Hormones and diet can play a role. Dr. Perricone's book about clearing Acne
internally helps but is hard to follow. He basically suggests that anything that causes a raise in your insulin level will break you out. This includes coffee, any kind of sugar, white unnbleached flower fooRAB, chips, all processed fooRAB. Vegetables and lean protein is about all you can eat on this diet. It does work but is hard to follow. I started getting acne in my late twenties..the cystic kind. It was horrible. I finally broke down and was on Accutane for 4 months. I have never had in breakouts again. I think my problem was definitely hormonal.