For the past 3-4 years this patient complained of an acne like break out occurring in the lower right hand side of her chin. The lesions would last all winter long and she noticed that every year they were appearing earlier (by September this year) and retreating later.

The lesions seemed to have started around the time her husband had developed Hodgkins lymphoma. An obviously stressful event that lead to increased responsibility as a care giver.

On examination, I noticed many raised red papules with no pustular head that were not painful to palpate. I could not see much evidence of commedones (white or blackheads) and noticed that the border around her lips (vermillion border) was spared. She explained that this area was always clear. I could see little evidence of scaling.

I diagnosed Perioral Dermatitis with the probable cause being from the stressful events happening at the time.

In Chinese medicine the main syndrome responsible for this type of skin problem is that of Liver Qi stagnation leading to depressed heat and blood stasis. Emotional upset can stagnate the free flow of the liver Qi which allows for heat to be generated. This heat flows upwards to the face, manifesting as red papules. This heat was also manifesting as early spotting before the onset of menstrual flow, increased thirst, raised night time temperatures, and a wiry, strong, and slightly rapid pulse.

I prescribed a herbal formula based on the principles of coursing the liver, rectifying Qi, clearing heat, and invigorating blood.

Within two weeks of treatment a significant reduction in her outbreak was noticed. Her menstrual cycle that month was also free of early spotting. I photographed her skin again at 8 weeks, where it was obvious that her lesions were more than 95% better. She was very happy with the out come.

From this case I would like to point out the importance of analyzing the menstrual cycle while observing the skin. In Chinese medicine both are related because both are related to the flow of the blood and the health of it. Very often I see women with a history of a stressful event come in with early spotting or shorter cycles while manifesting some type of skin problem. One of the first patterns I think of in these situations is heat in the blood causing the blood to move recklessly.