The Retinoid Uglies: How to Deal with Retinoid Side Effects and Purging

Image showing a woman with the retinol uglies.

If you’ve started using a topical retinoid such as tretinoin or adapalene to help clear your acne, you may be in for a rude shock if, instead of showing improvement, your skin takes a turn for the worse during the first few weeks.

When you are dealing with acne and already self conscious about your skin, it can be disheartening to struggle with irritation and peeling and sometimes even more acne. This uncomfortable adjustment period is referred to as retinization, but it is also aptly called ‘the retinoid uglies,’ ‘the retinol uglies,’ and ‘the tretinoin uglies.’

Fortunately, the retinoid uglies is a case of your skin getting worse before it gets better, and it shows what a powerful effect retinoids can have on your skin. Read on to learn more about the retinoid uglies and how to minimize its effect. 

What Are Retinoids?

Retinoids are derivatives of vitamin A and are often a first-line treatment option for acne therapy thanks to their proven efficacy. Topical retinoids work by accelerating the turnover of skin cells, which prevents the buildup of dead cells within hair follicles that can lead to the formation of acne. The anti-inflammatory properties of retinoids can also help reduce the redness and swelling associated with more inflamed acne. In addition to clearing acne, retinoids, particularly tretinoin, have been proven to reduce wrinkles and signs of photoaging.

Commonly prescribed retinoids for acne include tretinoin, adapalene, and tazarotene. Adapalene at a lower strength and retinol are also available over the counter. 

What Are the Retinoid Uglies?

The retinoid uglies (sometimes also called the retinol uglies, the tretinoin uglies, or the retin uglies) is a way of referring to the initial side effects some people experience when they start using retinoids. The term can mean both skin irritation and skin purging and it is a normal part of your skin adjusting to a retinoid.

The retinoid uglies are not the same as an allergic reaction. If you experience redness, swelling, or itching, stop using the retinoid and see a doctor or dermatologist.

Skin Irritation from Retinoids

While retinoids can help improve your skin by increasing the cell turnover, this same function can also cause your skin to temporarily have side effects such as:

  • Redness
  • Flaking
  • Dryness
  • Increased sensitivity

Your normal cleanser and moisturizer may begin to sting and you might even notice pieces of your skin peeling off. This is all a result of the skin adjusting to the active ingredient and it is sometimes called retinoid dermatitis. Introduce retinoids into your skincare routine gradually, starting with lower concentrations or fewer application days per week to minimize these side effects, particularly if you know that you have sensitive skin. If you do experience irritation, take a short break from your retinoid and use gentle face wash and moisturizer to help soothe your skin.

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What is Skin Purging?

Skin purging is a temporary breakout that can occur when you start using a new skincare product, such as a retinoid or chemical exfoliant. Retinoids accelerate the skin’s natural turnover process, meaning that underlying microcomedones (tiny clogged pores) come to the surface faster. As a result, some people may experience a temporary increase in breakouts when they first start using retinoids. 

While it may feel like the retinoid is causing new acne, in reality these breakouts were already due to come out; your retinoid is just bringing them out faster. Breakouts from purging usually last from 4-8 weeks, and most people find that their skin looks clearer and smoother in the long run. 

If you’re experiencing severe irritation or prolonged breakouts after using retinoids, you should consult your dermatologist. It may be necessary to adjust the strength, frequency of use, formulation, or in rare cases, discontinue it altogether. 

Skin Purging vs. Breakout

Identifying whether breakouts are due to normal skin purging or a reaction of your skin to the retinoid or other ingredients in the cream or gel it comes in can be challenging. Here are some general characteristics and guidelines to consider:

  • Location of breakouts: Purging typically occurs in areas where you usually already get breakouts or have clogged pores. If the new pimples are where you usually experience acne or have closed comedones, then it is likely what was already there is being brought to the surface. For example, you may normally get acne on your chin and jawline and after starting a retinoid you notice an increase of pimples on your chin. In this case, it is likely your skin “taking out the trash” and bringing blockages to the surface. However if you’re seeing acne in areas where you don’t usually break out, you should contact your doctor to be sure it is not a reaction to the medication.
  • Timeline: Purging generally has a limited duration. When you speed up your skin turnover by using a retinoid, purging can last anywhere from a few weeks up to six weeks. If your breakout is persisting longer without any signs of improvement, it might not be purging. You may also experience an additional wave of purging if you increase the strength of the retinoid you are using.
  • Severity: While purging can look more intense initially as existing microcomedones come to the surface, if you notice sudden, severe, or painful breakouts, it’s essential to consult a dermatologist. They can provide guidance on whether to continue the product or if it’s causing more harm than good.
  • Other Symptoms: If the breakouts are accompanied by other signs of irritation like itching, burning, or significant redness, it could be an allergic reaction or excessive irritation rather than purging.
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Tips to Minimize Purging and Irritation

