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,” Gynaecological 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.

It has been asserted that masturbation is a frequent or constant cause of acne at puberty. (See, e.g., discussion in British Medical Journal, July, 1882.) This cannot be accepted.  Acne very frequently occurs without masturbation, and masturbation is very frequently practiced without producing acne.  At the same time we may well believe that at the period of puberty, when the pilo-sebaceous system is already in sensitive touch with the sexual system, the shock of frequently repeated masturbation may (in the same way as disordered menstruation) have its repercussion on the skin.  Thus, a lady has informed me that at about the age of 18 she found that frequently repeated masturbation was followed by the appearance of comedones.

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