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The Truth About the Tretinoin Purge

Appearance, whether we like to admit it or not, plays a significant role in how we believe others perceive us – and how we perceive ourselves. No surprise, acne can lead to self-esteem, confidence, and anxiety issues for many men and women.

Thankfully, with advancements in our understanding of acne and skin, treatments have arisen through the years. One of the most effective and proven acne treatments is tretinoin, a prescription topical retinoic acid. While this topical treatment is proven to improve acne symptoms with long-term use, many patients find the first few weeks or months challenging because of “the purge.” According to accumulated anecdotal evidence, the first several weeks of tretinoin therapy can result in a period of worsening acne, inflammation, and breakouts.

For patients seeking relief for their acne, this can be incredibly frustrating.

Your frustration is understandable, and while there’s a legitimate physiological reason for the body's initial response to the therapy, it will pass, with quality outcomes for most patients. Furthermore, you may be able to limit the duration of the purge by following some helpful tips and tricks.

Getting To the Bottom of the Tretinoin Purge

Acne and skin blemishes sometimes result from a slow skin cell turnover process and a build-up of sebum (the skin’s natural oil) in pores. One way to reduce these problems is by speeding up the skin’s turnover rate, forcing fresh skin cells to the surface and eliminating problematic older cells. This is precisely what tretinoin and other retinoid therapies do.

Tretinoin is retinoic acid, and when applied directly to the face acts aggressively as an effective chemical exfoliant. While long-term use will reduce acne for most patients, these drastic changes can result in the problem getting worse – or at least feeling worse – before it gets better. 

Not everyone will experience the dreaded purge, and even if you do, there’s no telling how minor or severe your reaction will be compared to others.

This “purge” is an inflammatory and healing response to the initial therapy. While temporary, the early stages of tretinoin therapy can be uncomfortable and discouraging. The harsh and expedited process of skin cell turnover will cause some sensitivity, dryness, peeling, and breakouts for most people. The purge will resolve itself for most people, with the worst effects occurring within the first few weeks to two months. 

When the initial reaction subsides, you should begin to experience the positive therapeutic effects that your dermatologist expects: clearer, healthier skin. If your symptoms don’t begin to improve after the first couple of months, or your initial reaction doesn’t subside, consult your physician about any potential issues.

Handling The Purge Without Losing Your Mind

When you first begin using tretinoin, the adjustment period can be stressful and disappointing because you want your skin to get better, not worse! 

Despite this uncomfortable beginning period, clinical research and the experience of millions of patients has shown tretinoin therapy to be beneficial in the long term. Thankfully, there are several techniques to help you through, with some able to minimize adverse reactions.

Lower Concentrations

Tretinoin comes in concentrations between 0.025% and 0.1%. Maximum strength creams, gels, or solutions can speed up the therapeutic process, but also result in harsher chemical exfoliation, and for some, a more severe “purge” process.

As a prescription product, tretinoin cream is not one-size-fits-all therapy. Your skin might be more sensitive than someone else’s, meaning you might need a lower concentration.

If you’re experiencing overwhelming adverse reactions, consider talking to your doctor about a lower concentration, which may help to reduce the symptoms while still being effective in treating acne and improving skin health.


Any time you’re using retinoid therapy, it’s important to focus on protecting your skin from UV rays. Tretinoin can lead to dryness, and the increased rate of skin cell turnover means more sensitive, fresh tissues on the surface and more sensitivity to the sun and UV radiation.

This increased sensitivity means you’re at a greater risk of sunburn and skin damage. Wear a sunscreen of at least SPF 30 and remember that sunscreen should be reapplied every two hours or so if you're in the sun, and even more frequently if you’re swimming or sweating.


While it might seem obvious, using a moisturizer after applying tretinoin can help reduce any dryness you might experience. Many people who suffer from acne avoid applying moisturizers  because they feel the excess moisture or product weight can worsen breakouts. That’s not always the case. Excess oils can lead to breakouts, but hydrating creams formulated specifically for acne-prone skin should contribute to a healthier complexion. Talk to your specialist if you’re unsure what type of moisturizer to purchase.


One of the most common side effects of tretinoin in the first few weeks of treatment is irritated and dry skin. This dryness can lead to peeling and discomfort. Increasing your water intake during the initial stages of therapy can help improve the skin's hydration levels too, resulting in healthier skin (and better health in general). 

Progress Photos

A tretinoin purge can interfere with your confidence about the treatment process and progress. It’s challenging to see improvements just by looking in the mirror daily. That’s why the best way to track your progress and boost your confidence in the process is with monthly photos. 

The tretinoin purge is a temporary problem, and it’s a sign your medication is working. Tretinoin has shown repeatedly to be an effective therapy for treating acne and improving skin complexion. 

Tretinoin is slow-acting, and with the initial purge effects you may feel like nothing is happening. Don’t get discouraged. Take photos at the end of every month to have something concrete for comparison.

If you’re nervous about starting tretinoin therapy or are wondering if it’s the right option for you, consider a custom prescription treatment from Nava MD containing tretinoin. As a telemedicine and clinical skincare center, our physicians are prepared to help you find the right fit through our online consultation process. The process is easy and membership is affordable - we're the easiest dermatologist visit you've never had. Get started with your online consultation today.

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This article is intended for informational purposes only and should not be considered medical advice.
Consult a healthcare professional or call a doctor in the case of a medical emergency