January 2004
Dear Paula,
Have you come across the recently completed study by Dr. Jennifer Gan-Wong, which tested the efficacy of a 3% green tea cream on acne lesions as compared to a benzoyl peroxide cream? Here is a link describing the study in brief: www.applesforhealth.com/PersonallyYours/greteaextha4.html.

My question is this: I have very sensitive, inflamed, oily, fair skin with rosacea. I also have acne because of the rosacea. Acne on rosacea skin must be treated very differently from acne on regular skin, and the skin of people with rosacea cannot tolerate benzoyl peroxide. If you have read the work of Dr. Geoffrey Nase, Ph.D., a Microvascular Physiologist who specializes in rosacea (see www.drnase.com; Dr. Nase also suffers from rosacea), he discourages the use of any inflammation-producing product on rosacea skin. Many dermatologists concur with this sentiment. Green tea might be a less irritating alternative for those with rosacea who also have acne.

This leads me to my next question, regarding your product recommendations. I have bought your products for years, read all of your books, and get all of your email updates. I do not understand why you still recommend beta hydroxy acid preparations for rosacea skin. I have tried your mildest BHA formulation and it irritated my skin so badly that I could not leave my house for a week. Normally I trust your advice, but I vigorously disagree with you on this one. You should not be wholeheartedly recommending BHA for rosacea-afflicted people. Dr. Nase discusses this in depth in a couple of articles he has written. Rosacea is a vascular disorder, which is not that well understood, but anything that contributes to inflammation or irritation should NOT be used on rosacea skin. BHA is an irritant, despite its supposed anti-inflammatory properties. We have discussed your recommendations for BHA on rosacea skin often in the Yahoo! Rosacea email list, which has over 3,000 members, and the consensus seems to be that anyone who has tried BHA has had bad experiences with it. Please be careful with what you recommend.

In addition, MetroGel is only effective for some people--you should NOT be recommending it to everyone who has rosacea. Some individuals cannot tolerate MetroGel, and others see no remission or reduction in their symptoms. Again, I can point you to several articles by Dr. Nase that dissect the MetroGel studies, and the findings are such that MetroGel should not be recommended for everyone with rosacea.

So, why not investigate and perhaps formulate a green tea product that isn't irritating for sensitive skin?

Annie, Berkeley, CA

Dear Annie,
I am always extremely careful with what I recommend and I do not wholeheartedly recommend any one product or skin-care routine for rosacea or acne. I have been very careful to explain that rosacea is an extremely difficult-to-treat skin disorder that is not well understood. I have done the same for acne, clarifying what is known and unknown. For both skin problems, I have listed a diverse range of medical options, over-the-counter choices, skin-care alternatives, and some dietary considerations. As I have stated repeatedly, it takes experimentation to find out what works, whether it's for acne or rosacea. There is no one treatment that will work for everyone, and that includes Dr. Nase's recommendations as well.

I agree 100% that it is of vital importance for those with rosacea to stay away from ingredients or products that promote inflammation. Actually, I have advocated that for all skin types, which is why I zealously try to avoid those types of ingredients in my products. Yet despite the fact that there are many ingredients that should absolutely be avoided to prevent inflammation, the outcome with others is far less clear, as they react differently for different people.

It is also important to realize that there are many people who experience wonderfully positive results from using MetroGel or MetroLotion, as well as those who cannot tolerate the treatment. My recommending beta hydroxy acid (salicylic acid, which is an exfoliant and disinfectant that also has anti-inflammatory properties) for rosacea was a result of feedback I received from my customers, who told me it worked wonders for them, something I explain on my Web site. Again, it does not work for everyone. If there were something that worked for everyone, there wouldn't be chat rooms to discuss the pros and cons of treatment modalities and lengthy studies evaluating treatment options. Even Dr. Nase mentions the need for more research and pharmaceutical development of products.

In regard to green tea being an option for rosacea, the study you mentioned from Dr. Gan-Wong was a 12-minute presentation at the March 2003 meeting of the American Academy of Dermatology. It is not a published paper, so we don't know many details of the study. For example, what else was in the green tea product? What else was in the benzoyl peroxide product? If the benzoyl peroxide product contained alcohol or harsh cleansing agents, that could account for the irritation and dryness the participants experienced. It would also explain why those who used the green tea cream might have seen an improvement in their complexion. That is, the difference in the skin's complexion and appearance might have merely been because the green tea cream did not include the alcohol and other skin irritants that are usually present in benzoyl peroxide products and that can have an overall negative impact on the skin?s complexion and appearance. Further, the paper is not clear as to which product provided the most reduction in acne lesions or blackheads.

I will keep my eyes open for other research on green tea, but for now the research is way too preliminary to make any decisions about it being an option other than as an antioxidant and anti-inflammatory agent. However, there is no reason for you not to consider drinking green tea or using it as a toner on your face to see how it works for you. There is a small amount of research showing that a particular green tea tannin (specifically, epigallocatechin-3-gallate) can modulate the production and biological actions of the male hormones (namely testosterone, which women have, too) that can stimulate acne (Source: Hong Kong Medical Journal, December 2001, pages 369?374).

By the way, although I do not agree with everything Dr. Nase asserts, I strongly encourage those looking for other skin-care options and treatment modalities for rosacea to visit Nase's Web site (www.drnase.com) or read his book Beating Rosacea: Vascular, Ocular, & Acne Forms. The book is available for purchase on Dr. Nase's Web site.