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We’ve all had experiences where things get worse before they get better. Unfortunately, this mantra sometimes applies to your acne treatments, too. Some products may worsen your acne, a phenomenon called skin purging, before they clear up your breakouts. But what is skin purging, and why does it happen? Read on to learn more.
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What is skin purging?
Skin purging isn’t really a medical term, but it’s something that can happen with certain skincare ingredients, where the top layer of the skin gets “purged” and new skin in deeper layers comes to the surface faster than it otherwise would. We’re constantly shedding the top layer of skin, but some skincare ingredients speed up this process.
Essentially, skin purging is a process by which 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 (see Important Safety Information), both compounds in the retinoid or vitamin A family, increase the speed of this process (Zasada, 2019). That may be part of what makes these ingredients so effective at improving the appearance of the skin. But when you start using these products, your skin is likely to look worse before it looks better.
What is the skin purging process?
Skin purging forces breakouts beneath the skin to rise to the surface and causes the skin to peel. Of course, 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.
But before you get there, you have to deal with the skin purging process. As those dead skin cells are being shed, all the gunk under them is being pushed to the surface. So a normal skin turnover process that usually takes several weeks is happening more rapidly. And all of the dead cells, oils, dirt, bacteria, etc., that would gradually come to the surface are pushed out much quicker. This can lead to an “acne flare” characteristic of skin purging (Del Rosso, 2008).
For years, dermatologists have used retinoids to treat many skin concerns, from fine lines and skin discoloration to sun damage and even acne. Tretinoin is one of the most commonly used acne treatments and is notorious for its skin purging effect.
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), are powerful skin exfoliators often used in chemical peels and may also cause skin purging (Tang, 2018; Castillo, 2018). So can benzoyl peroxide, a common ingredient in acne-fighting skincare products (Zaenglein, 2016).
What does skin purging look like?
- Whiteheads or closed comedones
- Blackheads or open comedones
- Papules that have small amounts of inflammation
- Pustules that have pus and more inflammation
- Cysts or nodules that are deep areas of infection and inflammation
- Microcomedones or small “pre pimples” that were
- already on their way to the surface
In addition to acne, skin purging can also look like patches of dry skin and skin peeling.
Tretinoin vs. retinol: which is better for your skin?
Skin purging vs. breakouts
If you’ve started a new skincare product and have a sudden bout of irritated skin, it can be challenging to know whether you’re experiencing skin purging or a regular breakout. If you’re unsure, speak to your healthcare provider or dermatologist about the symptoms you’re experiencing—getting to the bottom of the skin issues is important. But before you ditch your new products, let’s dive deeper into skin purging vs. breakouts.
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 (or “acne flare”) also tend to disappear faster than your average zit. Skin purging only lasts about a few weeks (Leyden, 2017).
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, may potentially cause (Leyden, 2017; Yoham, 2020):
- Skin redness or irritation
- Skin that feels warm to the touch
- Increased skin dryness or peeling
- Burning or itching skin
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.
The main difference between blemishes caused by a typical breakout or flare-up and those caused by a skin purge is the length of time you’re dealing with them. Regular acne breakouts take time to form, become visible, and heal. This process typically lasts anywhere from days to weeks, depending on your skin type and the kind of acne breakout. And if left untreated, acne can last for months to years.
There are other possibilities, too. If you’re seeing pimples appear after starting a new product that does not include ingredients that commonly cause a skin purging effect, those bumps may be due to blocked pores from your new cosmetic. Redness and itching may be signs of an allergic reaction to the product. If you suspect this is happening, discontinue using the product and talk to your healthcare provider or dermatologist, who can help you get to the bottom of this sensitivity.
What to do about skin purging
We don’t know the true prevalence of skin purging, but it seems common with several skincare ingredients. If your skin is going through the purging process, the benefit is that clearer skin is right around the corner. Fortunately, there are ways to manage the skin purge.
How to get rid of acne scars
First thing, hands off—no picking or popping any whiteheads, blackheads, or pimples 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 during 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 containing exfoliating acids or retinoids that may cause skin purging generally come in different strengths, and you can use this to your advantage. 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 severe than with a more potent product. You can gradually increase the dose as your skin gets used to the product.
You may also be able to ease some of the symptoms of a skin purge by adding a moisturizer to your skincare routine. 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.
Talk to your dermatologist about easing into your retinoid use. Tretinoin gels and creams come in several different strengths ranging from 0.01% to 0.1%. Many providers recommend starting with a lower dose and slowly increasing the concentration to improve the tolerability and decrease side effects, like skin purging (Leyden, 2017).
While skin purging may seem like a step backward in the road to clearer skin, don’t give up! New, healthy skin is right around the corner.
- Castillo, D. E., & Keri, J. E. (2018). Chemical peels in the treatment of acne: patient selection and perspectives. Clinical, Cosmetic and Investigational Dermatology, 11, 365–372. doi: 10.2147/CCID.S137788. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30038512/
- Del Rosso, J. Q. (2008). Retinoid-induced flaring in patients with acne vulgaris: does it really exist?: A discussion of data from clinical studies with a gel formulation of clindamycin phosphate 1.2% and tretinoin 0.025%. The Journal of Clinical and Aesthetic Dermatology, 1(1), 41–43. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989803/
- Leyden, J., Stein-Gold, L., & Weiss, J. (2017). Why topical retinoids are mainstay of therapy for acne. Dermatology and Therapy, 7(3), 293–304. doi: 10.1007/s13555-017-0185-2. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557478
- Sutaria, A. H., Masood, S., & Schlessinger, J. (2021). Acne vulgaris. [Updated 2021 Aug 9]. In: StatPearls [Internet]. Retrieved on Nov. 2, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK459173/
- Tang, S., & Yang, J. (2018). Dual Effects of Alpha-Hydroxy Acids on the Skin. Molecules, 23(4), 863. doi: 10.3390/molecules23040863. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6017965/
- Yoham, A. L. & Casadesus, D. (2020). Tretinoin. [Updated Dec 5, 2020]. In: StatPearls [Internet]. Retrieved on Nov. 2, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK557478/
- Zaenglein, A., Pathy, A., Schlosser, B., Alikhan, A., Baldwin, H., & Berson, D. et al. (2016). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 74(5), 945-973.e33. doi: 10.1016/j.jaad.2015.12.037. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26897386/
- Zasada, M., & Budzisz, E. (2019). Retinoids: Active molecules influencing skin structure formation in cosmetic and dermatological treatments. Advances in Dermatology and Allergology, 36(4), 392-397. doi: 10.5114/ada.2019.87443. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791161/
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.