Why your skin gets worse before it gets better
Your skin is constantly cycling — old cells move to the surface and shed, while new cells form underneath. This process takes about 28 days in your 20s and slows with age. Retinoids and exfoliating acids accelerate it. When cell turnover speeds up, microcomedones that were quietly forming under the surface get pushed to the top faster than they would have naturally.
The result looks like a sudden wave of breakouts. But here's the key: those blemishes were already there. The retinol didn't create them — it just fast-forwarded the timeline. That's why it's called a purge and not a breakout.
The honest caveat dermatologists rarely lead with
"Skin purging" is not an official dermatological diagnosis. There is limited peer-reviewed research specifically studying it. What the evidence does support is that retinoids cause a period of increased acne activity in some people during initial use, and that this typically resolves as the skin adjusts. Whether that's technically a "purge" or initial irritation-driven acne is a genuine grey area in the literature.
The practical point is still useful, even if the term is informal. The question worth asking is: "Is this consistent with how a purge would behave, or does it look like a reaction?"
Purge vs. reaction: the four-question test
Where is it appearing? If the breakouts are in areas where you normally break out, that points to a purge. If spots are showing up on your cheeks when you've never had acne there, that's more likely a reaction to an ingredient.
What do the spots look like? Purging usually brings forward the kind of blemishes you already get — whiteheads, blackheads, closed comedones. Large, painful, cystic lesions that appear suddenly in new areas are a red flag for reaction.
Is there irritation beyond breakouts? Burning, stinging, persistent redness, and peeling that doesn't resolve are signs of skin sensitivity or an allergic reaction, not purging.
Is it improving? A purge should peak and then clear. If week 6 looks worse than week 2, you're not purging anymore.
A 2009 review in the Journal of the American Academy of Dermatology found no specific research confirming the "purge" phenomenon as a distinct biological event, but acknowledged that some patients experience transient acne worsening on retinoids. Clinical consensus supports continuing retinoids through this period unless irritation is severe, based on the known mechanism of accelerated desquamation.
What to do during a purge
- Don't layer more actives on top. Adding more acids or another retinoid to "speed up" the purge will increase irritation without helping. Strip back to cleanser, gentle moisturizer, and SPF only.
- Don't stop at week 2 unless you have clear reaction signs. Many women quit retinol during a purge, never knowing they were 2 weeks from clear skin. Mark 6 weeks on your calendar before deciding.
- See a dermatologist if you're unsure. A dermatologist can tell the difference between purging, contact dermatitis, and a new acne flare more accurately than any online quiz — including this one.
Dermatologist's Note
If you're in your 30s or 40s and the new blemishes are hormonal-pattern (chin, jaw, lower cheeks), that may not be a purge at all — it may be hormonal acne that was always going to appear and coincidentally showed up after you started retinol. Retinol doesn't cause hormonal acne, but the timing can be confusing. Worth addressing the hormonal driver separately if that pattern fits.
Sources
- Skin purging: Pictures, causes, and treatments. Medical News Today. medicalnewstoday.com
- Draelos ZD. (2009). Retinoids in cosmetics. Journal of the American Academy of Dermatology. Clinical commentary on transient acne worsening with retinoid use.
- SLMD Skincare. Skin Purging vs. Breaking Out: What's the Difference. slmdskincare.com
- Cascade Eye and Skin Centers. Skin Purging: What It Is, What It Looks Like, and How Long It Lasts. cascadeeyeskin.com