I work at a place that just recently clamped down on this. We decided to normalize the emails so that we have a column in the db like "email" and then also "normalized_email" where normalized_email has a unique key on it too. This way, people can still make their email look like whatever they want, but they also only get 1 per email inbox.
This was all because people were doing abuse more easily by churning lots of accounts while only needing 1 gmail address. Plugging this gap was a huge deal for us in reducing card testing problems.