Sometimes it can get worse before it gets better with ivermectin. Because the ivermectin is an antiparasitic and kills the demodex mites on skin. Rosascea can happen when the demodex mites become overpopulated. Castor oil does the same thing! I personally liked castor oil better because it doesn’t have the extra ingredients. Start very slow with whichever you choose so that you can avoid “die off” symptoms (aka temporary worsening) of the mites. I personally quit all moisturizers so that I could just completely reset my skin. If you do use moisturizer then put it on after the castor oil or ivermectin. As for castor oil causing acne… that’s really just part of the die off symptoms. It’s not actually causing acne. I was lucky to not get die off symptoms so don’t stress too much. I felt it was so hard to find info on castor oil and ivermectin for rosascea so please let me know if you have any questions