Inflammatory Papulopustules in a Young Woman

A 24-year-old Caucasian woman presented with intermittent, inflammatory papulopustules and nodules on the face, neck, chest, and back. The lesions would appear 1 week premenstrually and resolve 1 week postmenstrually with normal menstrual cycles. She has a history of adolescent acne that is only responsive to isotretinoin 6 years ago. Examination revealed scarring and postinflammatory hyperpigmentation diffusely on her face.