What really works!

* About 20 million teens fight the breakout battle every day. The question is this: What will be your weapon of choice? Once and for we help you find the right war on principles.

Used to be there was only one choice for fighting pimples--good ol' benzoyl peroxide. But now? The possibilities are endless...and endlessly confusing. Drug stores offer aisle upon aisle of washes, cleansers, lotions, toners, spot treatments, patches, bombs, strips, gels, phew! Health food stores claim the answer is an all-natural extract, like clove oil or tea tree oil. But what about those chichi "ethnobotanicals" you see in department stores? Is the secret to clear skin really something as creepy-sounding as Job's Tears? And what about those products you keep hearing about on radio and TV? Nature's Cure claims to naturally clear and prevent acne by working "from the inside out" with a combination of homeopathic tablets and "vanishing cream" (which turns out to be--surprise, surprise--benzoyl peroxide).

Pro-Activ is a pricey three-step product advertised with infomercials during late-night reruns. Makers of iSo-Care say it works thanks to "chiral separation, a process that differentiates molecules depending upon the direction of the spiral." Run that by us again?

To help clear up your confusion--as well as your skin--we asked a group of dermatologists to review all the treatment options out there and help you sort out the good, the bad and the totally useless rip-offs.

Meet our esteemed panel: "While there has been a big increase in the number of products out there, the cause of acne hasn't changed much," says Dr. Andrew Kaufman, a dermatologist and dermatologic surgeon in Santa Barbara, California (he's also an assistant clinical professor of medicine at UCLA). "There are only three real causes of acne--bacteria, stress and hormones."

And thanks to those pesky little puberty hormones, "almost every single girl will break out at some time or another," says Dr. Henry Gasiorowski, a dermatologist and dermatologic surgeon in Greenwich, Conn., who is also affiliated with Greenwich Hospital at Yale/New Haven.

The good news? No one needs to suffer one extra minute with acne. "While there are no cures yet," says Dr. Terry Polevoy, director of the Acne Care Clinics in London and Waterloo Ontario, Canada, "we have lots of effective treatment options. Everyone can be helped."

The trick is getting the right kind of help. "A lot of companies want you to believe their products work," says Dr. Polevoy. Why is that? Because acne is a $500 million industry. "There are huge dollars at stake," he says. That's part of the reason Dr. Polevoy started Healthwatcher.com--to expose misleading health practices and products, including acne treatments.

If all this talk about acne products has your head spinning, you're not the only one. That's why we put all the most popular pimple products to the test.

Read on for the real lowdown on the claims, the costs and the chance for a sure cure...

the naturals

You see the cute little bottles in health food stores and places like the Body Shop--oils and extracts purported to have magical properties that will clean and clear up your skin. What the heck, you figure, this stuff is all-natural, so how bad could it be? Not so fast says Dr. Kaufman: "You need to know that these 'homeopathic' remedies aren't regulated by the government and don't come with a guarantee of safety." Dr. Gasiorowski agrees. "Some of these oils may someday be shown to have benefits, but," he cautions, "some can actually make acne worse."

CLOVE OIL

THE CLAIM: Almond, sesame and clove oils can clear cystic acne. Enessa claims clove oil has strong anti-bacterial properties and that it can help to reduce swelling.

THE COST: $21.50 for a half-ounce bottle

THE VERDICT: "We've had some people who used it," says Dr. Gasiorowski. "Theoretically, it may work because clove oil is an anti-bacterial. But overall? I think there are better treatment options." Dr. Kaufman is less impressed: "What is the proper concentration? No one really knows." Dr. Polevoy is not a fan either: "Clove oil can be pretty irritating and smells terrible. There are no studies showing clove oil works."

TEA TREE OIL

THE CLAIM: Tea tree oil contains an anti-bacterial agent that is supposed to kill zit-causing bacteria. A recent study compared a 5-percent tea tree oil product to a 5-percent benzoyl peroxide product. Both were found to work equally well.

THE COST: $18 for 5 ounces

THE VERDICT: Dr. Kaufman buys this but also says he hasn't seen a lot of positive results. "Some patients become irritated," he says, "but it depends a lot on the product. Personally, if benzoyl peroxide works just as well, I'd stick with that." Dr. Gasiorowski also agrees, "Tea tree oil decreases bacteria so the acne could ease. But if this stuff really worked better, everyone would be marketing it." One note of cautlon: Dr. Polevoy has found that some people can be allergic to tea tree oil.

