Rosa is formulated for use in inflammatory facial skin conditions where Demodex overpopulation, bacterial dysbiosis, and dysregulated innate immune signaling contribute simultaneously to the disease presentation:

Rosacea (papulopustular subtype): The primary indication. Papulopustular rosacea is characterized by persistent central facial redness with recurring papules and pustules and is the condition for which both ivermectin and metronidazole have individual FDA approval. Rosa's dual-active approach addresses the Demodex burden (ivermectin), the bacterial and oxidative inflammatory components (metronidazole), and the barrier dysfunction and cytokine amplification that perpetuate chronic reactivity (niacinamide).

Rosacea (erythematotelangiectatic subtype): The flushing, persistent redness, and central facial erythema of ETR do not respond to antiparasitic therapy as directly as papulopustular subtype, but the anti-inflammatory properties of metronidazole and niacinamide contribute meaningfully to reducing baseline inflammatory redness and improving barrier integrity in reactive ETR skin.

Perioral dermatitis: A chronic inflammatory papular eruption around the mouth and nasolabial folds with incompletely understood pathophysiology but consistent response to metronidazole therapy. Demodex involvement has been documented in a subset of perioral dermatitis cases, and niacinamide's anti-inflammatory and barrier-supportive properties address the reactive skin environment in which this condition develops and persists.

Seborrheic dermatitis: An inflammatory condition driven by dysregulated immune response to Malassezia yeast on sebum-rich skin, with documented Demodex co-involvement in facial presentations. Ivermectin's antiparasitic activity and metronidazole's anti-inflammatory properties address the inflammatory component; niacinamide's barrier reinforcement and sebum regulation address the underlying skin environment.

Inflammatory acne: Acne vulgaris with significant inflammatory component — particularly where Demodex elevation or follicular inflammation is a contributing factor — may respond to the antiparasitic and anti-inflammatory combination of ivermectin and metronidazole, supported by niacinamide's sebum regulation and barrier protection. Your prescribing provider will assess whether this formula is appropriate for your specific acne presentation.

With consistent use as directed by your prescribing provider, Rosa supports:

Reduction in rosacea papules and pustules through dual antiparasitic and antimicrobial activity

Decreased facial redness and inflammatory burden through three independent anti-inflammatory mechanisms

Reduction in Demodex mite density — addressing a primary upstream driver of papulopustular inflammation rather than only downstream symptoms

Improved skin barrier integrity, reducing environmental trigger sensitivity in chronically reactive skin

Suppression of inflammatory cytokine signaling at multiple points in the innate immune cascade

Fading of post-inflammatory hyperpigmentation through niacinamide-mediated melanosome transfer inhibition

Reduced sebum production and improved pore appearance

Calmer, less reactive baseline skin with consistent use over time

Improvement across rosacea subtypes, perioral dermatitis, seborrheic dermatitis, and inflammatory acne as appropriate to individual presentation

Results vary by individual and condition. Some patients notice initial improvement in redness and papule formation within two to four weeks. Meaningful reduction in overall inflammatory burden and lesion count typically develops over six to twelve weeks. Rosacea and perioral dermatitis are chronic conditions; sustained improvement generally requires ongoing consistent use and trigger management in conjunction with topical therapy.

Apply as directed by your prescribing provider. Dosing frequency, application area, and duration of use will vary based on your specific condition, severity, and treatment response. General guidance is provided below.

General Application Instructions:

Cleanse the affected area gently with a mild, fragrance-free cleanser and pat dry.

Dispense a small amount of Rosa and apply a thin, even layer to the affected areas of the face. A pea-sized amount is typically sufficient for the full face; use less for localized application to specific affected zones.

Gently massage into the skin until absorbed. Avoid rubbing vigorously — aggressive mechanical stimulation can trigger flushing in rosacea-prone skin.

Avoid the eyes, inner corners of the nose, and mucous membranes.

Wash hands after application.

Allow to absorb before applying any other topical products, sunscreen, or makeup.

