Expert opinion and review article: The timing of comedone extraction in the treatment of premenstrual acne – a proposed therapeutic approach

Abstract

Synopsis The face is the most exposed part of our body, and deterioration of facial appearance, through disease or ageing, causes psychological distress. Acne lesions and subsequent pigmentation changes contribute to the unevenness of skin colour that is detrimental to facial attractiveness and leads to rejection and stigmatization in our society. The purpose of this review is to look at the root causes of premenstrual acne and, for the first time ever, propose that the specific timing of treatment can, at least in part, resolve the acne lesions. We postulate that it is the timing of the manual extraction that matters in resolving premenstrual acne and that the effectiveness of this therapy could be improved. Based on the reviewed evidence, we propose that it is important to remove the comedones at the time of ovulation, prior to the reduction of the size of the sebaceous orifice and epidermal barrier function, to counteract the onset of increased sebum production, prevent blockage of the pores and subsequent bacterial colonization and inflammation. If performed successfully, the extraction may contribute to a reduction in inflamed acne lesions and thus benefit women by increasing their facial attractiveness, well‐being, social function and thereby decrease psychological stress.

The menstrual cycle and the skin

“…Dermatoses such as atopic and contact dermatitis, psoriasis, acne and even EM and solitary fibrous tumour may be exacerbated premenstrually or perimenstrually . Nearly half of all patients with atopic eczema experience deterioration in their condition in the week prior to the menstruation, with the exacerbation rapidly settling after the onset of menstrual flow .…”

Adult female acne: a new paradigm

“…Mechanical procedures Mechanical procedures include comedone extraction, cautery, hyfrecation and dermabrasion, and intralesional injection of steroids. A recent study in adult females with premenstrual acne found that comedone extraction at the time of ovulation may contribute to a reduction in inflammatory lesions 67 . Dermabrasion is effective for the revision of atrophic acne scars in patients treated with isotretinoin, 68 and also when used in combination with chemical peels 69 .…”

Two cases of genital neutrophilic sebaceous adenitis

“…Because sebaceous gland growth and sebum production are controlled by sex hormones, sebum secretion becomes abundant and Fordyce's spots increase after puberty. While androgens increase sebaceous gland size and sebum production, estrogen and progesterone suppress sebum production . Therefore, sebum production and secretion are altered during the menstrual cycle in women.…”

“…Therefore, sebum production and secretion are altered during the menstrual cycle in women. Increased sebum affects the skin microflora and inflammation may occur subsequently . An exacerbation of acne vulgaris during the late luteal phase is sometimes observed in women .…”