Is skin purging normal?

Why does purging happen?

Retinol and tretinoin increase production of new skin cells and help unclog pores. During the early adjustment period, spots can temporarily increase rather than disappear. Faster skin cell turnover after a facial can also lead to a short breakout. Facials combine cleansing, exfoliation and moisturizing, so the appointment is more than outsourcing a face wash.123

A breakout after a new product is not automatically evidence that the product is working. Skin and hair products can cause acne, and switching acne treatments every week can irritate skin and cause more breakouts. The product you started and the symptoms you develop matter more than the name you give the reaction.4

How long should purging last?

Early worsening and the time needed for a treatment to work are different things. Topical retinoids, vitamin A medicines applied to the skin, can take 12 weeks or longer to show improvement. That is not a reason to ignore steadily worsening acne or significant irritation for 12 weeks.5

Is it purging or irritation?

Extra pimples during early retinol or tretinoin use can fit temporary worsening. Dryness, redness, peeling, burning and stinging are also recognized side effects, not signs that more pimples are being cleared. Retinoids can cause irritant dermatitis, meaning inflamed skin from irritation, and can worsen eczema. Irritation does not usually mean you are allergic, but an allergy is possible.356

What should you do while your skin adjusts?

1. 1Cleanse gently. Wash twice daily with a gentle cleanser, pat dry and avoid scrubbing. Do not pick or squeeze spots, which can cause scars.
2. 2Use the treatment as directed. For cosmetic retinol, follow the package directions; general starting guidance is a pea sized, thin layer at bedtime every other day for the first couple of weeks, followed by moisturizer.
3. 3Keep prescription instructions separate. Tretinoin is generally used daily at bedtime on clean skin, allowed to dry as directed. Apply a thin layer and keep it away from eyes, mouth, nose corners, sunburn and eczema. Ask your prescriber before changing the amount, frequency or moisturizer order.
4. 4Protect treated skin. Use sunscreen with UVA and UVB protection, SPF 30 or higher and water resistance, alongside shade and protective clothing.
5. 5Avoid adding extra acne medicines on your own. With tretinoin, discuss other topical medicines, including benzoyl peroxide and salicylic acid, with your doctor before combining them.

Choose moisturizer, sunscreen and makeup labeled "noncomedogenic," meaning formulated not to clog pores, which is a more useful job description than a glamorous bottle. These products avoid causing breakouts in most people.47

When should you get help?

Contact your prescriber if tretinoin causes severe or persistent burning, peeling, swelling or blistering. Call immediately for a rash, hives, or pain at the treated area rather than continuing under the assumption that it is purging.3

See a doctor for deep or painful spots, scarring, acne that is not improving with treatment, or breakouts affecting your mental health. Hot, swollen and red skin also needs medical assessment; redness can be harder to see on brown and black skin.7

If you are pregnant, planning pregnancy or breastfeeding, speak to your clinician before using retinoids. Some topical retinoids must not be used during pregnancy. If you become pregnant while using tretinoin, call your doctor.35