After several years of low-dose Effexor (37. mg every day, sometimes every other day, seemingly all I need), I've developed serious acne--which I've never had before--below my mouth (chin area) and beneath my nose. Red and ugly. I am taking only Effexor and Evista, nothing else in diet or cosmetics is new. I may drop Effexor and see what happens to the acne...it's increasing, and distressing. Impossible to cover up, and people notice and comment.
What an annoying problem! Its unlikely that Effexor is causing this but your gut feeling that it is systemic is probably right. If it were hormonal you would be breaking out along the jaw line more. By the way, you are not being superficial, this type of 'acne' is serious. Of course its going to affect your mood especially when you can't find a remedy. Dermatologists are a weird breed of doctors. They tend to assess and treat things quickly without dealing too much with the patient. So don't be surprised if you feel like they have blown you off. They might not even spend too much time explaining the cause to you, they tend to prescribe things immediately and move on to the next patient. However, I do hope they diagnose you correctly so that you can get some relief. I had some very uncomfortable acne in my 20s and the dermatologist would inject antibiotics into the affected areas. It diminished everything greatly. Please keep me posted as to what happens.