Sun Protection: Daily broad-spectrum SPF 30 or higher is strongly recommended throughout therapy. UV exposure is one of the most consistent rosacea triggers and can worsen both the underlying condition and any post-inflammatory pigmentation. Sun protection is not optional for patients managing inflammatory facial skin conditions.

Timeline Expectations: Antiparasitic therapy requires time to reduce Demodex population density; the life cycle of Demodex is approximately two to three weeks, meaning meaningful mite burden reduction typically requires several weeks of consistent application. Anti-inflammatory improvement may be noticed sooner. Patients should not discontinue before six to eight weeks of consistent use based on initial impression of limited response.

Rosa is a prescription-only compounded medication. Patients must be counseled regarding appropriate use, contraindications, and monitoring before initiating therapy.

Contraindications:

Pregnancy and breastfeeding: Safety of topical ivermectin and metronidazole during pregnancy and lactation has not been fully established. Use is generally not recommended during pregnancy. Breastfeeding patients should consult their provider — metronidazole is detectable in breast milk with systemic use; topical facial absorption is low but the risk-benefit decision requires individualized medical guidance.

Known hypersensitivity: Patients with documented allergy to ivermectin, metronidazole or other nitroimidazoles, or niacinamide should not use this product.

Active skin infection: Do not apply to skin affected by active bacterial, viral, or fungal infection in the treatment area.

Children: Safety and efficacy of topical ivermectin for facial inflammatory conditions in pediatric patients have not been established for all ages; consult your provider.

Potential Side Effects:

Common:

Mild skin irritation, burning, or stinging at application — particularly in the first one to two weeks as sensitized skin adjusts; usually transient

Mild dryness or tightness, particularly with gel formulation

Temporary initial flare in redness — occasionally reported in the first week of antiparasitic therapy as mite die-off triggers transient inflammatory response; typically resolves with continued use

Less common:

Contact dermatitis in patients with sensitivity to any formula component

Local erythema or pruritus at application site

Rare systemic absorption effects from topical metronidazole — negligible at typical facial application volumes but patients with hepatic impairment should inform their provider, as metronidazole is hepatically metabolized

Nitroimidazole note: Metronidazole is a nitroimidazole. Patients with a history of allergy or hypersensitivity to metronidazole, tinidazole, or other nitroimidazoles should not use Rosa.

Discontinue use and contact your provider if: irritation is severe or worsening beyond the initial adjustment period, spreading rash or blistering develops, or unexpected systemic symptoms occur.

Topical retinoids (tretinoin, adapalene, tazarotene): Concurrent use in the same facial area increases irritation and barrier disruption risk, particularly in rosacea patients with reactive baseline skin. Discuss timing and sequencing with your provider before combining.

Other topical antimicrobials: Concurrent use of multiple topical antimicrobial agents increases the risk of bacterial resistance selection and skin irritation without established additive benefit. Discuss all concurrent topical therapies with your provider.

Systemic metronidazole or other nitroimidazoles: Patients on oral metronidazole or tinidazole for systemic indications should inform their provider — combined systemic and topical metronidazole exposure, while low with facial application, should be considered in the overall treatment plan.

Alcohol-based topical products: Metronidazole has a disulfiram-like interaction with ethanol in systemic use; the clinical relevance for topical application is very low but patients with sensitivity should be aware.

Photosensitizing medications: Certain antibiotics, diuretics, and antifungals increase photosensitivity. Combined with the already UV-sensitive profile of rosacea skin, daily SPF use is essential when any photosensitizing agent is part of the treatment regimen.

Topical corticosteroids: Long-term periocular or facial corticosteroid use is associated with Demodex overpopulation and rosacea exacerbation — discuss any concurrent corticosteroid use with your prescribing provider, as it may counteract ivermectin's antiparasitic activity.

Store at room temperature, 68°F – 77°F (20°C – 25°C), away from direct heat, humidity, and light

Keep container tightly closed

Do not freeze

Keep out of reach of children

Do not use beyond the labeled expiration date

If refrigeration is specified on your label, store accordingly