I have typically managed my mild case of acne rosacea (AR) with affordable over-the-counter (OTC) medications, but there has always been a residual redness that bothered me.

Recently, while reading about Demodex, microscopic mites that live on the faces of many of us in our hair follicles and sebaceous glands, I became interested in their potential connection to AR. I wondered if a topical miticidal treatment might be helpful. Some research confirmed that ivermectin was indeed effective in treating AR.

So, I decided to acquire some.

As a pediatrician, I’m familiar with ivermectin because it’s used to treat head lice, a common childhood complaint. It was once available only by prescription but is now available over the counter as a lotion, priced at around $35.

I delved deeper into my research and soon discovered that AR treatment involved a 1% ivermectin cream, available in both brand and generic versions.

I consulted my Medicare Part D drug list and was shocked by the cost I would have to bear, especially considering that it was only available through a “step therapy” process, which required trying other cheaper medications first. So, I turned to the GoodRx website, which indicated an “average retail price” of $567 but promised that, with their coupon, I could obtain a small tube (45 g, enough for one month) for anywhere between $140 to $280. The Amazon online pharmacy quoted $509 for the brand Soolantra and $379 for the generic version.

Are you kidding me? Could I not find access to this straightforward medication, which has been in medical use since 1987 (and earned its inventor a Nobel Prize)? I scoured Amazon and found numerous options for a veterinary preparation used to deworm horses; a 6 g tube of 1.82% ivermectin was as cheap as $12! I wondered if I could use this topically for my AR.

Further research revealed that this was indeed a common practice among AR sufferers who faced the exorbitant cost of the human topical product. Some articles even included interviews with dermatologists who disapproved of the practice, albeit for safety reasons. One couldn’t help but wonder if they were protecting their interests.

So, I purchased some of the horse paste, which had a pleasant apple scent (and apparently, a taste for horses). Before applying it, I mixed it half and half with some hand cream from the dollar store ($1.25). I can confidently report a noticeable improvement in redness after only a few days. By the two-month mark, my AR had disappeared.

Why then is 1% ivermectin cream, whether brand or generic, so expensive? Clearly, it’s not due to the cost of the ingredients. I’m sure that if a representative of the Soolantra brand were questioned, they would mention expenses related to research, safety trials, and the like. My response would be, “Can you please explain why I can obtain your product through a legitimate government-regulated online pharmacy in the U.K. for about $40?” I’d watch them blush.

It’s hard to escape the conclusion that Big Pharma is once again taking advantage of us Americans.

Martin C. Young is a pediatric endocrinologist.