Tretinoin is a complete anti-aging, anti-oxidant powerhouse. But sometimes, in the beginning, usually when used in anti-acne, some sort of purging may occur. Irritation is “expected” for a while. It is not something to be scared of or be highly concerned about.

• What is the tretinoin purge?
• What does the tretinoin purge look like?
• How long does the tretinoin purge last?
• Does everyone purge?
• What to do when purging?
• Is it time to quit tretinoin?
• If I stop using tretinoin, will I purge again if I discontinue and then restart it?
• Final thoughts

What is the tretinoin purge?

Utterly new to tretinoin? Read our guide on tretinoin first!

To understand purging, you need first to understand the skin cycle. The ELI5 version is that the organ generates new cells from the inside out to replace older cells that slough off, called turnover. For adults, the process is roughly six weeks.

When you’re a child, your skin generates new cells more quickly, which is one primary reason kids are blessed with great skin and heal more rapidly from injuries.
Retinoids accelerate the skin cycle, generating new cells more quickly, and your skin has an enhanced ability to heal. However, this also means the acne cycle (impurities and bacteria underneath your skin coming to the surface as acne) accelerates. Typically, it may take a few weeks for the acne lesion formed in your skin to make its way to the surface and show up on your skin. So, purging is a phenomenon by which acne lesions that were already formed in your skin make their way to the top of your skin faster than they usually would. The process gives the impression that you are getting new acne when you just get rid of old ones more quickly. If purging is bound to happen to you, it cannot be avoided, nor should you want to avoid it because you’re just dealing with your existing problems faster.

A purge is, by its definition, a one-time thing. By the nature of its physiology, purging will usually last only for 6-8 weeks and will usually appear only on your usual breakout locations. If you’re getting new waves of acne in places you usually didn’t have them, or if that acne lingers or keeps coming again and again, that is likely not a purge. There is no “purging for six months” or “second, third, sixth, etc. wave of purging.” That would likely be a consequence of irritation.

This does not mean that tretinoin will bear its full effects in 6-8 weeks. You can still get acne after that period like you used to, but it would most likely not be considered a purge. However, once tretinoin shows its full effects after about six months and your skin’s structure gets in order, it is vital to maintain those effects and continue using it. After that, some people never have acne again, and others have a reduced amount. It’s all individual.

What does the tretinoin purge look like?

A purge should not be more than a 20% increase in breakouts. Closed comedones often surface, making it feel like your skin is getting much worse.

How long does the tretinoin purge last?

It can last anywhere from a few days to 6-8 weeks. The purge should only be a 10-12% increase in your existing acne [1]. If your purge is worse than that or lasts longer than 6-8 weeks, it is probably not a tretinoin purge and is irritation instead.  You may be sensitive to an ingredient in your tretinoin formula, but you’re far more likely using it too often. You can check up with your dermatologist to discuss your best plan, changing the formulation, or changing the regimen.

Ideally, you shouldn’t deal with much irritation once you’ve used tretinoin long enough for your skin to become acclimated.
Irritation is not a good thing at all after a certain point. Eventually, constant irritation will do more harm than good, and it might be better to slow it down or moisturize more.
I know first-hand how easy it is to fall into the trap of loving results and seeing if more will give me better. But I find that with tretinoin, everyone has their sweet spot where they can use it every 1-3 nights and experience little to no irritation with excellent results.

Does everyone purge?

No, gods favor a select few in the group of tretinoin users.

Tretinoin purging can occur if you have closed comedones and are acne-prone; otherwise, it’s not a concern. Purging is existing acne progressing more rapidly because of the change in skin cell turnover rate. If you weren’t going to break out anyway, then there’s no acne to surface more rapidly.

If you start tretinoin to treat acne, it might be advisable to get a formulation combining tretinoin, clindamycin, or any other antibiotic for topical use. Those formulations are often gel, and the antibiotic can help mitigate the tretinoin purge and even shorten its duration.

Purging can also occur if you start with really textured skin. Tretinoin will speed up cell turnover and bring up everything trapped under the skin.
The tretinoin purge is also not that common; people usually misinterpret it. Here is a link to one study to support that, and the study defined purging as a 10 to 20% increase in inflammatory lesions, which is a significant but not an enormous difference. [1]

Retinoids are very irritating. Remember, irritation also causes breakouts. Go as slowly as possible and focus on hydration and gentleness. The slower you go, the less likely you are to experiment redness. Not exceptionally, even if using it every night on bare skin, many people don’t experience any purging, so YMMV.

