The mother gave the history that for three years now her teenage daughter had been developing a purplish discoloration of her chin approximately three to five times a year. But now, the episodes were occurring with increasing frequency. The purple chin had appeared just prior to her last three menses. The attacks always came during school hours, and the color gradually faded during the following week. The skin always returned completely to normal.

We turned to the girl. What could she tell us? She described her chin as suddenly turning purple and becoming tender and painful. Her lips became swollen at the same time. Later, her chin was itchy. Steroid therapy, both orally and locally, had given no help. The attacks continued to come.

The daughter was a healthy thirteen year old. All of her blood tests were normal, and when we examined her nothing could be seen on the chin. We asked her to return during her next attack. Three weeks later, just before her menses, her chin suddenly became purple. We saw her five hours later, noting her chin to be diffusely discolored with a light purple color along with some dilated small blood vessels.

The premenstrual flare led us to believe she had a sensitivity to her own female hormones. We knew that progesterone, made by the ovary, reached its highest blood levels just before the menses.