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Jan. 10 2005 issue
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.
© 2004
Newsweek, Inc.
(*) In Austria
known as Roaccutan "Roche"
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