Retinol Purge: What Labels and the AAD Say About Flares

Quick answer: A retinol purge is the popular name for acne that looks worse after you start a retinoid. None of the sources we checked uses that word, and none gives a purge length for over-the-counter retinol. For tretinoin, a prescription retinoid, the Retin-A label says an apparent exacerbation of inflammatory lesions may occur in the early weeks. It adds that this should not be considered a reason to discontinue therapy. MedlinePlus says acne probably gets worse during the first 7 to 10 days of tretinoin. The Retin-A patient information says to discontinue Retin-A and consult your physician for severe or persistent irritation. MedlinePlus says to call your doctor immediately for itching, rash or hives, or for pain or discomfort at the treatment area.

This page covers what the labels and the American Academy of Dermatology (AAD) say about acne that flares on a retinoid. Where no allowed source answers a question, we say so instead of guessing.

What does a retinol purge mean, according to the sources?

“Purge” is a social media and skincare-blog term. It is a name for breakouts that appear or get worse after a retinoid is started. The sources we are allowed to use here are FDA and DailyMed labels, the AAD, MedlinePlus and PubMed. None of them defines a “retinol purge” or gives it a length.

The labels do not call that flare a purge. The lines below are for tretinoin and for over-the-counter adapalene, not for retinol. The Retin-A (tretinoin) label says that during the early weeks of therapy, an apparent exacerbation of inflammatory lesions may occur. It explains that this is due to the action of the medication on deep, previously unseen lesions. It adds that this should not be considered a reason to discontinue therapy.

The label for an over-the-counter adapalene gel, another retinoid, gives similar directions. It says that during the early weeks of use, your acne may appear to worsen before it improves, and that this is normal. It also says to continue using it as directed unless you get irritation that becomes severe. The same label says to stop use and ask a doctor if irritation becomes severe, or if you see no improvement after 3 months of once daily use.

Does retinol itself cause a purge?

We found no label, AAD page or trial abstract that reports a purge from retinol products. A 2006 paper on retinoids in cosmeceuticals says retinol and retinyl esters are not irritant, whereas demonstrating only a modest clinical efficiency. A 2022 study reported on 33 subjects with mild to moderate acne who completed it. It paired morning low-dose (2.5%) benzoyl peroxide with an evening topical retinol. It reported a significant reduction in global total acne count from baseline to week 12. It reported no statistically significant increases in objective or subjective facial irritation. The abstracts we checked do not report a measured flare.

Our article on retinol vs tretinoin compares the two, and the one on over-the-counter retinol covers those products.

How long does a retinol purge last?

No allowed source gives a purge length for retinol. Any purge-length figure you see online for retinol is not in the labels, the AAD pages or the abstracts we checked, so we do not repeat it.

For tretinoin, MedlinePlus says acne probably gets worse (red, scaling skin and an increase in acne sores) during the first 7 to 10 days. It says to continue using the medication. It adds that the sores should improve in 2 to 3 weeks, and sometimes more than 6 weeks, of regular use.

The Retin-A label says results should be noticed after 2 to 3 weeks, but more than 6 weeks of therapy may be required before definite beneficial effects are seen.

For adapalene, the over-the-counter label says irritation is more likely in the first few weeks of use and usually lessens with continued use. It also says it may take up to 3 months of once daily use to see results.

On its treatment page, the AAD says it takes at least 6 to 8 weeks before you start to see fewer breakouts. On its page about acne that won’t clear, the AAD says that if a treatment works for you, you should notice some improvement in 4 to 6 weeks. It adds that clearing can take two to three months or longer. These figures describe when treatment starts to help, not a flare countdown. Our tretinoin before and after article covers photo tracking.

Is it a purge, irritation, an allergic reaction or a regular breakout?

The sources do not give a test that sorts these four apart. We found no allowed source that says a purge shows up only in your usual spots. The sources do list signs that call for a prescriber.

What does a flare on tretinoin look like?

MedlinePlus, writing about tretinoin, says acne probably will get worse, with red, scaling skin and an increase in acne sores. So redness and scaling can come with the extra pimples, and those signs alone do not separate a flare from irritation.

What does retinoid irritation look like?

MedlinePlus lists dryness, itching, burning, stinging, peeling, swelling, redness, blistering or flaky skin at the treatment area. It says to tell your doctor if any of these are severe or do not go away. The AAD says tretinoin and other acne treatments tend to dry and irritate the skin. It adds that when your skin becomes dry, your body makes more oil, which can clog pores.

