Ivermectin 1% cream is used for papulopustular rosacea, combining anti-parasitic action against Demodex mites with anti-inflammatory effects on cutaneous cytokines to reduce facial bumps and pustules. In head-to-head and placebo-controlled trials, it achieved higher “clear/almost clear” rates and larger lesion count reductions than vehicle and than metronidazole 0.75% in moderate–severe disease, supporting its role as a first-line topical option.