When Pre-Period Breakouts Aren't Acne

I've always had pretty good skin, at least when it comes to my face. But in my 30s, I started getting lots of pre-period bumps on my chin, jawline, and neck. They itched and didn’t look like typical cystic pimples. Plus, standard acne treatments — salicylic acid, benzoyl peroxide, retinol — didn’t help.

My regular doctor couldn't figure out what was going on. So I asked for a referral to a dermatologist. When I finally got in — an appointment I had to wait a year for, thanks to lots of pandemic-related rescheduling — I gave her the rundown: I get small, itchy “zits” on my neck and face, and they always show up the week before my period starts and go away a couple days after I start bleeding.

And like I do with every doctor, I told her I have endometriosis. I added that I have other inflammatory issues and weird symptoms that get worse at the same time.

How my doctor helped

First, let's talk about acne, the skin condition that causes whiteheads, blackheads, and the kind of zits you want to pop. As an adult, you can get these blemishes because of changes in your menstrual cycle. Surging hormones can cause you to make more sebum, a naturally oily substance that protects your skin. But too much of it can clog your hair follicles. Bacteria or dead skin cells can also build up in your pores, blocking them and causing inflammation.

I explained my symptoms because I didn’t have visible skin problems at the time. My dermatologist didn’t think I was dealing with acne. Instead, she said it sounded like I had eczema on my face. I told her that made sense, and I admitted to using hydrocortisone on my “breakouts” sometimes, especially on my neck. That’s not a good idea, she warned. Steroids can damage areas where skin is sensitive.

Then she said the words every chronic illness patient longs to hear: I think I have something that can help.

She prescribed me the following:

• Tacrolimus ointment(0.1%): The brand name for this is Protopic. It's an immunosuppressant used to treat skin inflammation, including eczema, which is also called atopic dermatitis. Unlike other treatments, like steroids, it's safe for my face, she assured me.
• Sodium sulfacetamide lotion (10%): This is anti-inflammatory and antibacterial. It’s used to treat acne, rosacea and certain kinds of dermatitis.

My doctor said I could use both drugs if I needed to, waiting an hour between applications. But the tacrolimus works really well by itself. It clears up my bumps pretty much overnight.  That further confirms my hunch that this isn't acne. In fact, I'm pretty sure I have something called autoimmune progesterone dermatitis.¹ But more on that in a later post.

Ask about medication warnings

Long-term systemic immunosuppressant drugs, like the kind you take if you get an organ transplant, can increase your risk of certain kinds of cancer, including skin cancer. It’s not that the medicine makes you sick, but it weakens your immune system’s ability to keep cancer cells in check.

There isn’t any research linking tacrolimus ointment to cancer, but it does come with a warning. It’s something my doctor mentioned, but she wasn’t concerned about it, she told me. That’s because I'm not spreading it all over my body, and I only use it a few times a month.

Your doctor will probably ask you this, but before you try these drugs, tell them if you’re pregnant or plan to get pregnant in the future. That can affect what kind of medicine you can use. And don't take sodium sufacetamide if you have a known allergy to sulfa medication. If you're not sure if you do, ask your doctor about it.