Skin purging vs breakout
"Purging" is the name given to spots that appear in the first weeks of a new active ingredient, usually a retinoid. The idea is that the product brings clogs that were already forming to the surface faster. A breakout, in the same usage, is the product itself causing new clogs.
The second is the one you can check. Paste the product's label into our ingredient checker and it flags every ingredient with a published comedogenic rating, out of the 285 on our list.
How the two are usually told apart
The rule of thumb repeated across skincare sites runs like this:
| Said to be purging | Said to be a breakout | |
|---|---|---|
| Product | Said to be purging: An active meant to speed up skin turnover, such as a retinoid | Said to be a breakout: Any product |
| Where | Said to be purging: Where you usually get spots | Said to be a breakout: Anywhere the product goes, including new areas |
| Course | Said to be purging: Settles within weeks if you keep going | Said to be a breakout: Keeps going while you use the product |
That table describes the popular account. The next section is what the studies found. The account also has a plain consequence: a moisturizer, foundation or sunscreen is not meant to speed up skin turnover, so new spots after one of those are not purging even on the popular account.
What the studies found
In 2009 Yentzer, McClain and Feldman searched for evidence that acne gets worse when a topical retinoid is started. They found no primary data from clinical trials to support it. The data they did find pointed to retinoids improving acne, even in the first couple of weeks.
In 2012 Leyden and colleagues went back to clinical trial data for adapalene gel, a retinoid, and looked for a flare after the first week of treatment under several definitions, including a 5, 10 or 20 percent rise in inflamed spots. They found none.
The 2009 review offers another explanation for what people see: acne can get worse in the first week or two simply as part of its usual ups and downs. Starting a new product in a bad week can make that look like a reaction.
What this means for a new product
"It is just purging" is not a reason to keep using something that is causing spots. Both readings call for the same first step: look at what is in it.
How to check a new product
- Start one new product at a time. With two new things at once, there is no telling which one a change came from.
- Paste its full ingredient list into the checker. Note anything rated 3 or above, and how near the top of the list it sits: on a US label, ingredients above 1 percent are listed by amount, largest first.
- Give it time. The American Academy of Dermatology says acne treatments can take several weeks to a few months to show a difference, and that switching treatments too often can itself irritate skin and cause breakouts.
- See a dermatologist if spots are painful, leave marks, or do not settle.
The checker cannot tell you whether you are purging. It tells you whether the product holds ingredients with a published comedogenic rating, which is the part of a breakout that a label can show. Why the ratings exist at all is set out in acne cosmetica.
Common questions
Is skin purging real?
The trial evidence for it is thin. A 2009 review found no primary data from clinical trials showing that acne gets worse when a topical retinoid is started, and a 2012 re-analysis of adapalene trial data found no flare after the first week. The review notes that acne can worsen in the first week or two as part of its usual course, which may be what people are seeing.
How long does purging last?
There is no trial figure for it, because the trials reviewed did not find it. What the American Academy of Dermatology says is that an acne treatment can take several weeks to a few months to show a difference.
How can I tell if a product is breaking me out?
Start one new product at a time, so a change can be traced to it. Paste its ingredient list into the SkinSafeCheck checker, which flags anything on our list of 285 rated ingredients. If bumps appear where you apply it and you stop it, give the skin several weeks before judging, and see a dermatologist if it does not settle.
Check a product's ingredients
Paste a full ingredient list and the checker marks every ingredient on our list of 285, with its rating.
More questions about breakouts
Sources used on this page
- Yentzer BA, McClain RW, Feldman SR. “Do topical retinoids cause acne to ‘flare’?” Journal of Drugs in Dermatology, September 2009;8(9):799–801. (opens in a new tab) A literature review. It found no primary trial data supporting acne worsening when a topical retinoid is started, and notes that acne may worsen in the first week or two as part of the natural disease process.
- Leyden JJ, Preston N, Johnson LA, Gottschalk R. “Effects of topical retinoid therapy on acne lesions: a psychometric assessment.” Cutis, July 2012;90(1):46–50. (opens in a new tab) Re-analysed clinical trial data for adapalene gel after the first week of treatment and found no sign of a flare by any of the definitions tested.
- American Academy of Dermatology, “Acne: Tips for managing”. (opens in a new tab) Treatment can take several weeks to a few months to show a difference, and trying new treatments too often can irritate skin and cause breakouts.
- U.S. Food and Drug Administration, “Cosmetics Labeling Guide”. (opens in a new tab) Ingredients must be listed in descending order of predominance; those at 1 percent or less may follow in any order, and colour additives may be listed last in any order.
- Kligman AM, Mills OH Jr. “Acne cosmetica.” Archives of Dermatology, December 1972;106(6):843–850. (opens in a new tab) The paper that named cosmetic acne and started the search for which ingredients cause it.
- Draelos ZD, DiNardo JC. “A re-evaluation of the comedogenicity concept.” Journal of the American Academy of Dermatology, March 2006;54(3):507–512. doi:10.1016/j.jaad.2005.11.1058 (opens in a new tab) Found that animal-model results did not reliably predict what happened on human skin, and that a rating for a single ingredient does not tell you how a finished product will behave.
- American Academy of Dermatology, “Acne: When to see a dermatologist”. (opens in a new tab)