Premenstrual Acne

Abstract

A variety of distressing symptoms occur in many women just prior to menstruation. Nervousness and irritability (premenstrual tension) are often attributed to psychological influences. Objective changes also occur, such as weight gain and breast enlargement. These are not so easily passed off as having an emotional origin. Similarly, premenstrual exacerbation of acne is a genuine phenomenon, experienced by at least one third of patients. Typically, the woman notices an increase in papulopustules about a week or so before menstruation. These spring up rapidly and, like all other inflammatory lesions, are due mainly to the rupture of invisible closed comedones (microcomedones). The phenomenon is most evident in comparatively mild papulopustular acne, far less so when numerous deep-seated papules are present. An outcropping of five to ten pustules more or less regularly every month is bound to be noticed, though the overall effect may not strike an outside observer. Some physicians have even doubted the existence of premenstrual acne. Although lesion counts rarely increase greatly, the fixed rhythm of the process can scarcely be overlooked. Fingering the lesions owing to heightened tension is not the cause, though it may of course intensify the reaction. Indeed, there is no good explanation for the peculiar periodicity. There are unproved and, we believe, false claims that sebum secretion varies with the menstrual cycle, the increase occurring at just the right time to explain the flare. Othe rs have been persuaded that free fatty acids in the surface lipids increase at this time. It is exceedingly unlikely that the amount or composition of sebum is affected by the menstrual cycle. Even so, such changes would not explain a sudden outcropping of inflammatory lesions.