The Tretinoin Purge – How Long Does It Last?

Ever since I started consulting the internet for skincare research, nearly no skincare sub doesn’t have at least one person explaining their initial tretinoin purge phase when extolling the virtuous results after starting tretinoin.

Usually, it goes something like this, “At first, the purging from tretinoin was horrible, but a week later, my skin cleared up, and now it’s excellent, and my skin is so perfect I get marriage proposals from strangers. Also, I’m pretty sure I’m getting into heaven now despite not formerly being spiritually affiliated with any organized religion!”

You get the point. People get smug about passing through the tretinoin skin purge. Not Crossfit smug, but quite pleased with themselves.

I, however, come from the school of breakout. If my skin is having a bad reaction to something, this product is not for me. Even the instructions on almost any topically applied product tell you to discontinue use if you experience adverse reactions. It seems like, I don’t know… good advice? And isn’t a breakout an adverse reaction?

So why are people toughing out to tretinoin in the hopes that on the other side of the purge, they’ll have better skin than before?

What Is Tretinoin?

If you are struggling with acne, you may have heard of tretinoin as a potential treatment option. Tretinoin is a prescription-strength retinoid from a group of compounds called retinoids, derived from vitamin A that comes in different forms, such as creams or gels.

Tretinoin works by speeding up the life cycle of skin cells, making them divide and die faster so newer, healthier cells can take their place. Tretinoin can help unclog pores, reduce inflammation, helps the skin renew itself, treat sun-damaged skin, and improve skin texture and fine lines. In a nutshell, tretinoin improves the appearance of the skin.

What Is the Tretinoin Purge, aka Retinol Uglies?

According to Dr. Shereene Idriss, MD, a New York City-based board-certified dermatologist, founder of Idriss Dermatology, and creator of the PillowtalkDerm skincare brand, purging “is an adjustment period. It is a temporary moment in which, after starting either a retinoid or even a hydroxy acid, our skin has to adjust to the product”.

To understand tretinoin purging, you need first to understand the skin cycle. Purging happens because tretinoin increases the turnover of skin cells, bringing clogged pores and impurities from the lowest layer of the epidermis to the highest layer of the epidermis faster.

For adults, the process is roughly six weeks. Purging does not indicate that tretinoin is not working or harming your skin. It may indicate that tretinoin clears your pores and improves your skin texture.

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 reach the surface and show up on your skin. So, purging is a phenomenon by which acne lesions already formed in your skin make their way to the top of your skin faster than they usually would.

Pimples, blackheads, whiteheads, inflammatory lesions are like icebergs. What you see on the surface is one part of the story, with the real story happening underneath the surface of the skin. And what starts off as what appears to be a clogged pore has actually been happening over time underneath the surface of the skin. And by the time this micro-comedone comes up to the surface of the skin, usually, on average, for a normal person who’s not using a retinoid or a hydroxy acid, that process can take around 4 to 8 weeks.

Dr. Shereene Idriss, MD, a New York City-based board-certified dermatologist, founder of Idriss Dermatology, and creator of the PillowtalkDerm skincare brand.

This may seem like your skin is getting worse instead of better, but don’t worry. It’s not a sign that tretinoin is not working for you. It’s a sign that tretinoin is doing its job of speeding up cell turnover and bringing impurities to the surface. The process gives the impression that you are getting new acne when, instead, you get rid of old ones more quickly.

So I was wrong. But only partially.

What Does the Tretinoin Purge Look Like?

How Long Does the Tretinoin Purge Last?

According to Dr. Shereene Idriss, MD, a New York City-based board-certified dermatologist, the tretinoin purge lasts, on average, three weeks.

She further notes that “most people and most patients who come to my practice are actually experiencing skin reactions in which their skin is either super sensitive, it does not mean that they cannot tolerate it. It just means that they have to find the right balance between efficacy and irritation in order to tolerate a product, or they simply cannot tolerate the product at all, and the product is just not sitting well with their skin.”

