Is skin purging even a real thing that should be happening?

Skin ‘purging’ describes the response your skin makes when adding an active ingredient– it’s the body’s route of shedding allll the dead cells, oil, bacteria, and debris that’s collected underneath the surface of our skin. This can manifest as what feels like a really bad acne breakout accompanied by dryness or peeling… but the truth is, is that you could also be experiencing an irritation or dermatitic flare from your product(s), too. 

So how do we know when our skin is actually purging?

THE GOOD, THE BAD, & THE UGLY….

The good news is that if your skin is truly purging, it’ll usually be a temporary flare that’s shorter in duration than a standard breakout. It’s ultimately a sign that the products you just introduced are working, and while this may not the most scientifically correct way of thinking about it: You could assume this as your body’s way of rejuvenating, but with a ‘it gets worse before it gets better’ spin on it. Even with the proper, slow incorporation of a new chemical exfoliant, most will still experience an unwanted purging response after introducing a new active product to the skin care lineup.

SO HOW DO WE KNOW THE DIFFERENCE? 

Typically you can tell if your skin is purging (vs. irritation reaction causing you to breakout) based on the ingredients being incorporated, timing, location, + characteristics. 

TIMING

For starters, purging is not an immediate reaction to anything. If you start to notice redness or an immediate response after applying a product— you’re experiencing a reaction. 

Continuation of a product causing an adverse reaction will likely just make the situation even worse. Whereas, purging is noted a few days after introducing to your skincare– the skin may also show redness as well at this time, but with the addition of a breakout. This is expected and important to continue despite the purging symptoms to see the max benefit once skin clears.

INGREDIENTS

There are plenty of chemical procedures or products can precipitate purging skin… but continue to be a recommended treatment despite this because of the various benefits they offer. The primary culprits known to cause purging are actionable ingredients (commonly referred to here as ‘actives’) that function to increase skin turnover + exfoliate the skin, removing dead skin cells built up within the sebaceous ducts & hair follicles. These actives don’t just prevent acne, they can kill bacteria, tighten, & soften the appearance of fine lines to achieve anti-aging results — which is what makes them so desirable. 

Basically, skin purging should only occur when starting a product with an active ingredient that increases cell turnover.  Otherwise, it’s not purging…it’s just irritation.

Iex. Purging does not occur with products like non-exfoliating cleansers, moisturizers, etc. 

Some ingredients, products, or treatments that CAN increase skin cell turnover + have ‘purging’ potential:

• Retinoids (e.g. tretinoin, retinol, retinaldehyde, or any Vit A derivative, etc.)
• AHAs (e.g. glycolic acid, lactic acid, malic acid, mandelic acid)
• BHAs (e.g. salicylic acid)
• Lasers and chemical peels
• Physical exfoliation (e.g. scrubs, microdermabrasion, sugar or salt scrubs)
• Acne spot treatments or medications  (e.g. benzoyl peroxide)

LOCATION:

If the inflammation is located in a predominantly defined area where you’ve previously experienced frequent breakouts, then think skin purging.

BUT if you notice a breakout located in new areas where you don’t often get pimples, you’re likely seeing a separate cause of acne and irritation—often a causing cosmetic dermatitis. Recognizing the location and pattern of your breakout is another key, as if the skin breaking out because of the product, the irritation will not get better with continued use + time to reconsider your approach and/or product.

CHARACTERISITICS: 

Because of the particular properties within the ingredient’s that cause  an increased rate of cell turnover, this essentially causes skin to breakout sooner than it would have without it. 

Contrary to what it looks like, when purging occurs after introducing a new product, it’s not the product actually producing new blockages—but rather these microcomedones coming to surface. (Microcomedones aka a clogged pore in its beginning stages). 

Microcomedones chill out in the deep layer of skin where they are blocked by inflammation surrounding the follicle from surfacing—they remain in this deep layer until erupting as an inflamed lesion over the course of ~8 weeks. *But* when ‘actives’ are applied and begin to accelerate cell turnover, this allows microcomedones to also surface at an accelerated rate where we can physically see them wreaking havoc all together (ie. a nasty breakout). Eventually this acceleration eliminates the excess sebum remaining and reduces overall inflammation left in the sebaceous glands—clearing the skin! 

