Is your skin purging or breaking out? 3 dermatologists explain the difference

The word “purge” may conjure up one of two images: gunk being aggressively pushed out of pores or gruesome scenes from a dystopian horror film.

When it comes to skin purging, however, the truth is that it’s not nearly as gross or grisly. And while skin purging is more widely discussed these days, the question remains: is there a difference between skin purging and a regular breakout?

To find out once and for all, we check in with three of our most trusted dermatologists: Dr Teo Wan Lin, medical director of TWL Specialist Skin & Laser Centre; Dr Ker Khor Jia, medical director of Dermatology & Co, and Dr Liew Hui Min of SOG Dermatology – HM Liew Skin & Laser Clinic.

What exactly is skin purging?

According to our dermatologists, a skin purge refers to the temporary reaction some skin has to certain products, namely retinol and acids.

Dr Ker says, “[It consists] of an acne-like breakout – red papules or pustules (pus spots), blackheads and whiteheads, and cysts which surface on the skin due to increased skin cell turnover. There may be dryness and peeling skin.”

While red spots are the most common type of acne that surfaces during a skin purge, Dr Liew remarks that it all depends on your baseline skin condition.

“If it is cystic acne, it can be very uncomfortable with [an] eruption of pus with inflamed acne bumps,” she shares. “If it is moderate or mild acne, it will be red inflamed painful bumps on the face.”

What causes skin purging?

Turns out, retinoids and chemical exfoliants that are part of an acne skincare regimen are often the culprits of skin purging.

Exfoliants slough off the top layer of dead skin, prompting new ones to regenerate sooner than they would on their own, which can lead to blockages that cause breakouts.

Dr Teo says, “Retinoids, such as tretinoin and adapalene, work by reducing [the] formation of microcomedones, tiny invisible whiteheads and blackheads that gradually surface over two to four weeks as acne bumps.”

“Using the product for the first time can look like it is triggering off a flare,” she explains. But what it’s actually doing is shortening the time for microcomedones to appear.

Furthermore, skin purging doesn’t just happen for those who use those topical actives. Dr Teo says it can happen to those taking oral treatments for acne too.

“However, there really is no scientific consistency behind these reports, so it is hard to comment,” she leads on. “Oral medications take about two weeks to work. If one does have a flare [during the first few weeks], this may just be due to the natural course of [the] acne itself.”

Dr Ker chimes in, saying, “At times, certain procedures, for example, lasers, can also lead to a temporary skin purging process before improvement can be seen.”

How long does a skin purge last?

All three dermatologists anticipate a skin purge to last for two to four weeks. “If it lasts longer than four weeks, please see your dermatologist,” Dr Liew advises.

And if you think your acne treatment isn’t working, Dr Teo suggests discussing it with your dermatologist as there are other side effects that could develop along the way.

Due to the drying effects of acne treatments, you could develop “a form of eczema, known as irritant contact dermatitis.”

“The danger of believing that skin purging exists during acne treatment is that the individual does not seek medical attention for complications,” Dr Teo warns.

How can we spot the difference between skin purging and acne?

When you introduce a new skincare product to your routine, it’s also important to bear in mind that not all reactions are technically a skin purge.

The product you use could be irritating your skin for a different reason. For example, it can trigger an allergic reaction or clog your pores, which causes pimples.

“In purging, there would be a prior cause – for example, a product or procedure which led to it. In general, spots due to purging heal faster than an acne breakout,” Dr Ker explains.

Dr Liew concurs, pointing out that skin purging happens in the areas where you’ve applied an active ingredient. An acne breakout, on the other hand, can appear randomly on the face and take much longer to heal.

Can we prevent skin purging?

Preventing a skin purge aftermath when you’ve decided to use a new skincare product is something that’s fairly inevitable, but there are certain ways to reduce the overall damage.

For instance, Dr Teo says that if you have inflamed acne bumps or cysts, you should avoid applying retinoids (including over-the-counter retinol) on those areas.

“If the purging was due to the use of a retinoid-containing product, then reduce the frequency of usage to twice a week instead of daily,” Dr Ker suggests.

