Tretinoin has fast become the gold standard for addressing troublesome skin conditions. From the signs of aging to severe acne, tretinoin administered the right way can have lasting, transformative effects.

But before you can experience the benefits that tretinoin has to offer, your skin may go through a process known anecdotally as the "tretinoin purge" or the "retinoid purge."

In this article, we'll take a chronological journey through the tretinoin purge process and some best practices to get through it. It's all in the pursuit of great, long-lasting results on the other side, and with an effective wrinkle- and acne-buster like tretinoin, it's worth it.

What is Tretinoin?

Tretinoin, commonly known by the brand name Retin-A®, is a prescription medication used to treat acne, wrinkles, fine lines, saggy skin, and dark spots. While Retin-A was the first FDA-approved version of tretinoin, it’s now available as a generic medication, and you’ll see it discussed more frequently as tretinoin than Retin-A. 

Tretinoin is a retinoid, a class of molecules that are all a form of vitamin A, synthetic or naturally occurring. They all do roughly the same thing, but they each work a little differently, and some better than others. 

“What about retinol?” you’re saying, “Isn’t that a retinoid?”

Bingo. Retinol, retinaldehyde, retinal, and tretinoin are all some of the more common retinoids. Retinol is one of the most common retinoids in over-the-counter (OTC) skincare or beauty treatments. It does not require a prescription, while tretinoin does.

Here’s the big difference between tretinoin and retinol. Where retinol needs to be converted into retinoic acid by enzymes in the skin, tretinoin is already pure retinoic acid in a concentrated form that starts delivering its benefits immediately, especially when combating acne. All of these medications work on a receptor called the retinoic acid receptor – you can see why you’d rather give your skin retinoic acid than something that takes a couple steps to get there.

There is a hurdle, however. Because tretinoin is retinoic acid, it can cause temporary redness, itching, and sometimes peeling when first applied. That’s the tretinoin purge. 

Learn more in Nava MD's The Definitive Guide to Retinoids: The Best Wrinkle Creams

The Pros and Cons of Tretinoin

Tretinoin (and other retinoids) delivers its benefits in two ways:

1. It increases cell turnover at your skin and prevents the clogging of pores that can lead to acne, blackheads, and other skin problems. Because increased cell turnover means that more fresh skin cells are created in less time, this also means that acne breakouts and blackhead frequency is significantly reduced for most people.
2. Tretinoin can also boost collagen production and improve elasticity, and even reduce unwanted skin pigmentation. 

While tretinoin is highly effective at combating acne and wrinkles in the long-term, the first few weeks can be challenging for some new patients. Some users of tretinoin will experience a "purge" during their first application, where their skin condition gets briefly worse before it gets better. Or, they may experience uncomfortable irritation, dryness, or redness. These challenges can range from the occasional whitehead to breakouts, and the purge can lead users to think they’ve made a mistake. 

Patience my friend! Science has proven this treatment works over and over again, and success just comes down to a little bit of patience. 

Why Does Tretinoin Cause a Purge?

Why does tretinoin worsen the very condition it’s designed to treat, and what exactly is going on? 

The term “purge” is a bit of a misnomer. It’s tempting to imagine that your skin needs to rid itself of the substances that may be clogging pores: from oil and dirt to dead skin cells and bacteria. However, it isn't just ridding itself of these substances in the traditional sense of a purge. During this temporary phase, the skin is adjusting and preparing itself to help the new medication to work to its full potential. Remember, your skin is undergoing a more rapid cell turnover than it’s used to. All of the substances that were clogging your pores get pushed to the surface layer of your skin, and because things are happening at a faster pace, you may experience light inflammation, contributing to breakouts.

Frustrating? Without a doubt. Expected and necessary? Absolutely. You may experience breakouts in the usual areas, but you might also get pimples in new areas or a larger or lesser amount than normal. 

Everybody's experience is different, but dermatologists agree: the most important thing you can do is trust the process and stick with it. The tretinoin purge means that the retinoic acid is working and that you are on the way to healthy, clear skin, possibly for the first time in years! 

If you’re using tretinoin to treat the signs of aging, it’s still possible to experience skin purging even if you don't normally suffer from acne or breakouts. Again, put your faith in science and look forward to younger-looking skin.

When Does the Purge Start?

