Acne Purging: Full Dermatologist Guide

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 normal 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 or "skin purging" is when a person's acne condition worsens 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 usual, often more extensive and more inflamed. For example, clogged pores may become active pimples, whereas small pimples may become larger 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 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 to the surface. The pimples and cysts that would otherwise have come to the surface in the coming weeks and months start to come out much more quickly and seemingly all at once....oh, acne, the gift that keeps 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 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 of acne flaring (purging). Acne purging was noted in 15.4% of patients with moderate and 23.8% 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

• Isotretinoin/Accutane
• Facial Exfoliants (scrubs, brushes, enzyme exfoliants)
• Office Treatments (chemical peels, laser treatments, microdermabrasion)

How do you tell skin purging from regular acne breakout?

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 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: 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 the standard, temporary effects of your medication (new breakouts, redness, dryness, etc.) 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.

How do you prevent skin purging when starting a new acne treatment?

Slowly introduce your new acne treatment products into your routine to prevent skin purging or limit a purge's severity. 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 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:

1. 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 essential 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.
2. Use a Clay Mask: A great way to calm down skin purging faster is with specific clay masks. In particular, pink clay masks are effective yet gentle and soothing to the skin, helping draw out impurities and toxins from the surface while providing gentle physical exfoliation and reducing irritation.
3. 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.
4. Choose the Right Cleanser: Make sure you're using (or switching 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.
5. 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.
6. 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, mild treatment cream, which you should apply to the entire area with acne (not just individual pimples). Avoid sensitive areas around the eyes, nose, and lips. Once your skin adjusts to the treatment, you can use the more potent, undiluted cream.

How to get rid of a retinoid purge?

When starting retinoids, getting more pimples, skin dryness, and peeling are common. This retinoid purge is also called a differin purge or tretinoin purge, according to the retinoid used. Retinoid purging is caused by skin exfoliation 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 0.025% combined with niacinamide to protect the natural protective skin barrier will provide a more gradual treatment process, allowing good efficacy with retinoid 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 two 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 use your retinoid.
4. Use a milder retinoid. Retinoids are not made alike. Some retinoids (Tazorac, Differin, Epiduo) are irritating, and other retinoid creams are less irritating and cause less purging.
5. Avoid retinoid gels and use a retinoid cream instead. Gel-based retinoids are more irritating and cause more skin purging.
6. Look for retinol creams that include niacinamide. Adding niacinamide to retinol can help further reduce the redness and dryness associated with retinoid purging.

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 ensure 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 for 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 indicates that things will be getting much better in the coming weeks and months! It requires patience and resilience, but it'll be worth the clear skin just around the corner.

Shop:

MDacne's retinol + niacinamide dual-strength retinol starter kit.
MDacne's Retinol + Niacinamide Kit 60 Days (amazon).
Retinol Treatment System - Perfect Retinol starter kit
MDacne's Benzoyl Peroxide 2.5% Kit 60 Days (amazon).
Benzoyl Peroxide 2.5% (Amazon).
Benzoyl Peroxide 5% (Amazon).
Body Acne Benzoyl Peroxide 5%
Hydrating Acne Cleanser (Amazon).
Oil-free Sunscreen (Amazon).
Acne Supplements for Teen Acne (Amazon).
Acne Supplements for Adult Acne (Amazon).

FAQS:

Q1. What is acne purging?
A1. Acne purging, also known as "skin purging," is when a person's acne condition initially worsens upon starting an effective topical treatment. It can increase breakouts, including larger and more inflamed pimples and pustules.

Q2. What causes acne purging?
A2. The active ingredients in acne treatment products cause acne purging. These ingredients have side effects such as exfoliating the skin, increasing cell turnover, and rapidly destroying acne-causing bacteria. As a result, the upper layers of the skin shed off, pushing sebum, bacteria, and debris to the surface, leading to an immune response and increased inflammation, intensifying breakouts.

Q3. Which acne treatment ingredients cause purging?
A3. The most effective acne treatments, including Alpha Hydroxy acids (AHAs), Beta hydroxy acids (BHAs), retinoids, benzoyl peroxide, and vitamin C, can cause acne purging. Additionally, isotretinoin/Accutane and certain facial exfoliants and office treatments can also trigger purging.