The Retin-A patient information says the skin of certain sensitive individuals may become excessively red, swollen, blistered or crusted. It says that if you are experiencing severe or persistent irritation, discontinue the use of Retin-A and consult your physician.

Could it be an allergic reaction?

The Retin-A label says true contact allergy to topical tretinoin is rarely encountered. The AAD says that developing irritated skin doesn’t typically mean you have an allergy to this medication, and that a retinoid may still be a treatment option for you.

Neither statement lets you rule out an allergy at home. MedlinePlus says to call your doctor immediately for itching, rash or hives, or for pain or discomfort at the treatment area.

Could it be a regular breakout instead?

Yes, it could be an ordinary breakout. The AAD warns that trying a new acne treatment every week or so can irritate your skin and cause breakouts. If you started several new products at once, no allowed source says how to tell which one caused a flare. The AAD also says that if you have deep or painful acne, seeing a dermatologist is necessary to help clear it.

When should you stop and call your doctor?

The sources name separate reasons to stop or to call your doctor. Each one is a reason on its own:

• MedlinePlus says to call your doctor immediately for itching, rash or hives.
• MedlinePlus also says to call your doctor immediately for pain or discomfort at the treatment area.
• The Retin-A patient information says to discontinue the use of Retin-A and consult your physician if you are experiencing severe or persistent irritation.
• The same patient information says that if you become sunburned, you should stop therapy with Retin-A until your skin has recovered.
• The adapalene label says to stop use and ask a doctor if irritation becomes severe.

MedlinePlus says to tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. We found no allowed source that makes a pregnancy statement for retinol, so ask your prescriber about any retinoid in that situation.

When should you see a dermatologist about a flare?

First, the Retin-A patient information says to discontinue Retin-A and consult your physician for severe or persistent irritation. MedlinePlus says to tell your doctor if blistering is severe or does not go away. Second, if you have deep or painful acne, the AAD says seeing a dermatologist is necessary. Third, the adapalene label says to stop use and ask a doctor if you see no improvement after 3 months of once daily use. The AAD says to give an acne treatment at least 4 weeks to work. It adds that if a treatment works for you, you should notice some improvement in 4 to 6 weeks. Those AAD lines describe when treatment starts to help, not a deadline for booking a visit.

The 2024 AAD acne guideline gives topical retinoids a strong recommendation for acne.

If a retinoid irritated your skin in the past, the AAD says to let your dermatologist know. If you take isotretinoin, the AAD says to avoid retinol applied to the skin. It says this ingredient can irritate your skin, which is more sensitive while you take isotretinoin. Our article on using retinol or tretinoin while on Accutane® goes through that question.

How can you ease irritation while your skin adjusts?

Ask about using less

The AAD says your dermatologist may recommend a smaller amount of medication, using the retinoid less often, or applying moisturizer first. The last tip applies especially if your skin needs a stronger retinoid. It adds that you should only make these changes with your dermatologist’s help.

The Retin-A label says that if the degree of local irritation warrants, patients should be directed to use the medication less frequently, discontinue use temporarily, or discontinue use altogether. It says therapy may be resumed, or the frequency of application increased, when patients become able to tolerate the treatment.

Moisturize every day

The AAD moisturizer page says these treatments tend to dry and irritate the skin, and it lists adapalene, tazarotene and tretinoin. It adds that a daily moisturizer can help your skin tolerate them. It lists oil-free, non-comedogenic and won’t clog pores. MedlinePlus also says your doctor may tell you to use a skin moisturizer to help with dryness.

Keep the rest of your routine plain

For tretinoin, MedlinePlus says to use only non-medicated cosmetics on your skin. It says not to use topical preparations with a lot of alcohol, menthol, spices or lime, such as shaving lotions, astringents and perfumes. It adds that they can sting, especially at first. It also says not to use any other topical medications unless your doctor directs you to do so. That warning especially names benzoyl peroxide, hair removers, salicylic acid and certain dandruff shampoos.

The AAD recommends a mild, non-comedogenic cleanser. It says popping or squeezing acne can push pus, dead skin cells or bacteria deeper into your skin. That can increase inflammation, and sometimes scarring and pain. Our guide to a skincare routine on acne medication covers product order.

Protect your skin from sun and weather

The Retin-A label says exposure to sunlight, including sunlamps, should be minimized during use. It recommends sunscreen and protective clothing over treated areas when exposure cannot be avoided. The AAD says to use sunscreen that offers broad-spectrum protection, SPF 30 or higher, and water resistance. MedlinePlus adds that weather extremes, such as wind and cold, may be particularly irritating to the treated areas.

