Soolantra vs Alternatives: What Works Best for Rosacea?

If you’ve been dealing with persistent redness, bumps, or burning on your face, you’ve probably heard of Soolantra. It’s one of the few FDA-approved treatments specifically for rosacea that targets the mites thought to trigger flare-ups. But it’s not the only option out there. And if you’ve tried Soolantra and didn’t see results-or if the cost is too high-you’re likely wondering what else might work just as well, or even better.

What is Soolantra, really?

Soolantra is a topical cream containing 1% ivermectin. It’s not an antibiotic, not a steroid, and not just a moisturizer. It’s an antiparasitic that kills Demodex mites-tiny bugs that live in hair follicles and are found in higher numbers on the skin of people with rosacea. These mites don’t cause rosacea directly, but their waste and dead bodies seem to trigger inflammation, leading to the redness, swelling, and pimples you see.

Unlike oral antibiotics like doxycycline, which reduce inflammation broadly, Soolantra goes straight to the source. In clinical trials, people using Soolantra saw a 60-70% reduction in inflammatory lesions after 12 weeks. That’s better than most over-the-counter creams and on par with the best prescription alternatives.

It’s applied once a day, usually at night. Most people start noticing less redness in 2-4 weeks, but full results take up to three months. It’s safe for long-term use, and unlike some other rosacea treatments, it doesn’t cause skin thinning or rebound flare-ups.

Top Alternatives to Soolantra

There are several other prescription and non-prescription options that target rosacea in different ways. Here are the most common-and how they stack up against Soolantra.

Metronidazole (MetroGel, Noritate)

MetroGel has been the go-to topical treatment for rosacea for decades. It’s a low-dose antibiotic cream that reduces inflammation and kills bacteria. It’s cheaper than Soolantra and often covered by insurance.

But here’s the catch: metronidazole doesn’t touch Demodex mites. It only calms the inflammation they cause. In head-to-head studies, Soolantra cleared lesions faster and more completely. One 2018 trial showed Soolantra reduced bumps by 75% after 12 weeks, while metronidazole managed 60%. That gap matters if you’re tired of covering up redness every morning.

Metronidazole is still a good starter option-especially if you’re on a budget. But if you’ve used it for months with little change, Soolantra might be your next step.

Azelaic Acid (Finacea, Skinoren)

Azelaic acid is a naturally occurring compound found in grains. In prescription strength (15%), it reduces redness, kills bacteria, and gently exfoliates. It’s also safe to use during pregnancy, which makes it a top pick for expectant mothers.

Compared to Soolantra, azelaic acid works slower. It can take 8-12 weeks to see real improvement. But it’s gentler on sensitive skin and helps with post-inflammatory dark spots-something Soolantra doesn’t address as well.

If your rosacea comes with stubborn dark patches after breakouts, azelaic acid might be the better choice. If your main problem is deep, inflamed bumps, Soolantra wins.

Oral Doxycycline (Oracea, Vibramycin)

Oracea is a low-dose, anti-inflammatory version of doxycycline. It’s taken as a pill once a day and works systemically. It’s often prescribed for moderate to severe rosacea with lots of bumps and pustules.

It’s effective-about 65% of users see improvement in 3-4 weeks. But it’s not a long-term solution. Antibiotics can disrupt your gut microbiome, increase yeast infections, and lead to resistance if used too long. Plus, you can’t take it with dairy or antacids.

Soolantra doesn’t have these side effects. It’s topical, so it doesn’t affect your gut. For long-term management, Soolantra is safer. But if you need fast relief during a bad flare, doxycycline can help you get through the worst days.

Brimonidine (Mirvaso) and Oxymetazoline (Rhofade)

These are vasoconstrictors. They don’t treat the root cause of rosacea-they just make your face look less red by tightening blood vessels.

They work fast. Redness fades in 30 minutes. But the effect lasts only 8-12 hours. And if you stop using them, your redness often comes back worse than before. This is called rebound erythema.

Soolantra doesn’t cause rebound. It treats the problem, not just the symptom. If you’re using Mirvaso or Rhofade just to hide redness for a meeting or event, that’s fine. But if you want real, lasting improvement, Soolantra is the only one that actually changes the disease course.

Over-the-Counter Options: Tea Tree Oil, Green Tea, Niacinamide

Many people turn to natural remedies. Tea tree oil has antiparasitic properties and can kill Demodex mites in lab studies. But it’s not formulated for the face-using pure tea tree oil can burn your skin. Diluted versions in cleansers or serums are safer but much weaker.

