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Retinoids are the bell-bottoms of skincare: they’ve been around since the 1960s, have flattering effects for a diverse range of bodies, and are back—big time. Tretinoin, which belongs to this same drug family along with retinol (vitamin A), has been used by dermatologists since the 1960s to treat many skin concerns, from fine lines and skin discoloration to sun damage and even acne.
But though retinoids are the golden child du jour of the beauty industry, tretinoin comes with a not-so-sunny side effect: skin purging. It’s so notorious for this, in fact, that people refer to it by the more specific name: tretinoin purge.
- Skin purging is a process that happens with certain skincare ingredients. The skin often looks worse before it looks better.
- Skin purging often includes increased breakouts, redness, and dryness.
- Certain ingredients like retinoids, including tretinoin, and hydroxy acid exfoliants, are known to cause this effect.
- There are no studies on skin purging, but there is plenty of anecdotal evidence of it happening.
- There are several ways to manage the symptoms of a skin purge until it resolves.
What is skin purging?
Essentially, skin purging is a process by which your skin looks worse before it looks better. Often experienced when beginning a new skincare product, skin purging is a reaction to an active ingredient, so it only happens with specific products.
Certain skincare ingredients increase epidermal or skin cell turnover—the time it takes for your body to produce new skin cells at the bottom layer and shed old, dead skin cells at the topmost layer. Retinol and tretinoin both increase the speed of this process (Zasada, 2019).
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This process can force breakouts that were forming beneath the skin to the surface and cause skin peeling. But no one would go through this if the end result wasn’t worth it. The layers of skin underneath those being shed look younger—they’re newer cells, after all—and may have a more even look and texture.
A naturally-occurring pigmentation in our hair, skin, and eyes called melanin may cause hyperpigmentation when too much is produced. Tretinoin also disperses melanin, which may treat hyperpigmentation and lighten the skin. Of the retinoids, tretinoin specifically is known for causing this breakout, which is why it’s referred to by name as a tretinoin purge. That’s because tretinoin, a type of retinoic acid, is about 20 times more powerful than retinol (Zasada, 2019).
But retinoids aren’t the only products that can cause these skin concerns. Hydroxy acids, such as alpha hydroxy acids (AHAs) and beta hydroxy acids (BHA), which are powerful skin exfoliators, may also cause skin purging. So can benzoyl peroxide, a common ingredient in acne-fighting skincare products.
Skin purging may push a wide range of types of acne like whiteheads, blackheads, papules, pustules, cysts, and microcomedones that were already forming to the surface—as well as skin peeling and patches of dry skin.
Skin purging vs. breakouts
If you’ve started a new skincare product and have a sudden bout of irritated skin, it can be difficult to know whether you’re experiencing skin purging or a normal breakout. But getting to the bottom of the skin issues is important. If your new skincare routine is leading to acne, you may want to ditch the products you added.
Skin purging, on the other hand, may be a sign of smoother, clearer skin to come. We’ve broken down what to expect with each, though if you’re unsure, you can always speak to your healthcare provider or dermatologist about the symptoms you’re experiencing.
Irritation caused by skin purging generally happens where you typically break out, not in new areas. Any inflammatory or non-inflammatory acne bumps pushed to the surface by this increased cell turnover also tend to disappear faster than your average zit. Knowing the active ingredients of any new skincare products you use will also help narrow down the cause of any skin concerns. Tretinoin, for example, is known to potentially cause:
- Redness or peeling of the skin
- Skin that feels warm to the touch
- Increased dryness of the skin
- Burning or itching of the skin
- Skin lightening where applied
Not everyone will experience all of these potential side effects. People with sensitive skin may experience more of these side effects of tretinoin than others. But knowing what to look for with active ingredients such as retinoids, AHAs and BHAs (such as glycolic acid and lactic acid), and benzoyl peroxide can help you understand what’s happening to your skin.
Although we now use the terms “skin purging” and “tretinoin purging,” what we’re talking about is redness, irritation, peeling, and breakouts or “acne flares,” and these things are well-documented. Past studies on the efficacy of retinoids such as tretinoin have noted all of these side effects of this topical treatment.
In fact, as early as 1995, researchers investigated low-dose tretinoin treatments in order to provide the same skin improvements with fewer of the adverse effects because tretinoin specifically has long been associated with breakouts during the first few weeks of use (Mukherjee, 2006; Del Rosso, 2008).
The main difference between blemishes caused by a normal breakout or flare up and those caused by a skin purge is the length of time you’re dealing with them. Normal acne breakouts take some time to form, come to a head (if it’s that kind of zit), and heal. This process normally lasts anywhere from eight to ten days: four to five days for the blemish to fully form and another four to five days for it to heal and disappear.
But there is another possibility here. If you’re seeing pimples appear after starting a new product that does not include ingredients we mentioned that commonly cause this purging effect, those bumps may be due to this product causing blocked pores. Redness and inflammation may be a sign of an allergic reaction to the product. If you suspect this is what’s happening, discontinue using the product and talk to your healthcare provider or dermatologist who can help you get to the bottom of this sensitivity.
How to manage skin purging
We don’t know the true prevalence of skin purging, but it does seem to be common with several skincare ingredients. If your skin is indeed going through the purging process, clearer skin is right around the corner—but you need to make sure you don’t make the blemishes any worse while they’re around.
That means hands off—no picking or popping any whiteheads, blackheads, or pustules that appear. You should also avoid any harsh ingredients in your skincare routine, even if you’ve been using them for some time. If, for example, you start tretinoin, using your AHA exfoliating acid could irritate the skin further doing a tretinoin purge, even if it previously didn’t bother your skin. You should also avoid chemical peels or acne treatments with chemicals that may further irritate the skin like salicylic acid or benzoyl peroxide.
Products that may cause skin purging due to exfoliating acids or retinoids generally come in different strengths, and you can use this to your advantage. If you’re using an AHA or BHA, try starting with a lower strength product only a couple of times a week. Even if it causes skin purging, the reaction may be less serious than it would be with a stronger product.
You may also be able to ease some of the symptoms of a skin purge by applying a moisturizer. Just be sure to use a non-comedogenic product (those that don’t use oils) if you already have oily skin to avoid increasing sebum production and potentially worsening clogged pores.
You can also talk to your dermatologist about easing into your retinoid use. Tretinoin gels and creams come in several different strengths: 0.01%-0.1%. Most research has been done on 0.05% concentration products, but one study found that both 0.05% and 0.01% concentrations significantly improved photodamage of the skin after 48 weeks (Olsen, 1997).
Starting at a lower dose and slowly increasing the concentration has also been studied. Wrinkle size and skin texture both improved for participants of a study in which researchers started them on 0.01% tretinoin before transitioning to 0.025% and finally 0.05% (Caputo, 1990).