Ivermectin cream is a topical prescription medicine, sold as Soolantra and as generic ivermectin cream 1%, that the US Food and Drug Administration has approved for one specific use: the treatment of inflammatory lesions of rosacea — the bumps and pimples of papulopustular rosacea. It is not the same product as ivermectin lotion 0.5%, which is a separate, single-use formulation sold for head lice, or as oral ivermectin tablets.

Those three formulations are often discussed as if they were interchangeable, and they are not. This guide separates them: what the 1% cream is approved to do, where the evidence on lice and scabies actually stands, how each product is applied, and what changed recently in prescription status and state law. If you also want the oral side of the picture, see our separate reference pages on how oral ivermectin is dosed and on the broader range of approved uses and reported side effects. Prices, retail availability and state laws in this article were last verified on September 26, 2026.

Key takeaways

  • Ivermectin cream 1% is FDA-approved only for the inflammatory bumps and pimples of rosacea. It is prescription-only and available as brand-name Soolantra and as a generic.
  • Ivermectin lotion 0.5% (Sklice and generics) was switched from prescription to over-the-counter status by the FDA in 2020 for head lice in people 6 months and older.
  • No ivermectin product is FDA-approved for scabies in the US. Topical ivermectin has been studied for scabies, but permethrin remains the standard topical option.
  • Rosacea is a chronic condition. Ivermectin cream is described in labeling as a treatment for lesions, not a cure, and symptoms commonly return when treatment stops.
  • Recent state laws loosening access to ivermectin apply mainly to oral tablets and do not make the 1% cream over-the-counter anywhere.

What ivermectin cream is (Soolantra and generics)

Cropped view of a person's cheek and jaw with visible facial redness as topical cream is smoothed on with a fingertip.

Ivermectin is an antiparasitic compound discovered in the 1970s. It was first developed as a veterinary drug by Japanese microbiologist Satoshi Ōmura, who shared the 2015 Nobel Prize with William Campbell for the work. In the 1% cream, it is formulated for once-daily use on the face rather than for systemic absorption.

The FDA approved Soolantra (ivermectin) cream, 1% in December 2014 as a once-daily topical for the inflammatory lesions of papulopustular rosacea. Its mechanism of action in rosacea is not established, but is thought to involve a combination of anti-inflammatory effects and antiparasitic activity. Research has pointed to Demodex mites — microscopic mites that live in skin pores — as one factor in the inflammation associated with rosacea, which is the usual explanation offered for why an antiparasitic helps a skin condition.

Brand versus generic

A generic exists. Teva announced the US launch of its generic version of once-daily Soolantra (ivermectin) cream, 1% for the treatment of inflammatory lesions of rosacea, supplied as an AB-rated 45 gram tube — meaning the FDA considers it therapeutically equivalent to the brand.

Product Strength FDA-approved use Status
Ivermectin cream (Soolantra, generics) 1% Inflammatory lesions of rosacea Prescription
Ivermectin lotion (Sklice, generics) 0.5% Head lice, age 6 months and older Over-the-counter
Ivermectin tablets (Stromectol, generics) 3 mg tablets Certain parasitic infections Prescription (federally)

Ivermectin is also available by prescription as a 1% cream (Soolantra) approved for topical treatment of inflammatory lesions of rosacea and in oral tablets (Stromectol, and generics) for treatment of various parasitic infections. Veterinary ivermectin products — horse pastes, cattle pour-ons, injectable livestock formulations — are labeled for animal use only and are not approved for human use in any form, including applying them to skin.

Ivermectin cream for rosacea

A plastic dosing bottle of lotion and a fine-toothed nit comb with strands of hair on a towel, used for head lice treatment.

This is the only use the cream is approved for, and it is where the evidence is strongest. Galderma conducted two randomized, double-blind, controlled studies of ivermectin 1% cream versus vehicle applied once daily for 12 weeks in subjects with moderate to severe papulopustular rosacea. Improvement was reported as early as week two, with continuous improvement in patients with inflammatory lesions, and in a head-to-head comparison with metronidazole 0.75% cream, ivermectin cream showed better results as early as the third week.

Some limits are worth stating plainly. An independent review in American Family Physician concluded that ivermectin cream is an effective treatment for moderate to severe pustular rosacea, but that it is more expensive than some other available treatments and has not been studied in patients with milder forms of rosacea. The same review noted that generic metronidazole cream is a less expensive alternative, and long-term oral doxycycline may suit patients who want a more affordable option.

