Ivermectin 1% | Kojic Acid 3% | Metronidazole 1% | Niacinamide 3%

Route: Topical. Apply a thin layer to the entire affected facial area once to twice daily, or as directed by the prescriber. Avoid contact with eyes and mucous membranes. Apply with clean fingertips; gentle application is essential on rosacea-prone skin to avoid mechanical irritation.

Dosing is prescriber-determined:

• Typically applied once or twice daily to affected facial areas.
• Improvement expected at 8–12 weeks; maintenance therapy is often prescribed for rosacea management.
• Prescriber determines frequency, duration, and any concurrent systemic therapy.

• Ivermectin 1%: GABA agonist and glutamate-gated chloride channel activator in Demodex mite neurons (causing paralysis); also inhibits NF-κB and MAPK inflammatory pathways in human skin cells, suppressing TNF-α and IL-1β.
• Kojic Acid 3%: Chelates Cu²⁺ at the active site of tyrosinase, competitively preventing substrate binding and blocking the enzymatic conversion of tyrosine to melanin precursors; scavenges ROS that would otherwise amplify pigmentation.
• Metronidazole 1%: Reduced intracellularly to reactive nitroso intermediates that inhibit bacterial DNA synthesis (anaerobic bacteriostatic effect); also directly inhibits neutrophil oxidative burst (reducing ROS production at inflammatory skin sites) and downregulates pro-inflammatory cytokine production in keratinocytes — mechanisms directly relevant to the neutrophil-driven inflammation of rosacea.
• Niacinamide 3%: Inhibits the Rab3a-mediated melanosome transfer pathway from melanocytes to keratinocytes; boosts NAD+-dependent cellular repair; stimulates ceramide/fatty acid synthesis for barrier repair; suppresses inflammatory cytokines.

This four-ingredient formulation is designed for prescriber-directed management of papulopustular rosacea with concurrent post-inflammatory hyperpigmentation (a common complication in darker skin phototypes). The combination addresses the major rosacea pathogenic drivers — Demodex infestation, bacterial dysbiosis, oxidative inflammation, and melanocyte activation — while treating the pigmentary sequelae with kojic acid and niacinamide.

Monitoring: Lesion count, erythema, and dyschromia assessment at 8–12 weeks; skin tolerance; culture if secondary bacterial infection suspected.

Contraindications:

• Known hypersensitivity to any formulation component.
• Metronidazole: avoid in first trimester of pregnancy if possible; use with caution in hepatic impairment (though topical absorption is minimal).

Warnings & Precautions:

• Kojic acid: may cause contact sensitization in susceptible individuals; patch test consideration.
• Metronidazole topical: minimal systemic absorption; avoid concurrent alcohol use (theoretical disulfiram-like effect, negligible with topical).
• Avoid periorbital application.

Drug Interactions:

• Topical metronidazole: minimal systemic absorption reduces interaction risk; warfarin interaction is a concern with systemic metronidazole — unlikely to be clinically relevant topically.

Common Side Effects: Mild burning, stinging, erythema, or dryness at application site. Kojic acid: occasional contact sensitization. Metronidazole topical: generally well-tolerated.

Store at room temperature (15°C–25°C). Keep tightly sealed and protected from light. Do not freeze. Use within the beyond-use date assigned by Genesis Compounding.

Why is metronidazole included in a rosacea cream?

Metronidazole is a well-established rosacea treatment with dual activity: bacteriostatic effects against skin anaerobes and direct anti-inflammatory activity by inhibiting the neutrophil oxidative burst, which is a key driver of rosacea papule and pustule formation.

Why is kojic acid added to this rosacea formula?

Many rosacea patients develop post-inflammatory hyperpigmentation (dark spots) after inflammatory lesions resolve. Kojic acid inhibits tyrosinase (the key melanin-producing enzyme) to reduce new melanin formation and lighten existing PIH.

How long before I see improvement?

Ivermectin and metronidazole typically show significant reductions in papule/pustule counts by 12 weeks. Kojic acid and niacinamide work on pigmentation over 8–12 weeks. Consistent daily use is required.

Is this FDA-approved?

No. This is a patient-specific, prescriber-directed 503A compounded preparation from Genesis Compounding, not FDA-approved as a compounded drug.

Can I wear makeup over this cream?

Yes, after the cream has been fully absorbed. Choose non-comedogenic, fragrance-free products. Consult your prescriber or dermatologist for compatible cosmetic recommendations.