Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.
Public / practitioner-facing clinical reference — not a prescriber, not a diagnosis, not medical advice. A phenotype-driven, conventional-anchored TIERED plan: shared Foundation care, an evidence-graded Conventional / dermatology primary tier, and clearly-labelled complementary lenses (dietician, naturopath, Ayurveda, TCM) as honestly-graded adjuncts. Referral / red-flag notes are surfaced but never replace clinical judgement. Runs entirely in your browser — no data is collected.

Evidence: Health Canada — Drug Product Database (verified July 2026… 2026 · sources last checked 2026-07-29

Rosacea tiered-team selector

Rosacea is managed by phenotype, not subtype. Pick the predominant phenotype (and any co-existing features) plus modifiers, and assemble a plan: Foundation care for everyone, the evidence-anchored conventional / dermatology tier, then honestly-graded complementary adjuncts — each option carrying its lens, a transparent evidence grade, and the guideline reasoning behind it.

Predominant phenotype *required — gates the conventional-tier targeting

Co-existing phenotypes (optional — overlap is common)

Guideline lens

Modifiers

Severity

Triggers & course

Special populations

Care preference

Diagnostic flags

Guideline emphasis

Canadian CPG (Asai 2016) — the Canadian default and (as of 2026) still the only dedicated Canadian guideline. It uses the older four-subtype framing and PREDATES oxymetazoline (not mentioned); for the newer phenotype model and the vessels-need-laser framing, cross-check ROSCO/NRS. Canadian availability differs from the US — e.g. oxymetazoline (Rhofade) is NOT marketed in Canada.

Select the predominant phenotype to build the plan.

e.g. Inflammatory papules / pustules for topical ivermectin / azelaic acid / metronidazole, or Telangiectasia to see why laser / IPL is first-line.

References

  1. [1]Asai Y, Tan J, Baibergenova A, et al. Canadian Clinical Practice Guidelines for Rosacea. J Cutan Med Surg. 2016;20(5):432–445. DOI 10.1177/1203475416650427. (Canadian default; uses the older subtype framing and predates oxymetazoline.) link
  2. [2]Schaller M, Almeida LMC, Bewley A, et al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus (ROSCO) 2019 panel. Br J Dermatol. 2020;182(5):1269–1276. DOI 10.1111/bjd.18420. link
  3. [3]Thiboutot D, Anderson R, Cook-Bolden F, et al. Standard management options for rosacea: the 2019 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2020;82(6):1501–1510. DOI 10.1016/j.jaad.2020.01.077. link
  4. [4]National Rosacea Society — Rosacea Treatment Algorithms (phenotype- and severity-based; refreshed March 2025). Most-current NRS phenotype guidance, incl. oral flushing agents (carvedilol/propranolol) and laser options. link
  5. [5]van Zuuren EJ, Fedorowicz Z, Tan J, et al. Interventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments. Br J Dermatol. 2019;181(1):65–79. DOI 10.1111/bjd.17590. (The GRADE evidence backbone: brimonidine, azelaic acid 15%, ivermectin 1%, doxycycline 40 mg MR = High-certainty; oxymetazoline, metronidazole 0.75% = Moderate; laser/IPL = Low-to-moderate; low-dose isotretinoin/difficult-to-treat = Low.) link
  6. [6]Health Canada — Drug Product Database (verified July 2026): brimonidine 0.33% gel = Onreltea (DIN 02421208, Galderma); ivermectin 1% cream = Rosiver (02440342, Galderma); azelaic acid 15% = Finacea (02270811, LEO Pharma); metronidazole 0.75% = MetroCream (02226839, Galderma). link
  7. [7]Oxymetazoline 1% cream (Rhofade) — US FDA-approved for persistent facial erythema of rosacea, but NOT listed in the Health Canada Drug Product Database at any rosacea strength (verified July 2026): not marketed in Canada. link
  8. [8]National Rosacea Society — Rosacea Triggers Survey (N≈1,066): alcohol ~52%, spicy food ~45%, heated beverages ~36%. Patient-survey data (not RCT evidence) for trigger avoidance. link
  9. [9]Weiss E, Katta R. Diet and rosacea: the role of dietary change in the management of rosacea. Dermatol Pract Concept. 2017;7(4):31–37. (Reviews the observational/mechanistic diet evidence; notes the lack of trials.) link
  10. [10]Doxycycline 40 mg modified-release (Apprilon, DIN 02375885, Galderma Canada; US = Oracea) — sub-antimicrobial, anti-inflammatory dose (30 mg IR + 10 mg DR), below the antibiotic threshold. Canadian availability + CADTH review. link
  11. [11]Wang MTM, Ko J-S, et al. Omega-3 fatty acid supplementation for dry eye disease: systematic review and meta-analysis (19 RCTs, 4,246 patients; net positive, dose-responsive). J Clin Med. 2023;12(22):7026. Plus rosacea-specific Bhargava et al. Curr Eye Res 2016 (positive). link
  12. [12]Asbell PA, et al. (DREAM Study). n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease. N Engl J Med. 2018;378(18):1681–1690. Large RCT (N=535) finding NO benefit over placebo — the negative counterweight on omega-3. link
  13. [13]Draelos ZD, et al. The effect of 2% niacinamide on facial skin barrier function and rosacea. Cutis. 2005;76(2):135–141. Single small RCT (N=50) — improved barrier function/rosacea signs; not independently replicated. link
  14. [14]Topical green-tea/EGCG for rosacea: the sole RCT (Syed, J Am Acad Dermatol 2005) is DISCREDITED — the lead author was charged with practising medicine without a licence/fraud and his marketed cream was found to contain undisclosed hydrocortisone. No trustworthy, replicated evidence. link
  15. [15]Health Canada advisory — 'Some Ayurvedic medicinal products reported to contain high levels of heavy metals' (Mar 3, 2005) and 'Health Canada warns consumers not to use certain Ayurvedic medicinal products' (Jul 14, 2005); repeated advisories through 2022. Do NOT use ingestible bhasma/rasa-shastra (metal-mineral) products. link
  16. [16]Saper RB, et al. Heavy Metal Content of Ayurvedic Herbal Medicine Products. JAMA. 2004;292(23):2868–2873 (20% over limits); and Lead, Mercury, and Arsenic in US- and Indian-Manufactured Ayurvedic Medicines Sold via the Internet. JAMA. 2008;300(8):915–923 (21% contaminated; 40% of rasa-shastra products). link
  17. [17]NCCIH (US National Center for Complementary and Integrative Health) — Using Dietary Supplements Wisely (supplement quality/safety; no clinical-trial evidence supports Ayurvedic treatment for rosacea). link
  18. [18]Yu et al. Efficacy and safety of Chinese herbal medicine for rosacea: systematic review and meta-analysis (13 RCTs, 1,348 patients). Front Pharmacol. 2024. GRADE LOW quality, high heterogeneity, publication bias (Egger p=0.001) — authors caution against over-interpretation. No completed acupuncture RCT for rosacea (protocols only). link
  19. [19]NCCIH — Traditional Chinese Medicine: What You Need To Know, and Herb–Drug Interactions. Herbal products can interact with medications; unregulated products have been found adulterated with heavy metals and hidden pharmaceuticals. link
  20. [20]LiverTox (NIH/NCBI Bookshelf) — Chinese and Other Asian Herbal Medicines: hepatotoxicity documented for Jin Bu Huan, Ma Huang, He Shou Wu, Sho-saiko-to and others. Plus Health Canada seizures of adulterated herbal products (e.g. Calgary, Apr 2022 — undeclared sildenafil, dexamethasone, antibiotics). link