Most likely spiro (or other hormonal treatments like oral contraceptives) would work on it. They reduce male hormones (androgens) which are at the center of acne, so I can't see why they wouldn't help. If you haven't had your hormones checked, it's worth getting them looked at. But remember that hormones are a big deal and messing with them is, well, messing with them. It's not something to do lightly. You can talk over the pros and cons with your doc, but make sure you stay fiercely your own advocate.

Also, if you haven't tried The Regimen, that works really well to get that kind of acne under complete control really fast.