How to tell if your skin is purging

What makes purging more likely?

Start with what changed in your routine. Retinol increases skin cell production and helps unclog pores; acne can look worse during the first couple of months. Tretinoin, a prescription retinoid, also increases new skin cell production and can cause an early increase in acne sores. Retinoids are vitamin A based treatments. These are plausible settings for temporary worsening, rather than a reason to label every reaction to a new skincare product a purge.145

How long should it last?

There is no single timetable across treatments. With tretinoin, acne can worsen during the first 7 to 10 days. Acne sores should improve after 2 to 3 weeks, although improvement sometimes takes more than 6 weeks. Retinol users can still have pimples during the first couple of months. For topical retinoids more broadly, improvement can take 12 weeks or longer. These are treatment timelines, not permission to ignore worsening symptoms until a deadline.146

A facial can bring a temporary breakout as well as freshly treated skin, which is an awkward addition to the spa menu. Breakouts linked to faster cell turnover after a facial should subside within a week or two. That shorter window should not be applied to a retinoid you use at home.2

What should you do now?

1. 1Identify the treatment and when you started it. Compare that timing with its expected early effects rather than assuming that any new product causes purging.
2. 2Follow the package or prescription directions. Tretinoin is generally applied at bedtime in a thin layer to clean, dry skin. Do not use extra medication or apply it more often than prescribed.
3. 3Support your skin with gentle cleansing and moisturizer. Do not scrub while using retinol. For prescription retinoids, ask your dermatologist before changing the amount, frequency or moisturizer order.
4. 4Review other active products. With adapalene, avoid adding another retinoid, exfoliating acids or abrasive cleansers because they can increase irritation. Check with your prescriber before combining tretinoin with other topical medicines.
5. 5Protect treated skin from the sun. Use sunscreen, seek shade and wear protective clothing. The general acne guidance is broad spectrum, water resistant sunscreen with SPF 30 or higher.

When should you stop or get help?

For adapalene, very irritated skin calls for less frequent application or a temporary pause; severe irritation or irritation that does not improve calls for stopping and contacting your doctor. With tretinoin, call your doctor immediately for rash, hives, itching, or pain or discomfort at the treatment area. Report severe or persistent dryness, burning, peeling, swelling or blistering.47

Sensitive or eczema prone skin needs extra caution because retinoids can irritate skin and worsen eczema. In darker skin, irritation can trigger dark marks. Do not use retinoids during pregnancy; discuss breastfeeding with your clinician. Deep nodules, cysts, scarring or continued worsening deserve a dermatologist's assessment rather than an indefinite wait for a supposed purge to finish.567