Period Face: the dermatologist’s advice on ‘the big spot’

You know the drill. You wake up feeling more tired than usual and strangely anxious. You head to the bathroom mirror, and there it is on your chin – Mount Spotsuvius. A huge red or darkened mound. Hot, throbbing and swollen. It declares obnoxiously that your period is about a week away. These aren’t your ordinary type of spot.

They have no obvious head, are much more painful and swollen, and appear to be deep in the skin. Google is loaded with advice on how to deal with them. Too much, in fact. So I went to US-based expert dermatologist Dr Ranella Hirsch for professional advice. You’ll find Hirsch on Instagram @ranellamd, a comforting source of frank information, skin education and humour. According to her, this kind of breakout is directly related to our hormones. “Since it has to do with the menstrual cycle, it’s thought to be because increased hormones at the latter part of the cycle (which is mainly progesterone preparing the uterine lining for a theoretical fertilisation/pregnancy) increase oil production.”

If you suffer with these sorts of breakouts every month, it’s nothing to be dismissed. They can be painful, leave pigmentation scarring behind, and do qualify as acne. While you can use over-the-counter products to treat them if you just get the occasional one, prevention is more complicated. Hirsch says, “Your dermatologist can help — we have a couple of approaches we take with medications to work around the monthly cycle.” She also recommends speaking to your GP “about contraceptive options that can be helpful if what you are using is contributing and you want to consider alternatives”.

Once you wake up with a spot of this kind, the urge to pick will be overwhelming. Unsurprisingly, Hirsch strongly recommends to refrain. “Picking is among the worst things you can do.” These types of spots “are deep-seated and ripe for infection once opened”. She advises that “the spots we pick and prod at tend to be the ones with resistant prolonged redness and pigmentation after a lesion”. She also advises using sun protection while the blemish heals. I wanted to know what Hirsch herself does when she wakes up with one of these horror spots on her chin. “I don’t get them often enough to be on medication for them,” she says, “but when I do get them, I take one of two approaches. If it’s especially painful, a tiny dose of diluted steroid will help shrink it greatly (we do this frequently for brides).” This involves a dermatologist injecting the spot itself as a quick-fix (a prospect as horrifying as it is thrilling). “Darted pimple patches are wonderful because they both deliver the active ingredients and help allay the temptation to pick.”