A high percentage of women with acne vulgaris experience a premenstrual exacerbation. The figures in the literature vary between 27% and 70% (16,17). A study of 400 acne patients found a premenstrual exacerbation in 44% of the cases. Women older than 33 years of age appear to be affected more frequently than younger women between 20 and 33 years of age (18). A comparison of acne lesions in the late follicular phase and the luteal phase found that in the premenstrual phase, 63% of the women studied had an increase of inflammatory acne efflorescences, on average by 25%. In 54% of the women studied, the comedo rate increased by an average of 21% (19).
The definite mechanism of premenstrual exacerbations of acne vulgaris is not known. It is possible that premenstrual skin edema causes a narrowing of the lumen of the ducts of the sebaceous glands, which leads to sebum accumulation and/or to variations in sebum secretion (5,16). Treatment with oral contraceptives with an antiandrogenic component has proved successful, although increased androgen levels in women with acne were found in only some of the relevant studies (18).
Patients with rosacea can also experience premenstrual exacerbation (4). It is possible that the previously mentioned changes in sebum secretion and/or an increased blood supply to the skin in the luteal phase play a pathogenetic role.
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