Dermoscopic Response Predictors in Papulopustular Rosacea Treated with Topical Ivermectin and Metronidazole: A Prospective Observational Comparative Study

Background: Over recent years, dermoscopy has proven useful not only for diagnosing skin conditions but also as a tool for predicting treatment response in inflammatory dermatoses. However, no data are available on dermoscopic predictors in papulopustular rosacea (PPR). Objective: To evaluate whether certain clinical and dermoscopic findings serve as positive or negative predictors of response to topical ivermectin or metronidazole in PPR. Methods: Twenty-three patients with moderate-to-severe PPR were enrolled. Ten patients received ivermectin 10 mg/g cream and 13 received metronidazole 1% gel (non-randomized, based on physician preference), applied once daily for 8 weeks. Inflammatory lesion counts and key clinical/dermoscopic features were assessed at baseline and after 8 weeks by two independent, blinded physicians. Post-treatment clinical outcomes (optimal response: >75% lesion reduction; partial response: 50-75% reduction) were correlated with baseline features. Results: Both treatments significantly reduced inflammatory lesion counts (p