We Ask a Derm: What is a Tretinoin Purge (And How Do We Get Through One)?

We always talk about how "retinol is the gold standard" in skincare and, to be clear, it is a great ingredient. However, it's not without its downsides. Especially when you're dealing with tretinoin (that is, a prescription strength retinoid), which is some hearty stuff.

For many, there is an initial purge period, where your skin looks a lot worse before it gets better. Good news is that it's usually temporary and there are a few simple tricks you can employ in your routine to make the experience less unpleasant.

“Many people experience an uptick in acne when they start acne medications—especially retinoids. This is often referred to as a ‘retinoid purge’ [or ‘retinol uglies’] and is due to the increase in cell turnover [which is one of the main functions of retinoid]. This can cause any below the surface pimples to move upwards,” explains Rachel Nazarian, a board-certified dermatologist at Mount Sinai Dept of Dermatology and the Schweiger Dermatology Group in New York. Fear not: “There are certainly many ways to make this passing phase less difficult, and to minimize irritation,” she assures. 

Pre-retinoids, you may have been using an exfoliating serum or toner with alpha or beta hydroxy acids to help keep your skin clear. When a retinoid is added to the mix, the combination can be too abrasive for your skin and cause irritation.

The fix? “Only use gentle products on your skin when dealing with retinization [aka the process of acclimating to a retinoid]. This starts with using a gentle cleanser,” shares Dr. Y. Claire Chang, a board-certified cosmetic dermatologist at Union Square Laser Dermatology in New York. “You want to avoid any harsh soaps, scrubs, or exfoliating cleansers to prevent excess irritation and dryness,” she adds. (Chang recommends Differin Gentle Cleanser, which is free of soaps, fragrances, benzoyl peroxide, or salicylic acid, and is great for sensitive skin.)

According to Nazarian: Moisturizers should be extra hydrating, and preferably anti-inflammatory to counteract any irritation and dryness from the retinoid. She also encourages anyone who is new to using retinoids to apply their moisturizer before their retinoid at night, which “creates a buffer and prevents adverse effects, while allowing the retinoid to absorb.”

Both doctors agree that you should start slow. “I recommend starting every third night for the first couple of weeks, and then moving up to every other night, and then nightly,” advises Chang. “Rushing into a nightly application will only increase the likelihood of purging excessively. Along with the cadence, you also want to start with a tiny, pea-sized amount on fully dry, never damp skin. More is not better and it’s not more effective either,” adds Nazarian. 

“If your skin is already inflamed from using a retinoid, stop application immediately, and give your skin a break for a week to recover. During this time, you also want to increase both emollient and humectant use,” says Nazarian. “Look for moisturizers with ceramides and hyaluronic acid, and, if you have any raised or rough rash-like patches, you can apply a small amount of hydrocortisone 1% cream over it for up to two days to calm it down,” she adds.

If the inflammation is severe or isn’t improving, Chang recommends reaching out to your local board-certified dermatologist. You may require further evaluation and a topical steroid to improve the rash. 

Once your skin has calmed down, you can restart your retinoid, making sure to leave more “skip nights” in-between use to adjust to the regimen. “With time, you will find your balance, and eventually most people are able to tolerate retinoid nightly,” assures Nazarian.

“It’s always imperative to apply sunscreen during the day if you’re using a retinoid. Your skin is a bit more sensitive to sunlight, which makes daily protection even more vital,” says Nazarian.