Is my skin purging or breaking out?

What points toward purging, acne or irritation?

• An early treatment flare is plausible after starting a retinoid. These vitamin A treatments can make acne worse for a few weeks before improvement.
• Ordinary acne includes blackheads, whiteheads, red spots and pimples containing pus. Oily skincare, greasy moisturizers and hair products can cause or worsen acne.
• Dryness, peeling, redness, burning or stinging can be treatment irritation. Retinoids can cause an inflamed skin reaction as well as an increase in spots.

The appearance of a spot alone cannot settle the question. A dermatologist considers the type and location of the breakouts, and some conditions that resemble acne need different treatment. Treat a new or unusual rash as something to have assessed, rather than assuming it is an expected adjustment. Calling every new breakout a purge gives the product an unusually generous returns policy.16

How long should a purge last?

There is no single countdown for every product or procedure. After a facial, a temporary breakout should settle within one to two weeks. With tretinoin, acne commonly worsens during the first 7 to 10 days; sores should begin improving in two to three weeks, although improvement sometimes takes more than six weeks. Retinol users can still see pimples during the first couple of months.235

A temporary flare settling and an acne treatment reaching its full effect are different milestones. Acne treatment generally takes at least six to eight weeks to produce fewer breakouts, and many treatments take two to four months for their full effect. Topical retinoids can take 12 weeks or longer to show improvement. Persistent worsening deserves a review, not an indefinitely extended waiting period.146

What should I do now?

1. 1Identify the change. Note the product or treatment you started and when the worsening began. Tell your clinician about any new medicines too, because some can worsen acne.
2. 2Check the directions before changing treatment. Tretinoin is usually applied at bedtime in a thin layer over the affected area. Use the prescribed amount and frequency; applying more does not clear acne faster.
3. 3Support the treatment with a gentle cleanser and moisturizer. Do not independently add other acne medicines to a prescription routine. Clinician directed combinations are different from assembling your own.
4. 4Ask about irritation adjustments. Your dermatologist can advise using less medication, applying it less often or applying moisturizer first. Seek advice if irritation continues despite reducing application frequency.
5. 5Protect your skin during the day. With retinoids, use sunscreen offering broad spectrum protection, SPF 30 or higher and water resistance, alongside shade and protective clothing. Avoid picking spots, which can worsen acne and cause scars.

Prescription acne treatment can sit alongside nonprescription cleansers and moisturizers without adding another acne targeting cleanser. An expanding bathroom collection is not the same thing as a treatment plan.7

When should I get medical help?

Contact your healthcare provider promptly for hives, a severe rash or extreme swelling, especially of the lips or tongue. With tretinoin, call your doctor immediately for a rash, hives, itching or pain at the treatment area. Severe or persistent burning, peeling or blistering also needs review. Deep painful lumps, scarring or acne that has not responded to nonprescription treatment warrant an appointment.1457

If you have eczema, discuss retinoids with your clinician because their drying effect can worsen it. If you are pregnant, planning pregnancy or breastfeeding, discuss treatment safety rather than continuing on the assumption that symptoms are purging. Call your doctor if you become pregnant while using tretinoin.45