HEALTH: IN THE CLEAR FROM ACNE

When Brandi Jones first started breaking out at the age of 16, the cysts on her chin hurt more than just her vanity. "It was so painful," she says. "My face throbbed like someone had punched me." She spent her nights tossing and turning and her days popping Tylenol and Aleve. Over-the-counter acne treatments failed, so she saw a dermatologist, who prescribed antibiotics and topical creams. Neither worked. Finally, after her first year in college, she decided to try Accutane, a controversial prescription drug that attacks and destroys oil glands. Though she'd heard Accutane could cause depression and that it sometimes made acne worse before improving it, she took the pills for six months. "I felt pretty suicidal at times," says Jones, now 22, who posted her experiences in an on-line journal. Ultimately, the drug worked--and now her skin is mostly pimple-free. But Jones isn't sure she'd go through with the treatment again.

Everyone wants clear skin, but the decision about what treatments to try is becoming increasingly complicated. Acne, which usually results when bacteria build up inside oil-clogged pores, has no real cure, though medicine can reduce breakouts and limit scarring. Teens and adults with severe cases have long pinned their hopes on Accutane and its generic equivalents. But critics say the drug is underregulated. The Food and Drug Administration announced last November that it will create a national registry to better monitor patients and make sure that women have taken a pregnancy test (Accutane is known to cause severe birth defects). There's also been worry about a possible connection to depression and, in rare cases, suicide. "We have found no scientific basis [for these claims]," says a representative from Roche, which manufacturers Accutane. New options, like laser therapy, are also becoming available, giving patients more choices than ever before.

ACCUTANE. The drug, a derivative of vitamin A, is the most powerful weapon. It reduces the skin's production of oil, but it can also severely dry your eyes--a problem for contact-lens wearers. A good candidate suffers from painful cysts over large regions of the back, shoulders or face. Patients must take blood tests to check for liver damage --and women need to use two forms of birth control while on the drug. Accutane is used for four to six months at a time, with patients sometimes requiring repeat treatments.

LASER THERAPY. Lasers were only recently introduced as a treatment for acne, and "they work a lot better than we envisioned," says Dr. Tina Alster, director of the Washington Institute of Dermatologic Laser Surgery. Doctors pass a light over the affected areas to kill bacteria and penetrate pores to shrink oil glands. The major downside is cost, rarely covered by insurance, which ranges from $250 to $1,000 per session (it can take three sessions to bring the acne under control, with two follow-up sessions per year).

ANTIBIOTICS. They've long been used to reduce inflammation in those who suffer from widespread acne but aren't ready for Accutane. Tetracycline carries fewer side effects, the most common one being increased sensitivity to sunlight. Minocycline might be more effective for a wider range of people, but blood tests are recommended to check for liver damage. Dermatologist Kristen Kelly of the University of California, Irvine, says antibiotics are often used short-term to bring acne under control before allowing patients to use skin creams alone.

TOPICAL MEDICATIONS. Over-the-counter remedies work only for mild cases of acne. For more troublesome skin, two popular prescriptions are a retinoid, which unplugs follicles, used in combination with benzoyl peroxide, which kills bacteria. If you need to clear a problem spot fast, your doctor can inject a cyst with cortisone. The steroid flattens your zits in about a day. The needle hurts, but not as much as a blemish on prom night.