The good news is that once the purging phase is over, you should see noticeable improvements in your skin clarity, texture, and tone.

Tretinoin Purging vs. Run For the Hills Breakout

Purging has become a confusing catchall term for skin getting worse before it gets better. But in most situations, that’s just plain inaccurate.

It is essential to understand when the tretinoin purge is a breakout due to irritation, not a purge, which may necessitate a change in approach. Skin reaction or irritation from tretinoin is more common than you think.

Keep reading to learn more about this distinction.

If your breakouts last longer than a month, your skin is probably reacting to the retinoid, not a tretinoin purge. If the skin tends to be irritated, red, and inflamed, it doesn’t improve over time, then it is not a tretinoin purge.

At this point, whatever you’re using isn’t right for your skin. You may be sensitive to an ingredient in your tretinoin formula or something else in your skincare routine. But the more probable cause is that you use tretinoin too aggressively. You should 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 down on tretinoin or moisturize your skin 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.

Another telltale sign of whether your skin is purging or breaking out from tretinoin is to look at the location and type of your breakouts. Tretinoin purging, also known as Retin-A purging, occurs in areas prone to clogged pores and pimples, such as the forehead, chin, and cheeks. The pimples may also be more inflamed and extensive than usual, as the retinoids bring the underlying micro comedones (tiny clogged pores) to the surface.

On the other hand, if you are experiencing breakouts in areas where you normally don’t have acne, such as the temples, jawline, or neck, you may be allergic to retinoids or other ingredients in your skincare product. For instance, I always know something’s up when I get blemishes on my clear cheeks. The breakouts may also appear as small, red bumps that itch or burn.

Moreover, this study shows a purge should only be a 10-12% increase in your existing acne. What determines a purge is the concentration of either the retinoid or the hydroxy acid, plus the actual pH of the formulation and how that product is made.

If you are not sure whether your skin is purging or breaking out, it is best to consult your dermatologist before continuing or stopping your retinoid treatment. They can help you determine the cause of your breakouts and advise you on managing them. Retinoid purging can last from four to eight weeks, depending on your skin type and the strength of your retinoid product.

How to Avoid a Tretinoin Purge?

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. Starting with a low tretinoin strength (0.025%) may help you slow down some of the symptoms of the tretinoin purge.

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

Tretinoin Purge Before and After Pictures

Does Everyone Purge on Tretinoin?

No, gods favor a select few in the group of Tretinoin users. It depends on your skin type, the severity of your acne, and how your skin reacts to tretinoin.

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; 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 increase cell turnover and bring up everything trapped under the skin.
The tretinoin purge is also not that common; people usually misinterpret it. A study defined purging as a 10% to 20% increase in inflammatory lesions, which is a significant but not an enormous difference.

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.

Is There a Tretinoin Second Purge?

The tretinoin 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 repeatedly, that is likely not a purge. There is no “purging for six months” or “second, third, sixth, etc. wave of purging.”. Those would likely be a consequence of irritation.

This does not mean 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 by continuing to use it. After that, some people never have acne again, and others have a reduced amount. It’s all individual.

What to Do When Purging?

Purging can be frustrating and discouraging, but remember that it is temporary and will eventually lead to clearer and smoother skin. Tretinoin has been proven effective for treating acne and improving the appearance of skin in the long term.

Follow Your Derm’s Instructions

Most prescription retinoids are combined with an antibiotic to reduce the risk of purging. The best thing to do is to be patient and consistent with tretinoin and follow your doctor’s or dermatologist’s instructions.

Step Down

If you are experiencing purging, do not stop using tretinoin or switch to another product. Build a proper tretinoin skincare routine by incorporating tretinoin slowly and gently.

You may also want to use a gentle and non-comedogenic cleanser, moisturizer, and sunscreen to protect and soothe your skin while using tretinoin.

Avoid over-exfoliating or using harsh products that can irritate it further.

