When starting a new acne treatment, things can sometimes worsen before they get better... a phenomenon loving referred to as “acne purging.” This initial purge doesn’t happen for everyone —just an “extra lucky” group of us—but it is a totally normal thing for roughly 20-25% of people who start a new, medical-grade acne treatment.
What exactly is skin purging, why does it happen, and what can you do to reduce it? Read on for dermatologist insight and recommendations.
What is acne purging?
Acne purging or “skin purging” is when a person’s acne condition seems to get worse when they begin an effective topical treatment. This can mean more pimples popping, sometimes even in new areas. These breakouts can also be more intense than normal, often larger and more inflamed. For example, clogged pores may turn into active pimples, whereas small pimples may turn into larger pimples or even pustules.
What causes acne purging?
The active ingredients in acne treatment products have several “side effects” that can initially cause the acne to get worse while before producing the expected improvement, including;
- Exfoliation of the skin
- Increased cell turnover
- Rapid destruction of acne bacteria
Your new products are essentially causing the skin's upper layers to shed off while “pushing” all the gunk, sebum, and bacteria in your skin out to the surface. The pimples and cysts that would otherwise have come to the surface in future weeks and months start to come out much more quickly and seemingly all at once....oh, acne, the gift that keeps on giving!
Together, the effects trigger an immune response in your skin—essentially an overreaction of the body to “send help” to the skin. This causes an increase in inflammation, which intensifies the new and existing breakouts. Purging is more common in people with severe and cystic acne.
Which acne treatment ingredients cause purging?
Unfortunately, the most effective acne treatments (below) can cause acne purging. If you’re one of the 25% of acne-prone individuals also prone to breaking out when starting a new acne treatment, you’ll likely experience some degree of skin purge regardless of what new skincare routine you use.
One study found that tretinoin, a prescription topical retinoid is a common cause for acne flaring (purging). Acne purging was noted in 15.4% of patients with moderate and 23.8% of patients with severe acne that started tretinoin.
Topical acne treatments that can cause acne purging:
- (AHAs) Alpha Hydroxy acids (ex. glycolic acid, mandelic acid)
- (BHAs) Beta hydroxy acid (ex. lactic acid, salicylic acid)
- Retinoids (ex. retinol, tretinoin, adapalene, tazarotene, retinyl palmitate)
- Benzoyl Peroxide
- Vitamin C
Additional acne treatments that can cause acne purging
- Facial Exfoliants (scrubs, brushes, enzyme exfoliants)
- Office Treatments (chemical peels, laser treatments, microdermabrasion)
How to tell skin purging from regular acne breakout?
There are a few ways to tell the difference between a regular breakout and skin purging (check out the Zoe Report's article, "Skin Purging & Breakouts Are Different Beasts")
When they Occur: Breakouts usually develop under the following circumstances:
- Lack of acne treatment: when a person has acne but is not treating it with effective, acne-treatment medications
- Improper acne treatment: when a person uses the wrong topical products (often “home remedies” or “natural” products!), which clog the pores and make the acne condition worse
Skin purging is different. It happens when you start a new skincare product or routine that includes active, medical-grade acne treatment ingredients such as benzoyl peroxide, retinoic acid, and/or salicylic acid.
Location: Pimples from an acne “purge” tend to show up all over the face at once (yay!), whereas regular breakouts show up seemingly “randomly” on different areas of the face.
Treatment: Treatment of regular breakouts vs. breakouts from a purge is also different. With skin purging, it is recommended to continue with the same treatment reducing frequency and amounts (more tips below!). It is usually an indicator that an acne treatment needs to be added or changed with regular acne breakouts.
Duration: So here’s the good news about acne purging—it’s temporary! This initial breakout—while intense–usually does not last beyond a month, at which point things should begin to improve. However, regular, untreated breakouts may last for several months or years.
What is the difference between skin purging and an allergic reaction?
So, how can you tell the difference between normal, temporary effects of your medication (new breakouts, redness, dryness, and ) and a more serious allergic reaction? One indicator of an allergic reaction is the appearance of tiny, red, itchy bumps and/or swelling of the skin. If you experience these effects, stop using your products immediately and contact your skin care provider for more details. MDacne users can reach out to a dermatologist in the MDacne app for support at any time.
How to prevent skin purging when starting a new acne treatment?
If you want to prevent skin purging or limit a purge's severity, make sure you introduce your new acne treatment products slowly into your routine. This is true of other skincare products for most skin conditions! Slow and steady usually wins the race.
Modified Application: The “slow and steady” advice is essential for topical acne treatment creams (usually left on overnight). Start with smaller amounts of the cream than directed and apply it every 2 to 3 nights. As your skin adjusts to the treatments, gradually increase the recommended amount and application frequency.