Q4. How can you differentiate between skin purging and a regular acne breakout?
A4. Skin purging occurs when starting a new skincare product or routine with active, medical-grade acne treatment ingredients. Here are some ways to distinguish between skin purging and a regular breakout:

• Timing: Breakouts usually develop when acne is left untreated or improper topical products are used. Skin purging occurs after starting a new skincare routine or product.
• Location: Purging often results in breakouts appearing all over the face simultaneously, while regular breakouts tend to occur randomly in different areas.
• Treatment: With purging, continuing the same treatment but reducing the frequency and amount is recommended. Regular breakouts may require changes in treatment.
• Duration: Purging is temporary and usually lasts up to a month, whereas untreated breakouts can persist for months or even years.

Q5. How can you differentiate between skin purging and an allergic reaction?
A5. Differentiating between skin purging and an allergic reaction is crucial. An allergic reaction may present with tiny, red, itchy bumps and skin swelling. If you experience these symptoms, discontinue product use and consult a skincare professional. On the other hand, skin purging is characterized by an initial worsening of the acne condition upon starting a new treatment.

Q6. How can you prevent or reduce skin purging when starting a new acne treatment?
A6. Gradually introducing new acne treatment products into your routine is best to prevent or minimize skin purging. Here are some tips:

• Modified application: Start with smaller amounts of the treatment cream than directed and apply it every 2 to 3 nights. Increase the recommended amount and frequency as your skin adjusts.
• Avoid harsh products: Refrain from using additional harsh exfoliants, such as scrubs and alcohol-based toners, as the acne treatment products are already exfoliating the skin.
• Use a clay mask: Pink clay masks can help calm skin purging by drawing out impurities, providing gentle exfoliation, and reducing irritation.
• Avoid touching your skin: Touching and extracting pimples can worsen the breakout.
• Choose the right cleanser: Use a mild medicated cleanser with no more than 2% salicylic acid and ensure your skin is completely dry before applying the treatment cream.
• Check cosmetics: Use oil-free and non-comedogenic makeup and sunscreen to prevent clogged pores.
• Dilute your treatment: Combine a small quantity of your treatment cream with an equal amount of moisturizer to create a diluted, mild treatment that can be applied to the entire affected area.

Q7. How can you get rid of a retinoid purge?
A7. Retinoid purging, characterized by increased pimples, skin dryness, and peeling, can be managed effectively. Here are some tips:

• Start with milder retinol: Begin with 0.25% retinol for a gradual treatment process with less redness and dryness. Switch to a higher concentration, like 0.5%, once your skin adjusts.
• Start with a small amount: Apply a tiny amount of retinoid twice a week initially, gradually increasing the frequency over time.
• Apply to dry skin: Wait for three minutes after cleansing to apply retinoid to reduce irritation.
• Opt for a retinoid cream: Cream-based retinoids are generally less irritating than gel-based ones.
• Look for retinol creams with niacinamide: Niacinamide can help reduce the redness and dryness associated with retinoid purging.

Q8. When should you reassess the situation during acne purging?
A8. If the acne purge caused by a new treatment lasts longer than 3-4 weeks, it may be necessary to reassess your treatment and products.

Q9. Is there any reason to be afraid of skin purging?
A9. There is no need to be afraid of skin purging. It is a normal side effect in many people when starting effective acne treatments. Skin purging indicates the treatment is working, and clearer skin is on the horizon. While it requires patience, the temporary intensification of breakouts is usually followed by improvement.

Q10. Are there any additional tips to help with skin purging?
A10. Yes, here are some additional tips:

• Avoid harsh exfoliation: Since acne treatment products already exfoliate the skin, additional harsh exfoliation methods should be avoided.
• Use a clay mask: Pink clay masks can help calm skin purging and provide gentle exfoliation.
• Avoid touching your skin: Touching and extracting pimples can worsen the breakout.
• Choose the right cleanser: Use a mild medicated cleanser with no more than 2% salicylic acid and ensure your skin is completely dry before applying the treatment cream.
• Check cosmetics: Use oil-free and non-comedogenic makeup and sunscreen to prevent clogged pores.
• Dilute your treatment: Combine a small quantity of your treatment cream with an equal amount of moisturizer to create a diluted, mild treatment that can be applied to the entire affected area. Avoid sensitive areas around the eyes, nose, and lips.

References:

Retinoid-Induced Flaring in Patients with Acne Vulgaris

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