Two more points regulators and dermatologists consistently make. First, the approval covers inflammatory lesions — bumps and pimples — not the persistent facial redness or visible blood vessels that many people with rosacea find most bothersome. Second, labeling describes the product as indicated for treatment of inflammatory lesions of rosacea, not for eliminating the condition; rosacea is chronic, and lesions commonly recur after stopping.

Ivermectin lotion for head lice

A pharmacist's hands counting out white tablets on a tray next to an amber vial and a plain cream tube.

For lice, the relevant product is not the cream. Topical ivermectin lotion 0.5% (Sklice and generics), available by prescription since 2012, is FDA-approved for sale over the counter for treatment of head lice in patients 6 months of age and older. That over-the-counter approval came through an Rx-to-OTC switch; Sklice was originally approved as a prescription treatment for head lice infestation in February 2012.

The formulation is designed as a one-time application. Sklice contains ivermectin 0.5% as the active ingredient and is a single-use lotion for topical treatment of head lice. It is for external use only and should be applied to the scalp and dry hair, as noted in the label directions. It is not approved for any other use.

One practical caution about retreatment applies across lice products generally: because most available pediculicides are not ovicidal, retreatment is usually necessary 7 to 10 days after the first treatment to kill newly hatched lice. Ivermectin lotion's single-application labeling is the exception rather than the rule, so read the carton you actually buy rather than assuming all lice products work the same way.

Ivermectin for scabies

A printed pharmacy receipt, coins and a small white medicine carton side by side on a counter.

Scabies is where expectations and approvals diverge most. In the US, no ivermectin product — cream, lotion or tablet — carries an FDA-approved indication for scabies. Permethrin 5% cream is the conventional first-line topical, and permethrin is generally considered the most effective topical treatment for scabies. Oral ivermectin is used off-label by clinicians in some situations, including crusted scabies and outbreak settings.

Published trials of topical ivermectin for scabies exist but are modest in size and mostly conducted outside the US. One trial of 380 patients compared 1% ivermectin applied topically, repeated once the following week, against permethrin 2.5% cream: two applications of topical ivermectin produced a 63.1% cure rate at two weeks, rising to 84.2% at four weeks, compared with 65.8% and 89.5% for permethrin — statistically comparable at both time points. A separate open-label randomized trial in 315 patients compared permethrin 5% cream as a single application, oral ivermectin 200 mcg/kg as a single dose, and ivermectin 1% lotion as a single application.

Read that carefully: these studies used 1% ivermectin lotions and formulations prepared for research, not the 1% facial cream sold for rosacea and not the 0.5% lice lotion. Neither commercial product has been tested at the body-wide doses scabies treatment requires. If you suspect scabies, the practical step is a clinician visit — partly because the itch persists for weeks after successful treatment and partly because household contacts usually need treating at the same time.

How to apply it correctly

Ivermectin cream 1% (rosacea)

Labeling is specific about quantity. Apply to the affected areas of the face once daily, using a pea-size amount for each affected area of the face — forehead, chin, nose, and each cheek — and spread it out. Avoid the eyes, lips and inside of the nose and mouth. It is intended for use in adults; the FDA approval is for adults. Because the cream is used once daily on an ongoing basis, a 45 g tube is the standard dispensed size, and refills are the norm rather than the exception. Our companion page on topical ivermectin products covers tube sizes and storage in more detail.

Ivermectin lotion 0.5% (head lice)

Follow the carton directions exactly. It is for external use only, applied to the scalp and dry hair, and is not approved for any other use. It is not a leave-in product and it is not for use on the body.

What not to do

  • Do not substitute one formulation for another — the cream is not a lice treatment and the lotion is not a rosacea treatment.
  • Do not apply veterinary ivermectin products to human skin. Horse pastes, drenches and pour-ons are labeled for animal use only, are not approved for people, and are not formulated or concentration-controlled for human dermatologic use.
  • Do not compound your own dilution from tablets or animal products.

Prescription vs over-the-counter

The dividing line is by formulation, not by active ingredient.

  • Ivermectin cream 1%: prescription-only nationwide. It is a topical prescription medication labeled for the treatment of inflammatory lesions of rosacea.
  • Ivermectin lotion 0.5%: available over the counter. The FDA has described the Rx-to-OTC switch process as intended to promote public health by increasing consumer access to drugs that would otherwise only be available by prescription.
  • Ivermectin tablets: prescription under federal law, with several state exceptions described below.