Where does The Goal Is Clear fit in your plan?

The Goal Is Clear’s how it works page says every case is reviewed by a U.S. board-certified dermatologist licensed in your state. The quiz takes about two minutes, and you upload two photos, one from the front and one from the side. The dermatologist reviews your case within 24 hours. The page says patients can message their dermatologist through the dashboard, including side-effect reports, and that a real person reads every message.

Medication decisions stay with the dermatologist who reviews your case, and a prescription is never guaranteed. Medication is billed separately by the pharmacy, as low as $0 for the prescription with insurance. You pay at checkout and are refunded in full if your dermatologist does not prescribe. The pricing page has the details.

BNG Health Services, LLC operates The Goal Is Clear and is not your prescribing physician.

Common questions about the retinol purge

What is a retinol purge? It is a name for breakouts that appear or get worse after a retinoid is started. No allowed source uses the term. The Retin-A label says an apparent exacerbation of inflammatory lesions may occur in the early weeks of tretinoin. It says this is due to the action of the medication on deep, previously unseen lesions. We found no allowed source that reports a purge for retinol products.

How long does a retinol purge last? No allowed source gives a length for retinol. For tretinoin, MedlinePlus says acne probably gets worse in the first 7 to 10 days. It says the sores should improve in 2 to 3 weeks, and sometimes more than 6 weeks. The AAD figure of at least 6 to 8 weeks is about when you start to see fewer breakouts from treatment, not a flare countdown.

Is it a purge, an allergic reaction, irritation or a regular breakout? The sources give no test that separates them. The AAD says developing irritated skin doesn’t typically mean you have an allergy to this medication. The Retin-A label says true contact allergy to topical tretinoin is rarely encountered. MedlinePlus says to call your doctor immediately for itching, rash or hives, or for pain or discomfort at the treatment area.

When should you see a dermatologist? The Retin-A patient information says to discontinue Retin-A and consult your physician for severe or persistent irritation. The AAD says that if you have deep or painful acne, seeing a dermatologist is necessary to help clear it. The adapalene label says to stop use and ask a doctor if irritation becomes severe, or if you see no improvement after 3 months of once daily use. The how it works page says a board-certified dermatologist licensed in your state reviews your case within 24 hours.

How can you ease irritation from a retinoid? The AAD says your dermatologist may suggest a smaller amount, less frequent use or moisturizer first. It says to make those changes only with your dermatologist’s help. The AAD also says a daily moisturizer can help your skin tolerate these medications. For tretinoin, MedlinePlus says not to use topical preparations with a lot of alcohol, menthol, spices or lime. The AAD says to use sunscreen that offers broad-spectrum protection, SPF 30 or higher, and water resistance.

What is the short version of all this?

The Retin-A label says an apparent exacerbation of inflammatory lesions may occur in the early weeks of tretinoin. MedlinePlus says acne probably gets worse in the first 7 to 10 days of tretinoin. The adapalene label says acne may appear to worsen before it improves, and that this is normal. The sources give no length for retinol and no test that separates a purge from irritation or a regular breakout.

If you would like a board-certified dermatologist to look at your case, take the quiz. The how it works page says the quiz takes about two minutes, and that you upload two photos, one from the front and one from the side. Our article on retinol vs tretinoin for acne goes deeper on choosing between them.

This article is general information, not medical advice. A prescription is never guaranteed, and treatment decisions stay with the board-certified dermatologist who reviews your case. Accutane® and Retin-A® are registered trademarks of their respective owners, and isotretinoin and tretinoin are the generic names. The Goal Is Clear is operated by BNG Health Services, LLC, which is not the prescribing physician; board-certified dermatologists prescribe.

Sources

• Reynolds et al., Guidelines of care for the management of acne vulgaris, J Am Acad Dermatol 2024
• Sorg et al., Retinoids in cosmeceuticals, Dermatol Ther 2006
• Kosmoski et al., A Topical Combination Regimen of Benzoyl Peroxide and Retinol Moisturizer for Mild to Moderate Acne, J Drugs Dermatol 2022
• American Academy of Dermatology, Acne: Diagnosis and treatment
• American Academy of Dermatology, Acne that won’t clear
• American Academy of Dermatology, Moisturizer: Why you may need it if you have acne
• American Academy of Dermatology, 10 skin care habits that can worsen acne
• American Academy of Dermatology, Isotretinoin: side effects and skin care
• Retin-A (tretinoin) cream and gel prescribing information, DailyMed
• Adapalene gel 0.1% Drug Facts, DailyMed
• MedlinePlus, Tretinoin topical