Regarding the frequency of application, keeping tretinoin applications 3 to 4 days apart is recommended initially. The concept with 72h between applications is that this gap allows you to recognize a side effect (particularly when you are just starting with tretinoin), 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 stone; you might need to go down to every four days for a while or do two days on and three days off, but the principle is to keep a free interval to be able to react to side effects while still allowing retinization.

Switch from Gel to Cream or Vice Versa

Retinoids in gel form may suit acne-prone and congested skin types better than retinoids in cream form. Sometimes, switching from Retin-A cream to Retin-A Micro can help. But, sometimes, it’s the other way around. As always, it is best to consult with your doctor first.

Fix Your Skin’s Broken 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. If you must, use a soothing toner.
• Including a product that contains niacinamide can aid in reducing the effects of the tretinoin purge. Niacinamide effectively reduces inflammation and brightens the skin, and it can work in conjunction with tretinoin. Many users have experienced a noticeable improvement in skin tone when they begin using niacinamide.

(*affiliate links)

Hide Acne

Try hydrocolloid patches* 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.

Change Pillowcases

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

3 Months on Tretinoin, Still Breaking Out

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.

If you start using tretinoin to treat your acne and instead they just majorly freak your skin out, you’re just suffering from a different type of irritation now. The chronic irritation is no longer from acne. It’s from your acne treatment. So, it’s a zero-sum game for your skin health.

If you’ve been on tretinoin for months and you’re still breaking out, talk to your doctor. You shouldn’t use it without that initial consultation and suitable follow-up.

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. Consider switching types if you’re still breaking out after three weeks.
2. Your doctor could decrease or increase your tret concentration;
3. Decrease frequency. Pull back a little bit. It’s probably really intense for your skin. In the beginning, incorporate it two times a week. But note that 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.
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. Please read our guide on a good tretinoin routine.
8. Simplify your routine. Adding actives to irritated skin can only exacerbate the problem. Cut out products with high alcohol content, essential oils, and fragrances.
9. Stick to non-foaming, slightly acidic cleansers;

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.

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. Still, if you use tretinoin for anti-aging, you may experience tretinoin redness and skin peeling

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

• 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;
• Make sure you moisturize well; try the buffering/sandwich method;
• Try slugging with Aquaphor* on nights you don’t use tretinoin;
• Get married to sunblock and hats, hats, hats!

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 does not get easier just because you’ve been through it. It sucks the second and third times around. And even though I know it works out in the end, I still feel hopeless some days.

Shop this Tretinoin Purge Guide

While not much can be done to stop or speed up the process of purging, we have some Korean skincare product recommendations that will help calm the tretinoin purge, and avoid inflaming it.

Anua Heartleaf Pore Control Cleansing Oil

If you want to remove your makeup and day-to-day dirt without clogging your pores, try Anua Heartleaf Pore Control Cleansing Oil. It’s a gentle oil cleanser that contains heartleaf extract and plant-based oils to soothe and hydrate your skin. Just massage it on your dry face, add some water to emulsify, and rinse off with lukewarm water. Your skin will feel clean and refreshed!

Round Lab Birch Juice Moisturizing Cleanser

I tried Round Lab Birch Juice Moisturizing Cleanser quite a while ago, and the cleanser is still one of the most pleasant, mildly foaming gel cleansers I’ve used. My mother-in-law stole my first tube because it was so gentle on her very dry skin.

Round Lab Birch Juice Moisturizing Cleanser contains natural surfactants derived from coconut that foam beautifully to remove impurities. In addition to cleansing the skin’s surface, the Round Lab Birch Cleanser travels deep into pores to prevent buildup and blemishes, all without compromising the skin’s barrier function. It’s gentle yet effective, leaving skin clean, bright, and hydrated.

Round Lab Birch Juice Moisturizing Cleanser effectively rinses impurities without excess product or prolonged scrubbing. When rinsing, gently wet your face with warm water, massage a pea-sized amount of the cleanser over the skin in circular motions, rinse clean, and pat dry. This is a fantastic second cleanser for all skin types, and I recommend it for those with dry, aging skin.

