Why does skin purging happen?

Acne develops when hair follicles become blocked with oil and dead skin cells. Retinol increases skin cell production and helps unclog pores, but breakouts can look worse during the early adjustment period. After a facial, faster skin cell turnover can also bring on temporary breakouts. The name sounds like a deep cleaning service, but purging describes an increase in spots, not an extra level of cleanliness.234

How long does the purging phase last?

TreatmentWhat to expect early on
FacialTemporary breakouts should settle within a week or two after treatment.
TretinoinAcne can worsen during the first 7 to 10 days. Spots should improve in 2 to 3 weeks, although improvement sometimes takes more than 6 weeks.
RetinolPimples can continue during the first couple of months, and skin can initially look worse.
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These are different timelines, not one universal deadline. Acne treatment generally takes at least 6 to 8 weeks before you start seeing fewer breakouts. An early flare and the time needed for clearer skin are not the same thing. Avoid booking your first facial just before an event where you want predictable skin.36

Is it purging, irritation or another breakout?

Consider what changed in your routine, rather than treating every new spot as proof that a product works. Purging is a description of increased breakouts, not a five star review for the bottle. Retinoids can cause dryness, peeling, redness and burning as well as early acne worsening. Those symptoms need attention as irritation, not just patience with spots. Greasy skin or hair products can contribute to acne, and some conditions that resemble acne need different treatment.256

What should you do during purging?

  • Wash gently twice a day, remove makeup at night, and avoid scrubbing or picking spots. Picking can cause scars.
  • Support treatment with a gentle cleanser and a moisturizer labelled noncomedogenic, meaning designed not to clog pores. Avoid adding another acne treatment to a prescription routine without checking with your prescriber.
  • Follow the product directions. For cosmetic retinol, patch test a small area first; general starting guidance is a thin, pea sized layer at bedtime every other day for the first couple of weeks, followed by moisturizer.
  • Use prescription tretinoin exactly as directed, usually daily at bedtime. Apply a thin layer to clean skin, let the skin dry as directed, and keep the medicine away from eyes, mouth and sunburned or eczema affected skin.
  • Protect your skin with shade, clothing and sunscreen. For retinoid users, choose broad spectrum, water resistant sunscreen with SPF 30 or higher.
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If a prescribed retinoid irritates your skin, ask your dermatologist about a smaller amount, less frequent use or moisturizer before application. Make those changes with their help. Sensitive skin needs particular care with retinol. Do not start topical retinoids during pregnancy or breastfeeding; discuss alternatives with your clinician.467

When should you get medical help?

Do not push through hives, a severe rash or extreme swelling as purging; seek medical help promptly. With tretinoin, call your doctor immediately for rash, hives or pain at the treated area, and report severe or persistent burning, peeling or blistering. See a doctor for deep painful spots, scarring, hot swollen skin, acne that is not improving with treatment, or breakouts affecting your mental health.125

Where this answer comes from

  1. 1Prescription Skin Caremy.clevelandclinic.org
  2. 2Acnenhs.uk
  3. 3Facials: What Are They, and What Do They Really Do?health.clevelandclinic.org
  4. 4Retinol: Cream, Serum, What It Is, Benefits, How To Usemy.clevelandclinic.org
  5. 5Tretinoin Topical: MedlinePlus Drug Informationmedlineplus.gov
  6. 6Acne: Diagnosis and treatmentaad.org
  7. 7Acnerightdecisions.scot.nhs.uk