The intimate connection between the skin and the sexual sphere is also shown in pathological conditions of the skin, especially in acne as well as simple pimples on the face. The sexual development of puberty involves a development of hair in various regions of the body which previously were hairless. As, however, the sebaceous glands on the face and elsewhere are the vestiges of former hairs and survive from a period when the whole body was hairy, they also tend to experience in an abortive manner this same impulse. Thus, we may say that, with the development of the sexual organs at puberty, there is correlated excitement of the whole pilo-sebaceous apparatus. In the regions where this apparatus is vestigial, and notably in the face, this abortive attempt of the hair-follicles and their sebaceous appendages to produce hairs tends only to disorganization, and simple _comedones_ or pustular acne pimples are liable to occur. As a rule, acne appears about puberty and dies out slowly during adolescence. While fairly common in young women, it is usually much less severe, but tends to be exacerbated at the menstrual periods; it is also apt to appear at the change of life. (Stephen Mackenzie, "The Etiology and Treatment of Acne Vulgaris," _British Medical Journal_, September 29, 1894. Laycock [_Nervous Diseases of Women_, 1840, p. 23] pointed out that acne occurs chiefly in those parts of the surface covered by sexual hair. A lucid account of the origin of acne will be found in Woods Hutchinson's _Studies in Human and Comparative Pathology_, pp. 179-184. G.J. Engelmann ["The Hystero-neuroses," _Gynæcological Transactions_, 1887, pp. 124 et seq.] discusses various pathological disorders of the skin as reflex disturbances originating in the sexual sphere.)
The influence of menstruation in exacerbating acne has been called in question, but it seems to be well established. Thus, Bulkley ("Relation between Certain Diseases of the Skin and the Menstrual Function," _Transactions of the Medical Society of New York_, 1901, p. 328) found that, in 510 cases of acne in women, 145, or nearly one-third, were worse about the monthly period. Sometimes it only appeared during menstruation. The exacerbation occurred much more frequently just before than just after the period. There was usually some disturbance of menstruation. Various other disorders of the skin show a similar relationship to menstruation.