Please read Adela’s in-depth review on the Round Lab Birch Juice Moisturizing Cleanser.

Needly Daily Toner Pad

The Needly Daily Toner Pad is a multitasker and a good opportunity to incorporate gentle exfoliation into your routine. It is my favorite gentle exfoliating and hydrating toner pad.

Round Lab Mugwort Calming Toner

Round Lab Mugwort Calming Toner is made with Artemisia Vulgaris Extract and Artemisia Princeps Leaf Extract, which have anti-inflammatory and soothing properties. It helps calm redness, itchiness, and flakiness while hydrating and balancing your skin. I love how soft and refreshed my skin feels!

Apart from Artemisia Extracts, this essence contains glycerin, which happens to be one of the most effective (and therefore most common) humectants used in skincare products. Glycerin is naturally found in the stratum corneum (as part of the skin’s natural moisturizing factor). It is, therefore, an extraordinarily safe and non-allergenic skincare ingredient – suitable for any skin type.

Read Diana’s Round Lab Mugwort Calming Toner review.

I’m From Mugwort Sheet Mask

Do you know when you sometimes try foods from other cultures with scents or tastes of textures different from what you may be used to? You may be hesitant to try a particular dish or food at first, but once you do and try to understand some of the culture around it, you enjoy it. But please don’t let this deter you from trying something that can do wonders for your skin! Like the brand’s mugwort essence, the mugwort used in this mask is cultivated on Ganghwa Island in Korea.

Notable ingredients include Cordyceps sinensis extract, a mushroom with anti-inflammatory, skin-brightening, and anti-aging properties.

I’m From Mugwort Sheet Mask, the ultimate savior for dry skin. It has ten essential ingredients, with Mugwort as its main ingredient, making it a soothing mask that will result in hydrated and relaxed skin.

I am putting it on after a long, stressful day. It sounds like heaven! The I’m From Mugwort Sheet Mask can hydrate your skin and is especially good for sensitive skin. You can find I’m From Mugwort Sheet Mask Review here.

Benton Aloe Propolis Soothing Gel

The Benton Aloe Propolis Soothing Gel is a favorite for aloe vera skincare products. Bonus – It also contains bee propolis and was recently reformulated Houttuynia Cordata, aka heartleaf!

Whether you’re purging or breaking out, you still need sunscreen. Especially when on tretinoin, you should never skip sunscreen. So, choose a sunscreen you enjoy using.

The Beauty of Joseon Ginseng Moist Sun Serum was launched recently (2023) and is one of the best chemical sunscreens. Korean skincare products are all about hydration, from the routine’s first to the last step. This is why I have chosen this feather-like sun serum, which feels extremely lightweight. It doesn’t leave a white cast and has a dreamy, silky finish!

Final Thoughts

In the beauty world, we can get so excited by the cosmetic effects of tretinoin that we can forget that they are medicine, not cosmetics. Whether or not you use a prescription-only cream like a retinoid should be discussed with your primary care doctor or dermatologist. The decision should be based on your skin health and nothing else.

For example, one of the primary reasons the medical establishment takes acne so seriously is because it represents a chronic irritation to the skin. Chronic irritation is lousy news anywhere in the body and is just as detrimental to skin health.

Tretinoin purging is not as common as you would think. Not every breakout is a purge.

Tretinoin purging happens because tretinoin increases the turnover of skin cells and brings up all the dirt, oil, and bacteria trapped in the pores to the surface, causing more breakouts than usual. Tretinoin purging usually lasts for around three weeks. Although tretinoin proves to be highly effective in treating acne in the long run, the initial few weeks or even months of use can be disheartening and demanding.

Skin purging can be minimized by starting with a low concentration of tretinoin, applying it sparingly, using a gentle cleanser and moisturizer, wearing sunscreen daily, and being patient and consistent with tretinoin.

Ask your doctor or dermatologist for advice if you have any questions or concerns about purging or tretinoin.

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