What products or acne medications can cause skin purging?
Retinoids (such as Retinol and Tretinoin) are widely associated with skin purging. Retinoids are synthetic or natural derivatives of Vitamin A and they improve skin health in many ways. They stimulate collagen production, regulate skin cell turnover, increase blood flow, and decrease inflammation2.
Retinol skin purge
Anti-aging products containing retinol are known to cause the skin to purge. Beauty or cosmetic creams are not required to prove their effectiveness in the same way as medicines, so there is no formal assessment of documented side effects. This means it is harder to determine the facts about these products and skin purging. That being said, there are widespread reports of skin purging with retinol products. It is believed that these Vitamin A-derivatives stimulate collagen production and cell turnover in order to work, which is directly linked to skin purging.
What is retinization?
Retinization is a term associated with the use of topical retinoid treatments, such as retinol and adapalene (Differin) or oral (taken by mouth) isotretinoin3.
Retinization is described as the period during which the skin adapts to the retinoids and becomes dry, red and irritated. Not everyone experiences these side effects of retinoids (also known as retinol uglies) and it normally improves after four weeks.
In some cases, symptoms can be quite severe and it is necessary to discontinue product use. Retinization can be improved by using a gentle, non-oily moisturizer that will help rehydrate and soothe the skin.
Isotretinoin skin purge
Isotretinoin capsules belong to this class and are prescribed for severe acne that has not responded to other treatments. isotretinoin is sold under the brand names: Absorica, Absorica LD, Claravis, Amnesteem, Myorisan, and Zenatane in the U.S.
According to the manufacturers, it is not clear how isotretinoin works to improve acne, but it is known to reduce the size of sebaceous glands and also has anti-inflammatory action in the skin4.
It seems to reset the normal order of cell differentiation to do this and reduces sebum production. The bacteria associated with acne grow in the sebum and so they are reduced.
Isotretinoin may have a very rare side effect by which Acne can get worse in the first few weeks, but symptoms should improve with time5.
So, for Isotretinoin capsules, a flare up is a very rare, but a recognized event for this medicine. In addition, it is very common to experience dry, inflamed, and chapped skin with rash, itching and peeling; these symptoms are associated with the tretinoin purge but have also been called retinization.
Adapalene skin purge
Adapalene is a topical retinoid prescribed to treat mild to moderate acne. It is sold under the brand names Differin or Plixda in the U.S.A
Adapalene has an anti-inflammatory effect and an uncommon side effect related to skin purging, the so-called Differin purge6.
Some common side effects of Adapalene include dry skin, skin irritation, skin burning sensation and redness. This redness and irritation associated with the use of topical retinoids is also known as retinization and it normally improves after four weeks.
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Can other acne treatments cause skin purging?
Does benzoyl peroxide purge skin?
A first-line treatment for mild acne are creams and gels containing benzoyl peroxide which are available without a prescription.
Benzoyl Peroxide works primarily by killing the bacteria associated with acne, but it is also slightly anti-inflammatory and mildly keratolytic, which means it helps exfoliate the skin.
Benzoyl Peroxide does not have any reported skin purging or flare-like side effects by which acne worsens, but it does take six to eight weeks to take effect.
A common side-effect of Benzoyl Peroxide is dry skin, redness, peeling and burning. These side effects could be seen as a kind of flare up, even though the acne itself is not known to worsen.
There are a number of prescription treatments that are applied directly to the skin that are used for mild to moderate acne (acne with more spots on the face and often spreading onto the body) which do have the known side effects that are like skin purging. Most treatments for acne require at least 4-8 weeks to start to show improvements.
Does clindamycin gel and benzoyl peroxide purge skin?
Topical Clindamycin Phosphate and Benzoyl Peroxide, an effective treatment for acne, is sold under the brand names Acanya, BenzaClin, Duac, Neuac, Onexton, Z-Clinz 10 and Z-Clinz 5.
This combination has an uncommon side effect of worsening acne and some common side effects of redness, peeling, dryness which could also seem like a worsening of the skin.This side effect could be seen as a skin purging effect7.
Does azelaic acid aause skin purging?
Azelaic Acid, sold under the brand names Azelex, Finacea, and Finacea Plus is another prescription medication with an uncommon side effect of acne worsening and a common side effect of burning, itching and redness8.
Topical Clindamycin/Benzoyl Peroxide or Azelaic Acid do not cause an increased turnover of skin cells, therefore, the side effects these medications have should not be seen as real skin purging, even though the experience of worsening skin could be very similar.
Can oral antibiotics cause skin purging?
It is uncommon that oral antibiotics used to treat severe acne or widespread acne across the body, such as tetracycline, minocycline, lymecycline, erythromycin and Trimethoprim cause skin purging.
This is because they work by stopping the growth of the bacteria commonly associated with acne and by reducing the concentration of free fatty acids in sebum, which causes spots.
These antibiotics may also have anti-inflammatory properties, but do not directly affect the rate of skin cell turnover.