Skin purging: what it is and how to tell it from a breakout

Key takeaways

• “Skin purging” is an informal term for pimples that appear soon after starting an ingredient that speeds up skin cell turnover, like a retinoid or an exfoliating acid.

• Purging tends to show up where you usually break out and clears faster than a normal breakout. New spots in new places after a moisturizer or makeup product with no retinoid or acid in it are more likely a breakout.

• The popular estimate is four to six weeks, but controlled trials have mostly not found that topical retinoids make acne worse at the start.

• Burning, swelling, intense itching or a rash point to irritation or an allergy, not purging. Stop the product.

• Ease in slowly, change one product at a time and give a new treatment six to eight weeks before judging it.

What is skin purging?

Skin purging is a nickname, not a medical diagnosis. Medical News Today calls it “a colloquial term rather than a medical one,” and notes that scientists haven’t studied the concept directly.

The idea is simple. Acne starts as microcomedones, tiny clogged pores too small to see. Some ingredients speed up how quickly skin cells turn over, and the theory is that this brings those hidden clogs to the surface sooner, so you get a burst of pimples before your skin clears. Cleveland Clinic notes that with retinol you may still see pimples for the first couple of months and your skin may even look worse, which “is sometimes referred to as the retinol purge.”

What causes purging?

Purging is linked to ingredients that increase cell turnover. That’s mainly:

• Retinoids, including retinol, adapalene and prescription tretinoin. The American Academy of Dermatology (AAD) says tretinoin “spurs faster turnover of surface skin cells.”

• Exfoliating acids, such as AHAs like glycolic acid and BHAs like salicylic acid.

• Chemical peels, which remove one or more layers of skin cells.

A plain moisturizer, cleanser, sunscreen or makeup product doesn’t speed up cell turnover, so if you get new pimples after starting one, it’s more likely clogged pores or a reaction to the product than purging. Check the label first, though: some of these products contain retinol, glycolic, lactic or salicylic acid, and those can cause purging.

Is purging real?

It’s widely reported, but the evidence is thinner than the internet suggests. A 2009 review found “no primary data from clinical trials” supporting the idea that topical retinoids make acne worse at first, and suggested that some people’s acne simply gets worse in the first week or two as part of its natural ups and downs. A 2012 analysis of adapalene trial data also found no sign of a flare at the end of the first week of treatment.

One pooled analysis of tretinoin trials did find higher flare rates at two weeks in people with mild acne, but not in people with moderate to severe acne. Early flares are clearly documented with oral isotretinoin, a prescription acne medicine: the AAD says acne may get worse for one to two months after starting it, though this doesn’t happen to most patients.

So a rough first few weeks can happen, but you shouldn’t assume every new pimple is a sign that a product is working.

Purging vs breakout: how to tell the difference

It’s hard to tell them apart by looks alone, Medical News Today notes, but a dermatologist writing for Banner Health points to a few clues:

• Location. Purging tends to show up where you usually get pimples. A breakout from a product that clogs pores can appear in new places.

• What they look like. Purging spots are usually smaller and come to a head and heal faster.

• Timing. Purging starts soon after you begin a new active ingredient. If you haven’t started anything new, it’s likely an ordinary breakout.

• The product. If the new product contains a retinoid or an exfoliating acid, purging is possible. If it’s a moisturizer, cleanser or makeup product without those ingredients, it’s more likely a breakout.

Purging vs irritation or an allergic reaction

Irritation and allergies usually look different from pimples, though Medical News Today notes that irritation can sometimes cause acne-like bumps. Retinoids commonly cause redness, peeling and dryness, which dermatologists call retinoid dermatitis. That’s irritation, not purging, and the AAD notes it doesn’t usually mean you’re allergic.

An allergic reaction to a retinoid is rare, according to DermNet. Cleveland Clinic describes a skin care allergy as an itchy red rash, sometimes with blistering or oozing. It can take several days to appear. If you have burning, swelling, hives or intense itching, stop using the product.

How long does skin purging last?

The popular answer is four to six weeks, and it’s the range dermatologists quoted online cite most often, though some give longer windows. It’s often tied to a 28-day skin cycle, but skin renewal isn’t that exact: studies suggest it takes several weeks and varies from person to person.

It helps to think in terms of how long treatments take to work. The AAD says it usually takes at least six to eight weeks to see fewer breakouts from a new acne treatment, and DermNet says topical retinoids can take 12 weeks or longer to show improvement. If your skin is still getting worse after six to eight weeks, talk to a dermatologist.

How to minimize purging and irritation

• Start slowly. Use a new retinoid every other night at first and build up from there. Cleveland Clinic suggests applying retinol only every other day, at bedtime, for the first couple of weeks. Our list of retinol products for beginners covers gentle starting points.

• Add one product at a time. The AAD advises sticking with one acne product for six to eight weeks without adding another. Changing one thing at a time also makes it easier to tell what’s causing any changes.

• Don’t stack exfoliants. Using a retinoid and a strong acid together raises the odds of irritation. Our guide to how often to exfoliate explains how to space them out.

• Moisturize and wear sunscreen. A simple moisturizer helps with dryness, and daily sunscreen matters because retinoids and acids can make skin more sensitive to the sun.

• Don’t pick. The AAD says touching your face can make acne flare, and picking or popping pimples makes them take longer to clear and raises the risk of scars and dark spots.

When to stop and see a dermatologist

Stop using a product if you have burning, intense itching, swelling, hives or a rash, and see a doctor if it doesn’t settle. Also check in with a dermatologist if your skin is getting worse rather than better after six to eight weeks, or if the breakout is painful or leaving marks. If your skin feels raw or stings with everything, our guide to repairing a damaged skin barrier explains what to pause.

Frequently asked questions

How long does skin purging last?

It’s usually said to last about four to six weeks. If your skin is still getting worse after six to eight weeks, it’s probably not purging, and it’s worth talking to a dermatologist.

Is skin purging a good sign?

Not necessarily. Purging is widely reported with retinoids and exfoliants, but controlled trials have mostly not found an early flare with topical retinoids. Judge a product on how your skin looks after about two months, not on the first few weeks.

What does skin purging look like?

Usually small pimples or clogged pores in the areas where you normally break out, which come to a head and heal fairly quickly.

Can a moisturizer make you purge?

Only if it contains an active ingredient. A moisturizer with a retinoid, salicylic acid or an AHA like glycolic or lactic acid can speed up turnover, so purging is possible. A plain moisturizer doesn’t, so new pimples after starting one are more likely a breakout from a product that doesn’t suit your skin.

Should you stop using a product if you’re purging?

Not if it’s mild and in your usual breakout areas. Cut back to every other night and keep your routine simple. Stop if you have burning, swelling, a rash or intense itching.