatologist if you’ve tried two treatments without success
- Check if you qualify for the PBS subsidy - you may pay less than you think
- Don’t rush. Rosacea management is a marathon, not a sprint.
You’ve already taken the hardest step - you’re looking for answers. Now it’s about finding the right combination for your skin. Soolantra might be it. But even if it’s not, you’re not starting from zero. You’re one step closer to control.