You can expect the tretinoin purge to start soon after your first application, usually within the first two weeks. However, the timeframe can vary. Some people can take weeks to experience skin purging, and it all depends on a number of factors, including skin type, skin condition, and the strength of tretinoin or retinoid you’re using.

For instance, retinol is a more gentle retinoid for most people. That’s why it’s in OTC beauty products – and why it doesn’t work nearly as well as tretinoin. Remember, retinol has to be converted into the active form, retinoic acid, at your skin.

Tretinoin is about 20 times more powerful than retinol!

How Long Does the Tretinoin Purge Last?

Once the tretinoin purge starts you'll naturally want to know how long it will last. You’ve probably already guessed that it varies from person to person. Some people may be lucky and only experience a purge that lasts for a couple weeks, while others might go through an adjustment period that lasts a few weeks to a month.

The good news is that it definitely does end – and that's when you start seeing results.

It's also worth noting that if you don't see any improvement to your skin after 3 months you should check in with your prescribing clinician. They may need to adjust the strength of the formula or the frequency of application.

Tretinoin Purge Waves: Why It's Not Always a Linear Process

As with many skin treatments, you may experience good and bad days during the tretinoin adjustment. Just when you thought the purge was over, along comes another wave and your skin starts to break out again. Don't worry if you experience this; it's all part of the process, and again, it will vary from person to person.

Remember that whether you experience the purge in one go or in waves, your tretinoin is doing exactly what it was designed to do.

How to Get Through the Purge

While you might not be able to avoid the purge altogether, there are things you can do to make the experience a little more pleasant.

Expect and Accept the Purge

By being prepared for the purge, you can accept it when it happens and rejoice if you’re one of the lucky ones who sail through the adjustment phase without a breakout. Instead of getting anxious about every new sensation (stress can also cause breakouts), count each pimple as a sign that the process is working.

Start Slow and Low

While you can't stop the tretinoin process if you want it to work, you can help to make the process less severe. By starting slowly at a low strength or with every-other-day treatment, you can reduce the side effects and the impact on your skin. Start off by using tretinoin once every two days or three days, and then progress to regular use as your skin gets used to it. Of course, that means you may not experience such dramatic results after your first application, but you can strengthen the dose to get even better results over time. In fact, your doctor may recommend a lower strength to start, or explain the side effects that come with a higher strength application if you want to go down that route. 

Use a Niacinamide Treatment

Adding a product containing niacinamide can also help to alleviate the effects of the purge.

Niacinamide helps to reduce inflammation and brightens the skin, and it can work really well alongside tretinoin. Many people notice an immediate improvement in their skin tone when they start using niacinamide. 

Keep Your Face Clean

Touching your face or allowing oil or bacteria to build up can also increase the side effects of the tretinoin purge. Only touch your face with clean hands and leave your skin to do its thing. Also try not to pick at flaky or dry skin caused by the purge. The dryness will dissipate over time.

Take Before, During, and After Photos

You see your face in the mirror every day but do you really see it? If you're feeling a little demotivated, take some photos before, during, and after the purge. You'll see that those improvements might be small at first, but that they are happening. Again, if you don't notice any improvements within 3 months, speak to your prescriber. Photos will also help your doctor to see the progress that you might not be able to see for yourself.

Use At Night

Use your tretinoin formulation at night before going to bed. There are two reasons for this.

First, tretinoin doesn't play well with direct sunlight. Harsh sun and heat can contribute to inflammation and make the purge worse.

Second, your skin does its best healing overnight while you're sleeping. By using tretinoin before bed you're giving your body and this medication the best environment to do its thing.

Results That Are Worth the Wait

If anxiety about the tretinoin purge is holding you back from using a retinoid treatment, you’re not alone. Just like other things in life that scare us, a little information can go a long way to laying fears to rest. 

The most important takeaway about the tretinoin purge is that this phase is essential to achieving clear, glowing, and youthful skin. The purge is completely normal and even necessary. Every day with tretinoin takes you one step closer to the complexion you’re after.

Nava MD can help. We make prescription skincare treatments available online. With a virtual consultation and fast, free shipping, it’s easier and more affordable than ever to fight aging, acne, and more from the comfort of home. Our formulations are prescribed by dermatologists, and your order comes with access to your clinician any time through our Patient Portal.

Start your healthy skin journey today by clicking here.

Sources

Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments

Retinoic Acid and Its Derivatives in Skin

A comparative study of the effects of retinol and retinoic acid on histological, molecular, and clinical properties of human skin