ISO-CARE 3-STEP ACNE SYSTEM

THE CLAIM: iSO-Care treats the causes of acne, including bacteria, with only natural ingredients like Japanese mint, cranberry enzymes and citrus. The three-step system has cleanser, toner and a skin-control gel. Pumpkin seed works as a natural form of salicylic acid, and melaleuca, the sap of tea trees, works as an anti-bacterial. So what's the big deal? iSO-Care's success is based on the science of chiral separation. This process supposedly enhances the body's ability to make repairs to the skin. "You have a lot of active ingredients without side effects," says John Strucke, who is head of iSO-Care but not a dermatologist.

THE COST: $80 for a 4-ounce bottle each of cleanser and toner and a 1-ounce gel, which the company says lasts about three months

THE VERDICT: "It's an interesting concept," says Dr. Gasiorowski, "but I can't get behind their use of chiral separation. It's not just the chemistry of products that matters. As dermatologists, we've never seen a lot of research to support this. There could be some good ingredients in here that could help. But they sell products that, basically, are just cleansers. I've seen patients who have the cleanest skin in the world and still have acne." the traditionalists

Can you really beat the staples--salicylic acid and benzoyl peroxide? Hmm, maybe. But with so many different formulations on the market (washes, spot treatments, gels, you name it), what's the right choice?

ZAPZVT ACNE WASH, CLEAN & CLEAR PERSA-GEL 10

THE CLAIM: These are just two of the many products that use a combo of salicylic acid and benzoyl peroxide to clear your skin.

THE COST: Zapzyt Acne Wash, $5 for 6.25 ounces; Clean & Clear Persa-Gel, $6 for one ounce

THE VERDICT: Bottom line? Dr. Kaufman doesn't mince words: "As a general rule, this stuff works. Salicylic acid is effective, especially on whiteheads and blackheads. It helps loosen the junk clogging your pores. Benzoyl peroxide is great at reducing inflammation. Simply put, these are the best anti-bacterial products on the market." Dr. Gasiorowski agrees, "All my patients use a salicylic acid wash. The trick is don't scrub--no washcloth! It drives the bacteria down farther and along the hairline. Rinse, and then dab on benzoyl peroxide. Then add a gentle moisturizer, like Cetaphil, right over the zit to combat flakes!"

"Just don't overdo it," says Dr. Polevoy. "You don't want to make a bigger mess out of your face by irritating it. I always tell my patients to start out with the lowest amount of active ingredient and work their way up." in-betweens

Some companies cover all the bases--"We'll give you some stuff, and we'll throw in proven ingredients like salicylic acid and benzoyl peroxide." So do they work? And are they worth all that money?

EPOCH

THE CLAIM: Salicylic acid combined with "ethnobotanicals," like Job's tears, yarrow and burdock, is more effective.

THE COST: $12 for a half ounce

THE VERDICT: Both Drs. Kaufman and Gasiorowski acknowledge that you could be soothed or irritated by these "ethnobotanicals." There's no reliable info, they say. Dr. Polevoy is sure about one thing: "There is no evidence that botanicals work except for claims by the companies that are trying to sell them. Some of these herbs can be astringent. But what's really working here? The salicylic acid." In other words, save your money.

PRO-ACTIV

THE CLAIM: Use all three steps to get clear skin. The cleanser blends benzoyl peroxide with a chemical moisturizer, exfoliator, and chamomile to soothe. The toner is a combo of natural ingredients, like witch hazel, aloe vera, comfrey and chamomile. The repairing lotion? Yep, benzoyl peroxide.

THE COST: $39.95 for the three-step system--a 4-ounce cleanser, 4-ounce toner and 2-ounce repairing lotion

THE VERDICT: "Combining two products like benzoyl peroxide and salicylic acid can be beneficial," says Dr. Kaufman "I have some patients who swear by this stuff. But some haven't been successful and needed more aggressive treatment."

But Dr. Gasiorowski thinks he knows why so many people love Pro-Activ: "They bank on the theory that people don't wash their faces as much as they would unless they are using Pro-Activ. Do I think the stuff works for some people? Yeah, the people who didn't wash their faces twice a day--they get the biggest improvement. And as for the three-step system, just know that toners are baloney--there are no benefits."

Dr. Polevoy has never "seen a study that shows all these extra ingredients work and are, therefore, worth paying for." Still, he admits, "About a third of the kids I know who have used it have been satisfied." For the record, a Girls' Life staffer also uses it...and swears by it.

NATURE'S CURE

THE CLAIM: It naturally clears and prevents acne by working "from the inside out" with a combo of homeopathic tablets and "vanishing cream" (which turns out to be--surprise again--benzoyl peroxide).