Here are some suggestions to help you get through purging and irritation from retinoids:

Start Slow

Jumping straight into daily use of retinoids can shock your skin, leading to increased chances of irritation and damaging your skin barrier. Instead, consider applying the product every other night or even once every three nights initially. You can try skin cycling with your retinoid and gradually increase the frequency as your skin acclimates.

Pare Back Skin Care

During your initial phase of retinoid use, you should find ways to simplify your skincare routine. Avoid using other actives or exfoliants concurrently, as this can heighten sensitivity and irritation, and stick to gentle cleansers and moisturizers that will help support your skin barrier instead. You may find that you need a richer moisturizer to help deal with the dryness from your retinoid.

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Apply Correctly

A little goes a long way with most retinoids. Put a pea-sized amount onto your fingertip and dot it on your forehead, cheeks, and chin. Then, gently spread and blend it over your entire face, avoiding sensitive areas like the eyes, nostrils, and corners of the mouth.

Use Lower Strength Retinoid

Beginning with a milder formulation can reduce the risk of a difficult adjustment period. As your skin becomes more tolerant, you can consider moving up to a higher strength if necessary. 

For example you can start with over-the-counter 0.1% strength adapalene before using the prescription strength 0.3%. Or you can start a tretinoin prescription as low as 0.025% and once you are able to use it nightly with no side effects, you can increase to 0.05% and then maybe even 0.1%. If your insurance covers it, the microsphere version of tretinoin is time released which can reduce irritation. 

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Buffer or Sandwich Method

“Buffering” is a method where you apply moisturizer before your retinoid. By reducing its direct contact with the skin it can diminish potential irritation. The “sandwich method” goes a step further by applying moisturizer before and after your retinoid, sandwiching it between layers of moisturizer. Start by applying a light moisturizer, then the retinoid, and finish with another layer of the same or a thicker moisturizer.

Sun Protection

Retinoids’ ability to accelerate skin cell turnover, quickly bringing newer skin cells to the surface, can make your skin more sensitive to the sun. Additionally, retinoids can thin the outer layer of the skin while enhancing the deeper layers, making your skin more susceptible to UV damage. To reduce the risk of irritation or damage from the sun, make sure to use a broad-spectrum sunscreen every day, even on cloudy days, seek shade when the sun is at its peak, and wear protective clothing, sunglasses, and hats.

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Apply to Dry Skin

Applying retinoids to damp skin can increase their absorption, which might intensify potential reactions. To minimize this risk, always ensure your skin is thoroughly dry before application. After washing your face, wait about 10-15 minutes before applying your retinoid.

Other Treatment

If you have inflammatory acne such as cystic acne and are at risk for a huge breakout or scarring from a purging phase, you can speak to your doctor about other treatments that can be used concurrently with your retinoid to manage or reduce purging while you adjust. 

Common co-treatments include: topical antibiotics, benzoyl peroxide, oral antibiotics, azelaic acid, and spironolactone or certain types of birth control pills for hormonal acne. If your acne is severe, your doctor may recommend a course of Accutane first before using topical retinoids.

@shereeneidriss

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Experiencing the irritation and purging that can accompany a new retinoid treatment can feel like a hazing ritual your skin is putting you through. As long as you are not experiencing an allergic reaction, and the purging and irritation are not severe, the best thing you can do is have patience. 

Try to ease into retinoid use and know that the retinoid uglies are a temporary phase. In fact, by seeing the negative effects their potency can have on your skin initially, you’ll get an idea of all that retinoids can do for you in the long term once their power is harnessed and they are working for the benefit of your skin.

The use of topical retinoids for acne should be done under the guidance of a healthcare professional or dermatologist. They can assess your skin concerns, medical history, and provide tailored recommendations for the most appropriate retinoid treatment.

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