Menstrual cycle phases and acne flares: A retrospective analysis in Indian women

Acne vulgaris is among the most prevalent dermatological conditions worldwide, exerting a substantial impact on physical appearance, psychological well-being, and quality of life. Although its pathogenesis is multifactorial, hormonal regulation plays a central role, particularly in female patients. Both acne development and menstrual symptoms are influenced by cyclical variations in estrogen, progesterone, and androgens, suggesting a biologically plausible link between menstrual cycle phases and acne flares. However, existing evidence has largely relied on self-reported symptoms or limited population samples, underscoring the need for objective, clinician-assessed data. This retrospective analysis aimed to investigate the association between menstrual cycle phases and acne severity in young Indian women suffering from mild to moderate acne. The study utilized pooled data from two prior clinical trials that originally evaluated the efficacy of topical acne treatments. Importantly, acne lesion counts had been recorded by dermatologists using standardized procedures, providing a reliable and objective outcome measure.

Menstrual cycle timing was determined by calculating the number of days between the participant’s last menstrual period and the clinical visit date. Participants were then categorized into four biologically relevant phases: early to mid-follicular (1–7 days), mid- to late follicular (8–15 days), post-ovulation to early luteal (16–24 days), and mid- to late luteal (>24 days). Global acne counts were cross-tabulated with these phases and analyzed using descriptive statistics and inferential methods to assess between-group differences.

The results revealed a statistically significant increase in acne counts among women assessed during the late luteal phase and early follicular phase, which correspond to the premenstrual and menstrual periods. This increase—averaging 5–6 additional lesions—was observed at the baseline visit following a 14-day washout period, during which participants used a neutral cleanser and adhered to a basic skincare regimen. These findings support the hypothesis that endogenous hormonal fluctuations, particularly declining estrogen and progesterone levels, may exacerbate acne severity during these phases.

Notably, this menstrual phase–dependent variation was not observed during the active treatment phase of the trials. The attenuation of hormonal effects during product use suggests that topical interventions or consistent skincare practices may mitigate hormonally driven acne fluctuations, an observation with important methodological implications.

In conclusion, this study objectively confirms an association between menstrual cycle phases and acne flares in Indian women, with peak severity occurring during the late luteal and early follicular phases. The findings highlight the importance of accounting for menstrual cycle timing in acne clinical trials and routine clinical assessments to avoid confounding treatment outcomes. By integrating endocrinological considerations into dermatological research and practice, this work contributes to more accurate evaluation strategies and improved personalized management of acne in women.