THE COST: $11 for a month's supply

THE VERDICT: Dr. Gasiorowski is completely unimpressed with this whole "curing from the inside" concept. "The only things you can do to clear up your skin from the inside are eat a balanced diet, get regular exercise and drink eight glasses of water every day. What's really working in this product is the benzoyl peroxide cream.

Dr. Polevoy is equally unamused: "There is no evidence that herbs taken orally will help clear up acne. I had a girl who came to me for help and, after eight weeks on a prescribed acne medication, she wasn't getting any better. I couldn't imagine why she wasn't improving. I asked her to bring in anything else she might be using. She brought in some herbal supplements, and I looked up the ingredients. These herbs raise the levels of testosterone and iodine, two key aggravators of acne. Once we got her to stop taking the herbals, she cleared up right away."

The prescriptions

You've tried it all. Drug store washes, health food store spot treatments, even fancy three-step systems that cost a fortune. But nothing is working. Face it--it's time to call in the pros. Your dermatologist is the only person truly qualified to help you treat your acne--and the only person who can prescribe one of the heavy hitters listed below. Please note that none of our dermatologists have any affiliation with any of these products.

DIFFERIN

THE CLAIM: Differin penetrates the follicle and loosens up clogged materials. It's also an anti-inflammatory. The downside? You may get a little bit of burning, redness or scaling.

THE COST About $30 for a 15-gram tube

THE VERDICT: Boy, talk about a lovefest. "Differin is very effective for treating blackheads and whiteheads, and even some cystic acne. It's less irritating. Quiets down inflammation. It's great!" says Dr. Kaufman. Explains Dr. Gasiorowski, "The cells lining the hair follicle are very sticky. The oil is supposed to be released via sebum. What Differin and Retin-A do is make the cells no longer sticky, meaning pores won't clog. Plus, you can go out in the sun with this stuff. And Differin now comes in cream and patches, so it's a little less irritating." Dr. Polevoy is just as enthusiastic: "I use this a lot. Good safety profile, not as much problem with the sun. I think this is great stuff."

RETIN-A MICRO

THE CLAIM: This is a less irritating cousin of Retin-A. Unlike regular Retin-A, Micro gradually releases Retin-A to reduce tenderness and soreness.

THE COST: About $36 for a 20-gram tube

THE VERDICT: Only Dr. Gasiorowski has tried the relatively new Retin-A Micro: "I don't like this stuff. It's alcohol-based and was supposed to be less irritating, but I don't like it."

ACCUTANE

THE CLAIM: Accutane decreases the amount of oil produced. Improvements can take up to two months.

THE COST: 100 10-milligram capsules for $622--what a bargain!

THE VERDICT: The good news about Accutane? This product is a highly effective last resort for girls with severe cystic acne. The bad news is that many girls may be steered away from using Accutane because of safety concerns.

Early this year, the makers of Accutane, a company called Hoffman-LaRoche, have listed suicide and depression among the risks of taking Accutane. So what do our docs have to say about the possible risks?

"I put my own kids on this stuff," states Dr. Gasiorowski. "It's a miracle drug that's getting a bad rap. In my 19 years of prescribing this stuff to literally thousands of patients, I've only taken three people off for depression." Dr. Polevoy is also confident: "I use this a lot for severe cystic acne and acne that has resisted other treatments. My gut reaction on all the hype about depression is that it's overblown. I have never seen a depression case in 11 years."

Gizmos

You have your trusty tubes of salicylic acid and benzoyl peroxide. Now, these super-effective ingredients are available in all sorts of new gee-whiz formulations. But do pricey blemish bombs and patches make any impact?

THE CLAIM: Each of these newfangled pimple fighters are based on the notion that by keeping the active ingredients right on the spot, you get more benefits.

THE COST: Jane Peel Out Acne Treatment Gel Patch, $5 for .75 ounces; Biore Blemish Bombs, $6 for 10 .03-ounce packets; Clean & Clear Overnight Acne Patches, $5 for 30

THE VERDICT: Out of all the products we showed him, Dr. Kaufman likes the Biore Blemish Bombs and the Clean & Clear Acne Patches the best. "You can't beat the convenience of the blemish bombs," says Dr. Kaufamn. "It's a fresh packet every time. The best thing about patches? They keep your fingers off your face! A pimple you leave alone heals twice as quickly as one you mess around with."

Dr. Polevoy is also a fan of the Clean & Clear Overnight Acne Patches: "These products are especially helpful for zits in bad spots where other products might not stay, like at the jawline." As for blemish bombs and other gizmos? "Companies like Biore need to come out with new products to keep up revenues. This is just marketing. It doesn't work any better. Same thing with the Jane Good Skin Peel Out acne treatment gel patch--this stuff is just a ploy."