Recent state law changes

Several states have changed access rules for ivermectin since 2022, and this is the part most likely to be out of date in older articles. Tennessee was the first state to make the drug available, in 2022, with SB 2188/HB 2746, which authorized ivermectin as suitable for human use. In 2025 several other states followed: Arkansas passed SB 189 and Act 396 on March 25, 2025, and Idaho passed SB 1211 on April 14, 2025, both providing that ivermectin is suitable for human use and may be sold or purchased as an over-the-counter medication without a prescription or consultation with a health care professional. Louisiana's SB 19 and Act 464 took effect June 20, 2025. As of reporting in 2025, Arkansas, Idaho, Louisiana and Tennessee had passed such bills, and Texas signed a bill in August 2025.

Three caveats matter more than the list itself. The laws differ in mechanism: Arkansas and Idaho's statutes are written as true OTC sales, with no prescription and no pharmacist consultation required, while Louisiana, Tennessee and Texas use a pharmacist-dispensing model. Only the FDA can grant a true federal OTC reclassification. And legal permission is not the same as availability: reports note that the state laws do not include dosing guidance, and that pharmacies and retailers remain free to decide whether to stock or dispense ivermectin, so legal permission does not guarantee availability at any given store. Pharmacy associations have warned that without FDA OTC labeling information on dosage and interactions, pharmacies face practical difficulties stocking and advising customers. None of these laws changes the prescription status of ivermectin cream 1%.

Cost, as of September 2026

GoodRx lists Soolantra with an average retail price of $328.58 for the most common version — a 45 g tube of 1% cream — and a coupon price as low as $92.67. GoodRx notes it has partnered with InsideRx and Galderma to reduce the price for this prescription; coverage varies, as Soolantra is covered by some Medicare and insurance plans. Prices change, so treat these as a snapshot verified on September 26, 2026 rather than a current quote.

Side effects

Local skin reactions are the main issue, and they are uncommon. In controlled clinical trials with Soolantra cream, the most common adverse reactions (incidence 1% or less) included skin burning sensation and skin irritation. The American Family Physician review reported that fewer than 2% of patients experience local adverse effects such as burning skin sensation (1.3%), skin irritation (1%), pruritus (0.8%) and dry skin (0.7%), and that these effects are usually transient and decrease over time. On discontinuation, the same review found that ivermectin cream is generally well tolerated, with about one in 77 patients stopping by 16 weeks because of adverse effects, and roughly one in 83 discontinuing among those using it for up to a year — rates similar to vehicle, metronidazole cream or azelaic acid.

Some people report a transient flare or stinging in the first weeks. Report persistent burning, worsening redness or any rash to your prescriber, and report suspected reactions to the FDA: the label directs reports to Galderma at 1-866-735-4137 or to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. Systemic side effects of oral ivermectin are a different matter and are covered in our page on oral ivermectin's safety profile.

Frequently asked questions

Is ivermectin cream available over the counter?

No. The 1% cream is prescription-only throughout the US. The product available without a prescription is ivermectin lotion 0.5%, FDA-approved for OTC sale for head lice in patients 6 months and older. State ivermectin laws passed in 2022–2025 concern oral ivermectin and do not reclassify the cream.

Is there a generic version of Soolantra?

Yes. Teva launched a generic version of once-daily Soolantra (ivermectin) cream, 1%, and its 45 g tube carries an AB equivalence rating. Note that GoodRx's Soolantra page has at times stated that there are currently no generic alternatives to Soolantra, so ask your pharmacy directly what is in stock and what it will cost you.

How long until it works for rosacea?

Trial results showed improvement as early as week two with continuous improvement over time, and the pivotal studies ran for 12 weeks. A reasonable expectation is weeks, not days, and your clinician may want to reassess at around 12 weeks.

Can I use ivermectin cream for scabies or lice?

It is not approved for either. Scabies treatment requires application over most of the body under clinician guidance, and the facial cream has not been studied that way. For lice, use a product labeled for lice.

Can I use horse paste or other animal ivermectin on my skin?

No. Veterinary ivermectin products are labeled for animal use only and are not approved for human use. They are formulated for large animals, are not made to human dermatologic standards, and there is no reliable way to dose them for a person. Information on human dosing is available on our dosing reference page.

Does ivermectin cream cure rosacea?

No. It is indicated for the treatment of inflammatory lesions of rosacea, which is a chronic condition. Neither the label nor the trials support a claim of cure or prevention, and lesions commonly return after stopping.

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