For most of us the dreaded time of the month is hard enough with hormonal mood swings, let alone coping with an onslaught of acne to deal with as well, however this is the reality for a lot of women. Pre-menstrual breakout is a great cause of distress to many women and many have never really found an answer to this type of acne. Around 40% of the adult population suffers from acne and it is increasing[3]. The majority of therapists are not aware that there is in fact an ideal time to do extractions that will minimise the amount of pre-menstrual breakout that occurs.
Chin acne is one of the major spots for hormonal acne to occur. The chin in particular is prone to acne because of its poor skin barrier function [4] signified by the presence of smaller corneocytes and further aggravated by the sebum being transformed into unsaturated free fatty acids [5]. The follicular pore size fluctuates in response to the menstrual cycle [6]. Skin with enlarged pores has a poor skin barrier function [6], more immature para-keratotic corneocytes and sebum richer in unsaturated free fatty acids. The chin and perioral area are prone to inflammation because of the combination of a high density of sebaceous glands and poor skin barrier function.
Skin changes during the menstrual cycle
Women are more susceptible to acne because of higher levels of androgens during the follicular phase of their menstrual cycle [7]. Skin physiology changes during the menstrual cycle: the sebum production increases following the release of oestrogen after ovulation [8], resulting in a higher level of skin lipids and subsequent increase in skin microflora [9]. The barrier function becomes impaired prior to menstruation [9], probably because of the bacterial release of unsaturated free fatty acids disturbing the stratum corneum. It is the reduction in the size of the sebaceous follicular orifice after ovulation that is likely to contribute to the subsequent increase in acne lesions [6].
With the knowledge that the sebaceous follicle constricts like a tourniquet after ovulation, it makes sense to time your facial extractions at the time of ovulation or just before. This is when the sebum is more fluid and the follicle opening is larger and easier to remove comedones. This will help prevent blockage of the pores and subsequent bacterial colonization and inflammation.
Let’s examine what happens to our skin during a menstrual cycle.
Your monthly cycle starts with the first day of your period. The body is producing more of a hormone called prostaglandin which causes contractions in the uterine walls during menstruation. As your period starts, your levels of such hormones as progesterone and oestrogen drop, making you feel emotional.
Prostaglandin increases pain sensitivity. Your skin will be more tender; spots will feel more painful. Prostaglandin makes blood vessels constrict too so you may flush more easily. With less soothing oestrogen in your blood, skin will feel drier and lines or wrinkles appear more obvious.
Estrogen and progesterone levels both fall during the menstrual phase, though secretions of the former start to gradually rise halfway through the phase. The body temperature falls during menstruation, which slows the blood circulation and the metabolism leaving the skin with a dullish appearance.
Sebum secretions decrease and the moisture-retention functions of the skin deteriorate. These changes dry the skin, promote chapping, and make it more difficult to apply makeup. Overall, the skin becomes very sensitive.
Days 8-14
What happens to your body: Your ovaries have restarted production of oestrogen, increasing serotonin levels (the ‘feel good’ hormone) and improving your mood.
Skin may have a better, more even tone, and feel firmer. Oestrogen is plumping up skin cells and encouraging the production of collagen. People don’t get spots at this time. This is the best your skin looks all month. This is the part of your cycle that’s controlled by estrogen. Estrogen works in tandem with progesterone to maintain a delicate equilibrium. Your skin is hydrated and smooth.
Estrogen and progesterone are not only balanced during this time, but our bodies are secreting more of the former now than in other weeks in our monthly cycle. And, miraculously, that can show on our faces. Estrogen receptors are located in the skin, both in the dermis and blood vessels. Since the dermis also contains the cells that create collagen, elastin, and a matrix composed of hyaluronic acid, our skin is more likely to look clear, healthy, and brighter when our estrogen secretion is at its cyclical peak.
Day 12 is the perfect time to have a facial and extractions. It is just before ovulation.
If you are not pregnant, hormone levels start to drop in preparation for menstruation. One hormone, progesterone, does briefly increase. While this can leave some women’s skin calmer, it makes others’ oilier and more spot-prone. That is because progesterone stimulates the production of sebum. As levels rise, the skin swells and squeezes pores shut, leading to a break-out. Testosterone also creates sebum so can aggravate the problem. The risk of skin problems is highest about now. Secretions of sebum rise together with the body temperature, which creates a skin environment favorable for acne and other minor problems. The skin also tends to dull, and pigments in the skin darken.
Stress and irregular lifestyle may aggravate physiological symptoms during the luteal phase. Premenstrual symptoms such as irritability and quick temper tend to appear, and the physical and mental condition may deteriorate for a week or longer.
Between seven to 14 days before the start of our period, our levels of the sex hormone estradiol fall. Meanwhile, our testosterone remains at higher levels than those of the estradiol. This move to more male-prevalent hormones can lead to a more acne-prone complexion, particularly for those with skin that’s more acneic in the first place.
It’s that shift of balance that can lead to increased activity of sebaceous glands and can manifest as oily skin, with an increase in developing acne lesions and oily hair and scalp as well. Furthermore, higher testosterone relative to estrogen and progesterone can spur the clogging of pores during this week.
Days 23 — 28
Excess oil production can continue, especially if you’re more prone to acne at other times of the month. The week before our period our bodies are producing more androgens than at any other time in this cycle. We can also expect larger pores along with that increase in oil production. Your skin will look shinier, and you’ll be more likely to get breakouts, including cystic acne.
There are many health advocates that advocate different care of the skin at different times of the cycle. If you are acne prone you should not spot treat your skin. All of your follicles are prone to acne and should be treated on a daily basis. Given that we know that just before your period your skin barrier tends to be disrupted is when you should focus on barrier repair actives that include ceramides, cholesterol and essential fatty acids.
Research:
1. K. Steventon. Expert opinion and review article: The timing of comedone extraction in the treatment of premenstrual acne – a proposed therapeutic approach. International Journal of Cosmetic Science, 2011, 33, 99–104
2. M, Farage, S. Neill and A. MacLean. Physiological Changes Associated with the Menstrual Cycle – A Review. Obstetrical and Gynecological Survey. (2009) Volume 64, Number 1.
3. Shafer, T., Nienhaus, A., Vieluf, D. et al. Epi- demiology of acne in the general population: the risk of smoking. Br. J. Dermatol. 145, 100–104 (2001).
4. Marrakchi, S. and Maibach, H.I. Biophysical parameters of skin: map of human face, regional, and age-related differences. Contact Dermatitis 57, 28–34 (2007).
5.Tagami, H. Location-related differences in structure and function of the stratum corne- um with special emphasis on those of the facial skin. Int. J. Cosm. Sci. 30, 413–434 (2008).
6. Takada, K., Iida, T., Gozu, Y. et al. Human facial pore area and sebum are affected by the menstrual cycle. Abstract from the 34- th Annual European Society for Dermatological research ESDR meeting in Austria, Vienna, 9 – 11 September 2004.
7. Farage, M.A., Neill, S. and MacLean, A.B. Physiological changes associated with the menstrual cycle. A review. Obstet. Gynecol. Surv. 64, 58–72 (2009).
8. Thiboutot, D. Regulation of human sebaceous glands. J. Invest. Dermatol. 123, 1–12 (2004).
9.
Muizzuddin, N., Marenus, K.D., Schnittger, S.F. et al. Effect of systemic hormonal cyclicity on skin. J. Cosmet. Sci. 56, 311–321 (2005).