Keep in mind: It’s possible for accelerated cell turnover to irritate already inflamed skin, which can also result in inflammatory acne, pustules, whiteheads blackheads, cysts, etc – In fact, it’s not uncommon to see both irritation and purging simultaneously. Your new product could work well and have the best ingredients, but if you’re noticing a lot of irritation with applying…it may just be too irritating or potent for you. You may find better results by findings a less potent option that is better tolerated by your skin or an alternative recommended by your Dermatologist. While it’s nice to know a product is strong & works well, a higher percentage of active ingredients doesn’t always mean better results. Trialing a product less potent and building up to the full strength or using small areas to patch test the ingredients is also an option to ease your way in incorporating routine actives until you reach a strength or formula that’s tolerable.

Personally, I’ve been going through such bad breakouts recently that have honestly just continued to worsen with COVID + mask use—so when I write comments like “focus on the positive!” Let it be known that I personally feel the struggle of applying this type of advice! I’m now 30 years old and experience terrible hormonal acne, all while seeing patients as a provider in plastic surgery (where everyone presumes you should have perfect everything, right? Well, not quite the case.)

I use my acne to remind myself to also really take care of myself, too…like, in more ways than simply having a really great skincare regimen. 

We’re all human with recent effects by the most disastrous year known to our generation yet (esp. those in healthcare)—our bodies are overworked, stressed, and likely with less than ideal dietary choices, too .

So yes, while this type of breakout is different than the temporary skin purging you may encounter introducing a new retinol or chemical exfoliant… I tell you all of this to say that I know how it feels to be really discouraged by acne/breakouts. 

I get it, no one wants to start a new product knowing that it may likely cause unwanted side effects, preemptively… But don’t let this stop you on your way to glowing skin—active ingredients like Retinoids (Vit A derivative) or exfoliants like AHAs/BHAs are widely used as a treatment modality for acne! Studies have actually shown that applying actives like Retinol can reduce the release of proinflammatory cytokines and decrease the number of acne breakouts by 40% –70% (Kraft & Freiman, 2011) – which is honestly a huge number. Especially when we’re talking about something as frustrating as acne.

TIPS TO MINIMIZE IRRITATION WHEN STARTING AN ACTIVE—-

Completely avoiding skin purging isn’t really possible, but you can definitely avoid a lot of unwanted irritation by introducing products properly. 

• If a product isn’t working well on your skin, start by first determining whether or not you’ve changed any lifestyle patterns, added any other new products to your routine, or changed routine(s) in anyway. Breakouts can be caused by so many addt’l various factors of our life including; diet, stress levels / new stressors, hormones (ie. monthly cycle, changing birth control methods), medications, & hygiene habits, or increased sensitivities causing irritation or clogged pores, ingrown hairs, etc. 
• If starting an active ingredient, it should be the only new product being added 

• Apply a pea sized amount 1-2x/wk + increase in a slow stepwise fashion until you’re able to tolerate applying routinely (this can take up to  6-8 wks). This will eliminate the extra redness and irritation caused by applying too much and/or too fast. 
• Mix in a small amount of the product with a regular moisturizer prior to applying on the skin and slowly increase the amount you use.

As always, it’s best to chat with your Dermatologist about the route that’s best for you esp. if you have known sensitivities.

Have questions? Ask away down below! 

References 

1. Josse, G., Mias, C., Le Digabel, J. et al. (2019). ‘High bacterial colonization and lipase activity in microcomedones’, Exp Dermatol, 29(2), 168-176. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/exd.14069
2. Kraft, J., & Freiman, A. (2011, April 19). Management of acne. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080563/. 
3. Saurat, J. (2015). ‘Strategic targets in acne: the comedone switch in question’, Dermatology, 231, 105-111. Available at: https://www.karger.com/Article/FullText/382031