I'm 33 and have had severe hormonal cystic acne only on my chin for about 3 years now. My face breaks out twice a month like clockwork when estrogen levels drop (premenstraul and ovulatory phases.) I didn't have acne as a teenager and this is not normal acne. I've tried every topical, antibiotic, and treatment you can think of including blue light treatments. Spironolactone (an aldosterone inhibitor) was prescribed "off-label" by my physician but I was unable to take it due to GI upset. My Endocrinologist suggested Metformin (increases insulin sensitivity) but I'm hesitant to try new medications and have not tried Accutane yet. I'm back on the pill Orthotricylin-low, but hate the side effects. I do try to eat a low glycemic diet and am very careful about screening ingredients in the very few products I use. Gunilla of Sweden mud mask helps, but not enough.

I strongly suspect that PCOS (Polycystic Ovarian Syndrome) is more prevalent than previous medical literature has elucidated. This disorder is characterized by an imbalance in sex hormones (excessive androgens) and insulin resistance. It is associated with abnormal menstraul periods, infertility, acne, hirsuitism, and sometimes centralized weight gain. But many women have atypical or vague symptoms and do not fit all of the criteria.

I'm not a doctor (yet) and not trying to diagnose anyone. I'm simply looking at this problem from an epidemiological perspective and wonder if this disorder is widespread enough to do a large case control or cohort study on causes and interventions. If anyone fits these criteria (even somewhat) and is interested, please let me know.