How to reduce skin purging?
If you’ve just started a new topical treatment and you feel like you see more breakouts, don't worry! This is totally normal.
The dermatologist guidelines for acne care suggest that patients with initial acne flare-ups should continue the treatment as this effect is a sign that improvement is pending. It may be counter-intuitive, but the best way to reduce skin purging is to continue with the same acne treatment. However, one way to help calm this effect is to follow the advice above, reducing the application amount and frequency.
Additional tips to help with skin purging:
- Avoid Harsh Products: While it’s commonly advised to exfoliate your skin to get rid of dead skin cells and increase cell turnover, it's important to realize that your acne treatment products are already doing this! Adding additional harsh exfoliation (such as scrubs, electric cleansing brushes, and alcohol-based toners) is typically excessive and over-irritating.
- Use a Clay Mask: A great way to calm down skin purging faster is with certain clay masks. In particular, pink clay masks are effective yet gentle and soothing to the skin, helping draw out impurities and toxins coming to the surface while providing gentle physical exfoliation and reducing irritation.
- Don’t Touch: Do not touch your skin! Touching your breakouts to “see if they’re still there” (we’ve all done it…) as well as manual extraction of comedones (blackheads and whiteheads) are sure-fire ways to make your acne breakout even worse. Just don’t touch.
- Choose the Right Cleanser: Makes sure you’re using (or switch to) a mild medicated cleanser with no more than 2% Salicylic Acid. Any stronger will be too irritating and no more effective. Ensure your skin is completely dry after cleansing before applying your treatment cream.
- Check Your Cosmetics: Ensure that your makeup and sunscreen are clearly labeled “oil-free” and/or “non-comedogenic” to ensure they do not contribute to clogged pores.
- Dilute Your Treatment: Depending on which type of acne treatment cream you’re using, a good rule of thumb is to combine a small quantity of your treatment cream (pea size) with an equal amount of moisturizer in your palm. This will result in a diluted, more mild treatment cream, which you should apply to the whole area with acne (not just individual pimples). *avoiding sensitive areas around the eyes, nose, and lips. Once your skin begins to adjust to the treatment, you can work up to the more potent, undiluted cream.
How to get rid of a retinoid purge?
Getting more pimples, skin dryness, and peeling are common when starting retinoids. This retinoid purge is also called differin purge or tretinoin purge, according to the retinoid used. Retinoid purging is caused by exfoliation of the skin caused by higher amounts of retinoids and the skin's immune system's reaction to dead skin cells' fragments.
Fortunately, retinoid purging can be eliminated or at least minimized.
1. Our skin needs time to adjust to retinoids. A milder retinol 0.25% will provide a more gradual treatment process, allowing good efficacy with retinoids purging without significant redness and dryness. When the skin adjusts to the milder retinol, one can switch to retinol 0.5%.
2. With all types of retinoids, treatment should start with a tiny amount twice a week. After 2 weeks, when the skin adjusts to the new retinoid, the frequency can be increased every two days and after 2-4 more weeks to every night.
3. Retinoids are less irritating when applied to dry skin. Wait 3 minutes before you apply your retinoid.
4. Use a milder retinoid. Retinoids are not made alike. Some of the retinoids (Tazorac, Differin, Epiduo) are irritating, and other retinoic acid 0.025% and retinol are less irritating and cause less purging.
4. Avoid retinoids gels and use a retinoid cream instead. Gel-based retinoids are more irritating and cause more skin purging.
5. Look for retinol creams that include niacinamide. Adding niacinamide to retinol help can help further reduce the redness and dryness associated with retinoid purging.
MDacne's retinol + niacinamide dual strength retinol starter kit.
When to reassess the situation?
If the acne purge that started with your new treatment lasts longer than 3-4 weeks, it could indicate that your treatment and/or products need some updating. If you’re seeing a dermatologist, book a follow-up consultation before making any changes to your routine. One of the benefits of the MDacne treatment is that users can follow-up with their dermatologist (free of charge) at any time to make sure they’re on the right track and see what can be done to ensure they get the best results.
A final note about acne purging
There is no reason to be afraid of skin purging. It is a normal side effect that happens to many people when starting even the best acne treatments.
Purging is like cleansing the pipes—a lot of gunk can come up before things start to clean and clear. While frustrating and disheartening, this tends to indicate that things will be getting much better in the coming weeks and months! It requires some patience and resilience, but it’ll be worth the clear skin that’s just around the corner.
Retinoid-Induced Flaring in Patients with Acne Vulgaris
To find the right acne treatments for your unique skin, take the free skin assessment by clicking here.