Tretinoin for Anti-Aging — Did You Purge?

A tretinoin purge, by definition, happens in people who have acne. You are less likely to purge if you don’t have regular acne.

So if you started tretinoin for anti-aging purposes, the tretinoin purge could be irritation from too much tretinoin. You should consider:

• talk to a derm (as always the first thing, and the most important one);
• take it down to twice a week. There is no rush with tretinoin for anti-aging. The less you compromise your skin barrier, the better it is;
• make sure you moisturize well; try buffering / sandwich method;
• Try slugging with Aquaphor on nights you don’t use tretinoin;
• Get married to sunblock and hats hats hats!

What to do when purging

Step down

Build a proper tretinoin skincare routine by slowly and gently incorporating tretinoin.

Regarding the frequency of application, keeping tretinoin applications 3 to 4 days apart in the beginning, is recommended. The concept with 72h between applications is that this gap gives you the time to recognize a side effect (particularly when you are just starting with tretinoin) and act on it and keep the skin exposed to tretinoin to keep retinization going.

If you started applying tretinoin every evening, you would assume that everything is going fine for the first 2 to 4 days to wake up to a destroyed skin barrier on day 5. If you apply just once a week, you will have too low exposure to tretinoin to keep retinization going. Then, when you try to increase frequency, you assume you cannot tolerate it because you start seeing side effects. Your skin has not been exposed to tretinoin often enough to begin retinizing. Then, of course, the 72h is not set in stones, you might need to go down to every four days for a while or do two days-on and 3-days off, but the principle is to keep a free interval to be able to react to side effects while still allowing retinization.

Hide acne

Try hydrocolloid bandages to get through the tretinoin purge without picking at your skin. The drug store has them as “spot dots”, but you may try other brands. They all do the job. They’re clear and go over active acne. They work very well.

Fix broken skin barrier

Take care of your skin barrier. If the moisture barrier has been damaged, your skin will be very irritated, which could look like a tretinoin purge.

• Temporarily quit tretinoin
• Although you may be used to having greasy skin, you might now need the extra moisturizer. A heavy moisturizer at night helps a ton. The heavy-duty moisturizers popular with tretinoin users are La Roche Posay Cicaplast Balm B5*, Aquaphor* and Vaseline*.
• Try not to wash your face in the morning.
• Simplify your routine but if you must, use a soothing and calming toner.

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Change pillowcases

If you are desperate, try using a fresh pillowcase every night!

Still getting breakouts after X months of use. Is it time to quit tretinoin?

Treating acne is much more than just putting a routine together. If using tretinoin consistently for over three months has not improved your acne, the first thing to do is contact your medical provider to discuss options. Possible strategies are:

1. Change the formula from tretinoin cream to gel or the other way around. Some people experience breakouts triggered by a particular formulation. If you’re still breaking out after 4-6 months, consider switching types.
2. Increase concentration;
3. Increase frequency. If you use tretinoin too infrequently, the skin must undergo retinization each time. That inherently involves some irritation. If you go too slow, your skin may never acclimate. Try increasing your frequency to at least four times a week.
4. Add an antibiotic to the tretinoin topical preparation or as a pill to take daily for a few months;
5. Add benzoyl peroxide as a wash or as a spot treatment to use in the morning (it cannot be combined with tretinoin);
6. Switch to adapalene in combination with benzoyl peroxide.
7. Moisturize. Moisturize. Moisturize. All skin types need moisture and hydration: read our info on a good tretinoin routine.
8. Is your routine too irritating? Cut out ALL other actives and focus on hydration.

Your clinical history and how you reacted to tretinoin will guide the choice of your provider. However, skin irritation can sometimes be mistaken for “unresponsive” acne.

In that case, don’t get discouraged; there are simple steps that can lead to an improvement without changing your prescription:

• Apply tretinoin less often; Pull back a little bit. It’s probably really intense for your skin.
• Simplify your routine. Adding actives to irritated skin can only exacerbate the problem. Make sure other products are not breaking you out.
• Stick to non-foaming, slightly acidic cleansers;
• Remove all products with high alcohol content;
• Avoid essential oils and fragrances

If I stop using tretinoin, will I purge again if I restart it?

Maybe! This isn’t easy to predict.

I’ve learned that the tretinoin purge is not something that gets easier just because you’ve been through it. It sucks the second and third time around. And even though I know it works out in the end, I still feel hopeless some days.

Final thoughts

Sometimes it’s s going to get worse before it gets better.

References

[1] 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%. J Clin Aesthet Dermatol. 2008;1(1):41-43.