Ivermectin and Eczema Treatment
Eczema, also referred to as atopic dermatitis, is a very common skin condition that presents as dry, itchy, inflamed and irritated skin. It is a chronic problem involving the immune system that can manifest in any age, though it's most common in children and young adults [1, 2, 3, 4]
Signs and symptoms of eczema
The symptoms can vary between individual patients. However, the main symptom are patches of skin that are dry, itchy, rough and irritated, often reddish in colour.
Other symptoms can include intense itching or discolouration of the skin to brownish-gray. Sometimes raised bumps can appear, and these can ooze fluid as a result of intense scratching and crust over with a yellowish dried ooze.
Some patients find their symptoms worsening at night, making it difficult to sleep.
It is important to note that in people with dark skin tones eczema can manifest differently - including symptoms such as swelling, flaking, formation of bumps around hair follicles or dark circles around the eyes [1, 2, 8, 3, 4, 5].
Treatment options for eczema
The treatment of eczema involves a combination of lifestyle changes and medication.
Sometimes it is possible to identify a trigger - this could be a chemical or a kind of food that the immune system overreacts to, resulting in worsening of the eczema symptoms. This can be identified either through observation and trial, or also through tests administered by a medical professional. For eczema management, these triggers should be avoided.
Skin hygiene and moisturising are important - it is recommended to use a gentle moisturising cream on the affected areas after showering / bathing.
As for medication, these typically include topical corticosteroids or immunomodulators - these regulate the immune system locally to downregulate inflammation in the affected areas. In very severe cases, systemic immunosuppressants can be considered [2, 5, 6, 7].
What is Ivermectin?
Ivermectin is a commonly-used antiparastic drug used in human and veterinary medicine. It was discovered in the 1970s and since it has been widely used worldwide as a first-line treatment for parasite infection [9, 10, 11].
Mechanism of action of ivermectin
Ivermectin is an effective antiparasitic as it kills the parasitic worms. On a molecular level, ivermectin acts on the glutamate-gated chloride-dependent channels in invertebrate neurons, interrupting signal transmission [12, 11].
Importantly, ivermectin does not act on the human (humans are vertebrates) nervous system due to several protective mechanisms that prevent any interaction. These include the P-glycoprotein, which is present on the blood-brain barrier, which is a layer of tightly-packed cells that prevent harmful substances from entering the brain.
More recently, an anti-inflammatory effect of ivermectin has been described, which it exerts by blocking the nuclear factor kappa-light-chain enhancer of the activated B (NF-κB) pathway that modulates the expression and production of proinflammatory cytokines [9]. Cytokines are messenger molecules of the immune system, which signal to cells to either activate or downregulate an inflammatory response.
Indications for ivermectin treatment
Ivermectin is mainly used to treat parasitic infections including:
- common hookworms and whipworms [13], and other intestinal nematode infections,
- onchocerciasis, which is an infection of the eye and skin, referred to as river blindness,
- strongyloides infection,
- resistant head lice [11].
Ivermectin is indicated to adults and children who weigh at least 15 kilograms [10].
It is also important to note that ivermectin should not be used to treat viral infections such as COVID-19.
Can ivermectin be used to treat eczema?
Given its anti-inflammatory effects, ivermectin could potentially be used to treat eczema, though it is currently not approved for this indication by regulatory bodies such as FDA or EMA.
The application of ivermectin in eczema treatment requires further research, however, a study on mice concluded that ivermectin applied topically (on the skin) improved the eczema and modulated the immune system around the affected area. The activation of T-cells (which are the effector cells of the immune system) was reduced, as were the levels of pro-inflammatory cytokines [14].
Can ivermectin be used to treat other skin conditions?
Ivermectin is a drug that is cheap and readily available worldwide. Therefore, research has been conducted on its potential use in dermatology, given its anti-inflammatory properties.
Some of the investigated conditions include:
- Rosacea and severe acne - A study involving 20 patients diagnosed with perioral dermatitis, seborrheic dermatitis, and acne vulgaris found that all patients responded well to treatment with topical ivermectin, with a gradual reduction in inflammatory skin lesions [15, 16].
- Demodex mites - Ivermectin was shown to effectively kill Demodex mice, thus improving the symptoms of rosacea [17].
- Persistent facial erythema - In a study of 39 patients, topical ivermectin was found to alleviate the symptoms and reduce the size of the erythema [18].
- Onchocercal dermatitis - this is a skin infection by the parasite onchocerca volvulus associated with inflammation. A study found that a single dose of ivermectin led to alleviation of the dermatitis in three months [19].