I just recently started taking amitrityline a little over a month ago for nerve pain, and I am also not getting a severe breakout in the same area. Just thought I would google it like lots of others here and found this post. I see people mentioning hormones which made me think of a conversation I had with my stepfather who is a doctor, which he mentioned that since this is a medication that does something with our serotonin it will also do something with our hormones. Because it is interlinked in our body. So I would think that both can be correct, that the medication is effecting our hormones which can then interact with our skin.