If you’ve been using skincare for a while, chances are you’ve experienced a product reaction of some kind at least once. Perhaps you were excited over a new product but began to notice breakouts a few days later. The first time this happens, many of us find ourselves on Google trying to figure out what to do next and this is often when we first hear of terms like “purging.” What is purging and what’s a myth? Let’s find out!

Skin Purging

“Purging” is a non-scientific term used to describe the flare in acne that can occur when starting exfoliants and other topical acne medications like retinoids. The medical term used in the scientific literature is acne flare but we’ll stick to purging since it’s become such a widely recognized term.

It’s important not to confuse purging with other types of reactions. If you’re experiencing a product-induced acne flare, all of the following will be true:

• Recently began using an exfoliant, retinoid, or other acne product like benzoyl peroxide
• Increase in acne occurring in areas where you normally experience breakouts (for example, around the chin or in your T-zone)
• Acne flare began 3-10 days after starting new product (may take longer depending on the product type and frequency used)
• Breakouts subside after a few weeks of consistent use

Skin Purging Myths 

Social media often gets the basics of skin purging right. But it‘s the “why” behind purging where we start to get away from the science.

Common Myths

“Products that increase cell turnover bring clogged pores and impurities to the surface, causing purging.”

“Purging is just a detox breakout where your skin is expelling trapped toxins.”

“Purging is a good thing and means your products are working!”

Surprisingly, there’s little evidence for these claims. In fact, the primary theory behind purging is that it’s due to an increase in inflammation from irritating actives, which exacerbates acne1. Purging was found to more commonly occur in patients using more irritating vehicles (the base for the active ingredient) as well the use of tretinoin by itself. More irritation means a higher incidence of product-induced acne flares – aka purging. That’s also why purging goes away after a few weeks; your skin acclimates to the new active and develops a tolerance for the irritation.

Now, it is possible that retinoids and other topical acne medications could be increasing the rate by which a microcomedone forms. Our skin sheds dead skin cells in a process called desquamation and if this isn’t occurring normally, cells can begin to clump within the pore. This leads to microcomedone formation 8 weeks2 before there’s a visible acne lesion. The evidence isn’t very clear here but perhaps by encouraging cell turnover, we cause faster acne formation. 

What we know:

• Skin does not detox. It has no mechanism by which to expel toxins and our liver does a fantastic job acting as a filtration system and converting toxins to waste products all by itself.
• Purging is primarily caused by increased inflammation worsening acne while the skin is acclimating. Corticosteroids and other medications that decrease inflammation associated with acne have been shown to prevent and treat flares.
• Acne products likely shorten the life cycle of acne lesions. But microcomedones occur because of the pore opening being blocked, not impurities being brought up from elsewhere in the skin.

Product Reactions

It’s very important to not confuse skin purging with other product reactions. With purging, you should push through and keep using the product until the purge is finished; with regular product reactions, it won’t get better and you should stop using the product right away.

Allergic Reaction

Some common signs include itching, bumps, swelling, and redness. Immediately stop using the product and try to look for common culprits in products that cause a reaction so that you can hopefully identify your triggers.

Acne Triggers

Godfather of dermatology Dr. Kligman published a 1972 paper where he used the term “acne cosmetica” to describe the worsening of acne by skin care products3. You’ll occasionally come across products that worsen acne4 for no apparent reason. Your skin is as unique as your fingerprint, and sometimes a random ingredient or formula will cause skin congestion or irritation. If it’s a product not known to cause purging (or if it is but the purging doesn’t resolve), discontinue use. 

Barrier Impairment

Sometimes, products are just too much for your skin or you did too much too fast. When this happens, your skin can become very irritated and you may see signs of barrier impairment like stinging when applying your moisturizer and a tight, shiny appearance to the skin. You’ll want to remove any irritating products and let your skin heal before trying again. The good news is that you may be able to successfully use the product in question once your barrier is healthy.

Starting a New Product 

While it’s impossible to completely avoid products that won’t work for you, we can quickly identify and minimize product reactions by starting new products the right way.

Tips for New Skincare

• Start 1 new product at a time and wait at last 2 weeks between new products (this will both minimize irritation and help you pinpoint which product is the culprit of a reaction)
• Make sure you’ve got a basic skincare in place before you add more targeted treatments to minimize irritation
• Start “low and slow” with retinoids and exfoliants to further reduce irritation
• If you know you’re sensitive or have a lot of ingredient triggers, utilize methods like patch testing and contact therapy

Patch testing is your new BFF if you’re sensitive or acne prone. Anytime you’re starting a new product, apply only to a small area on your jaw or neck for 3-5 days before you apply all over. If you observe a reaction, this product may not be for you.

Contact therapy is another great one if you’re sensitive or not sure how your skin will respond to a retinoid or other powerful active. Apply onto the skin for 10 minutes like a mask and then wash off. If your skin responds well, you can move onto leaving it on. Best for: benzoyl peroxide and chemical exfoliants like glycolic acid and salicylic acid.

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989803/
2. https://www.sciencedirect.com/topics/medicine-and-dentistry/hyperkeratinization
3. https://jamanetwork.com/journals/jamadermatology/article-abstract/532944
4. https://pubmed.ncbi.nlm.nih.gov/23859829/