Green tea extract and niacinamide (vitamin B3) reduce inflammation and strengthen the skin barrier. They help with mild redness and sensitivity. But they won’t clear 10-15 bumps like Soolantra can.

Think of these as support players. They’re great to use alongside Soolantra to calm irritation or prevent flares. But they’re not replacements.

Cost, Availability, and Insurance

Soolantra isn’t cheap. A 30-gram tube costs around $250-$300 in the U.S. without insurance. In Australia, it’s about $50-$70 with a PBS subsidy. That’s more than metronidazole ($30-$50) or azelaic acid ($60-$90).

But here’s what matters: if you’ve tried cheaper options and they didn’t work, you’re spending more time and money on products that don’t fix the problem. Soolantra’s higher upfront cost often pays off in fewer doctor visits, less makeup, and better confidence.

Some pharmacies offer patient assistance programs. Your dermatologist can help you apply. In Australia, the PBS makes it affordable for most people. In the U.S., GoodRx coupons can cut the price by 40%.

Who Should Use Soolantra? Who Should Avoid It?

Soolantra works best if:

• You have papulopustular rosacea (bumps and pimples, not just redness)
• You’ve tried metronidazole or azelaic acid with no results
• You want a long-term solution without antibiotics
• Your skin is sensitive but not allergic to ivermectin

Avoid Soolantra if:

• You’re allergic to ivermectin or any of its ingredients (like propylene glycol)
• You have ocular rosacea (eye symptoms)-it doesn’t help with that
• You’re pregnant or breastfeeding and haven’t discussed it with your doctor

It’s safe for most skin types, including sensitive skin. But always patch-test first. Apply a pea-sized amount on your jawline for 3 days. If you get stinging, redness, or itching, stop.

Combining Treatments: The Smart Approach

Most people don’t need just one treatment. A smart plan often combines a few things:

• Morning: Gentle cleanser + niacinamide serum + sunscreen
• Night: Soolantra cream
• As needed: Azelaic acid for dark spots, or a short course of oral doxycycline for flare-ups

This layered approach tackles multiple triggers: mites, inflammation, UV damage, and pigmentation. It’s not about one miracle product-it’s about building a system.

Many dermatologists in Melbourne and Sydney now start patients on Soolantra as a first-line treatment, not a last resort. The evidence is clear: it’s more effective than older options.

What Happens If Soolantra Doesn’t Work?

It happens. About 1 in 5 people don’t respond to ivermectin. If you’ve used it daily for 12 weeks and see no change, talk to your dermatologist.

They might:

• Switch you to oral ivermectin (a low-dose pill taken once a week for 2-4 weeks)
• Try isotretinoin (Accutane) for severe cases
• Recommend laser therapy for persistent redness

Don’t give up. Rosacea is treatable. But it’s not one-size-fits-all. Finding the right combo takes time.

Real Results: What Patients Actually Experience

One patient I spoke with in Melbourne-Sarah, 42-had tried everything: antibiotics, retinoids, expensive serums. Nothing worked. She started Soolantra after her dermatologist noticed her bumps clustered around her nose and cheeks-the classic Demodex hotspots.

At week 4, her redness dropped by half. At week 12, her skin was clear. She stopped using foundation. She started going out without a hat. She told me: "I didn’t realize how much I’d been hiding until I wasn’t hiding anymore."

Another man, 58, used Soolantra with azelaic acid. He had both bumps and dark spots. After six months, his skin looked even-toned and calm. He still uses both, but only twice a week now. Maintenance, not daily battle.

These aren’t rare cases. They’re common outcomes when the right treatment is matched to the right symptoms.

Final Takeaway: Soolantra Isn’t the Only Option-but It’s Often the Best

Soolantra isn’t perfect. It’s not cheap. It doesn’t fix redness overnight. But it’s the only topical treatment that targets the actual biological trigger behind many rosacea flare-ups.

Metronidazole? Good for mild cases. Azelaic acid? Great for dark spots. Doxycycline? Fast relief, but risky long-term. Vasoconstrictors? Just a mask.

If you’re tired of treating symptoms instead of causes, Soolantra is the most scientifically backed option available. It’s not magic. But it’s medicine that works.

Start with a dermatologist. Get a proper diagnosis. Don’t assume your redness is just "sensitive skin." Rosacea is a real condition-and there’s a real treatment that can change your life.