Sounds like a case of good old hormones to me. I can commiserate. The whole of my life, until two years ago, I have enjoyed clear skin. Then, at age 40, my face erupted like a teen-age boy in puberty. The acne on one side of my jawline looked disfiguring to my eyes, and it didn't help that this was a time I was on the job market for a major career move, and all I could worry about was my jawline full of zits. I was already a vegan for many years, already using no cosmetics but occassionally Bare Essentials, drinking a lot of water, etc. I eat a very clean diet with no sugar, no preservatives/ additives, no caffiene--so none of this was the problem. The dermatologist said the problem was purely hormonal and recommended a drug (I forget the name of it, but it begins with an S) that is successful in clearing acne in perimenopausal women who are producing too much testosterone. It's an excess of testosterone, by the way, that causes hormonal acne in women in their 30's and 40's. I talked to many women who went on this drug, and they testified to its miraculous results. As much as I wanted my clear skin back, I chose not to take it at the time because I was trying to conceive--and one of the possible side effects is feminization of a male fetus (in addition to sprouting facial hair). The drug does work, however, and if you're not pregnant, nursing, trying to conceive, etc., you might check it out. I wish I could remember the name of it. Doctors used to use it to treat high blood pressure. Maybe somebody else out there knows. For some reason, the word "Aldactone" comes to mind. Yes, I think that's it. Much better than Acutane.
But on an emotional note, acne sucks, and I feel for you. The whole thing has been very humbling for me, as I have enjoyed bodily beauty the whole of my life. I am just resigned to riding it out. I've tried everything, and because of the TTC issue/birth defects possiblity, I can do nothing else but wait for nature to take its course. For about three months this fall, my skin did clear up, and I breathed relief, thinking I was free. But low and behold,the rejoicing did not last. After New Years, my skin erupted again (in a matter of three days!), and my jawline is once again a raw battle zone. Oh well, at least I got the job--zits and all.
Best wishes to you, as I know exactly how frustrating this problem can be.
Manmohini