A 39-year-old woman self-referred to a dermatology practice for evaluation of a skin condition that had been present since puberty, waxing and waning, often paralleling her menstrual cycle.
According to the patient, the condition involved the frequent appearance of “boils,” painful lumps, and constant irritation in the affected areas. She was also distressed about having so many “blackheads” in her axillae and on her chest.
A similar condition had affected other family members, all women, all beginning at puberty.
This patient had been treated with topical retinoids, topical antibiotics, and oral antibiotics, to no good effect.
The patient reported a 15-year history of smoking.
What's your diagnosis?