“When the purging has improved, slowly increase the frequency of usage to every other day and then daily. You can also start with a lower concentration of retinoids first and increase the strength when the skin has adapted to it.”

To prevent severe purging, Dr Liew also recommends ingesting oral medication on alternate days instead of daily. Just as Dr Ker advised, Dr Liew says you can gradually increase the dosage of topical and oral medication once the purging subsides.

How to treat a skin purge

Now, when it comes to treating your skin during a purge, the best thing that you can do is to wait it out (i.e. the least gratifying answer you’d want to hear).

However, there are ways to make the healing process a little more bearable. Dr Liew suggests using “a gentle cleanser and hydrating moisturiser [that are] not irritating to the skin.”

Look out for formulas that contain hyaluronic acid, vitamin E, and ceramides as they hydrate, nourish, and bolster your skin barrier.

“When treating cystic acne, your dermatologist may consider a low dose of oral steroid to prevent severe purging,” she adds.

Dr Ker also recommends using a gentle cleanser to ease the purging period. “Do not pick on the spots and wash your face with cool or room temperature water,” she says. Additionally, soothing, fragrance-free formulas can aid your skin.

If you’d like to know for sure that your skin is purging, Dr Teo suggests visiting an accredited dermatologist first.

“Many conditions such as acne rosacea and infected eczema can co-exist or even be the underlying cause of acne-like bumps on the face,” she shares. “When an episode is deemed severe enough for the individual – it is wise to advocate medical attention.”

“If it is clearly a case of inflamed acne bumps, take care to use a non-irritating acne cream. Benzoyl peroxide and retinoid formulations will worsen inflamed acne bumps,” Dr Teo warns.

For those with zits that are ready to pop, Dr Teo recommends hydrocolloid patches as they “can help to reduce bacterial growth and improve drainage of pus.”

How to treat different types of acne

Whether it’s caused by hormonal imbalance, prolonged mask-wearing, or pore-clogging products, acne can be a real struggle to manage.

So, we asked our doctors to find out how we can best treat the different types of zits that show up on our faces uninvited.

Whiteheads and blackheads

According to Dr Teo, “comedones (whiteheads and blackheads) are best treated with retinoids [and] chemical peels, which help to resurface the skin and normalise the rate of skin shedding.”

Dr Ker also recommends topical retinoids, topical antibiotics (with or without benzoyl peroxide), as well as face washes that contain salicylic acid to reduce pesky whiteheads and blackheads.

Related read: 14 best salicylic acid products to unclog pores for clearer skin, from cleansers to leave-on exfoliants

Papules, pustules, and nodules

In terms of mild acne, it may take the form of papules, which are small, raised reddish bumps on the skin.

Meanwhile, pustules are small white or yellow spots surrounded by a swollen, reddish area that’s painful. That points to an infected and inflamed hair follicle within the contained sebum.

Nodules, on the other hand, are larger, more solid lesions that lie deeper within the dermis layer of the skin, hence they’re often painful.

Similar to the treatment of whiteheads and blackheads, both Dr Ker and Dr Liew suggest oral antibiotics and topical retinoids to treat papules, pustules, and nodules.

Depending on the severity of your acne, Dr Liew also recommends over-the-counter products that contain salicylic acid and benzoyl peroxide.

Large nodules and cysts

Cystic acne is similar to nodular acne, where bumps form beneath your skin’s surface. But unlike nodules, cysts are softer, while nodules are firmer and more painful.

“Inflamed acne, such as papules, pustules, nodules, and cysts should be treated with anti-inflammatory temporising methods,” Dr Teo says.

“For example, a botanical-based ingredient such as chlorella vulgaris [and] berberine proven to reduce inflammation can be helpful,” she adds.

“Low potency topical steroids can quickly calm inflammation, though these must be for short-term, localised use,” Dr Teo alerts.

For stubborn, active cysts, Dr Teo and Dr Liew recommend steroid injections. However, Dr Teo says, “These are associated with higher risks for indented scars and [their] use must be discussed with a dermatologist.”

If a large cyst doesn’t settle after a steroid injection, Dr Liew suggests visiting a dermatologist “for surgery to either drain it or excise it.”

Featured image credit: xFrame.io