The menstrual cycle and the skin

Abstract

Perimenstrual exacerbations of dermatoses are commonly recognized, yet our knowledge of the underlying pathophysiological mechanisms remains imperfect. Research into the effects of oestrogen on the skin has provided evidence to suggest that oestrogen is associated with increases in skin thickness and dermal water content, improved barrier function, and enhanced wound healing. Research into the effects of progesterone suggests that the presence of various dermatoses correlates with peak levels of progesterone. Dermatoses that are exacerbated perimenstrually include acne, psoriasis, atopic eczema and irritant dermatitis, and possibly also erythema multiforme. Exacerbations occur at the peak levels of progesterone in the menstrual cycle. Underlying mechanisms include reduced immune and barrier functions as a result of cyclical fluctuations in oestrogen and/or progesterone. Autoimmune progesterone and oestrogen dermatitis are the best-characterized examples of perimenstrual cutaneous reactions to hormones produced during the menstrual cycle. In this review, we describe the current understanding of the menstrual cycle, and its effect on the skin and cutaneous disorders.

Neuroendocrinology of the skin

“…Estrogens and estrogen receptors [154] have been implicated in skin pathophysiology as skin disorders are known to worsen during the menstrual cycle [155]. Estrogens may reverse skin aging [156] but may worsen melanoma [157] and possibly neurofibromatosis-1 [158].…”

Autoimmune progesterone dermatitis manifesting as mucosal erythema multiforme in the setting of HIV infection

“…Although the exact pathogenesis is uncertain, APD is likely attributable to direct effects of progesterone on epithelia. The progesterone surge reportedly reduces immune and barrier functions and increases vascularity and sebum production of skin, in some way creating a trigger for dermatitis expression 7 . Progesterone skin testing confirms the diagnosis of APD.…”

Estrogen dermatitis: Case report and examination of estrogen receptor‐β in the skin

“…There are two categories of skin eruptions directly associated with sex hormones, which are stratified based on the intradermal test results: autoimmune progesterone dermatitis (APD) or estrogen dermatitis. 5 Estrogen dermatitis and APD both get worse in pregnancy, but when one has gone through menopause, estrogen dermatitis remits while APD does not. 3 Its etiology is said to be autoimmunity against the subject's own progesterone.…”