Is There Any Truth Behind The Infamous Tretinoin Purge?
I’ve been chasing good skin for as long as I can remember - a pursuit only intensified by a period of severe acne. Though the term 'good skin' is subjective, I’ve definitely fallen prey to the mainstream portrayal of what it's defined by: a blemish-free, bright, glowing and evenl-toned complexion. I want it all. When my skin looks good, I feel good. Am I superficial? A victim of beauty industry marketing? Either way, I'm not alone.
With over 319.7 million views on TikTok, and Google searches doubling in the past year, it seems tretinoin is the skincare ingredient we're counting on for that elusive blemish-free complexion. Tretinoin isn't a new thing: as Dr Ben Esdaile, consultant dermatologist at Skin + Me explains,'it was first used in 1962 and is backed by over 50 years of clinical scientific evidence to support its efficacy.' However, thanks to social media – and the remarkable before-and-afters that make for viral content – it’s having a skin-saving revival right now.
A pure form of retinoid, 'tretinoin is a prescription-strength topical active used to treat acne, hyperpigmentation, sun damaged cells, fine lines and wrinkles,' continues Dr Esdaile. 'It belongs to a family of synthetic and naturally occurring compounds called retinoids that are all derived from Vitamin A.'
Tretinoin is similar to, but absolutely not the same as retinol: a less potent retinoid in the Vitamin A family. While retinol and its sisters (think: retinal, retinol esters, retinyl palmitate) all require a series of 'conversions' within the skin before they are put to good use, 'tretinoin works directly on the retinoic acid receptors found on your skin cells, making it the most powerful retinoid available,' explains Esdaile.
While in America, tretinoin is available over the counter, in the UK it’s prescription only. That was until online dermatology services like Skin + Me, Dermatica and Klira simplified the process, making tretinoin more accessible.
A new kind of prescriptive skincare service, Skin+Me offers dermatological services with just a simple online consultation. A quick series of questions closely echoing those you would be asked in a face-to-face appointment, plus unfiltered photographs of your skin that are sent off to a dermatology team to examine, and you're ready to go. My prescription? A personalised treatment plan that included a low dosage tretinoin cream.
So what's tretinoin's skin-saving secret? The topical treatment works by accelerating the process of removal of dead skin cells and growth of new skin cells at a staggering rate. An overachiever, not only is it deemed a sure way to treat acne, it also increases collagen production, works on pigmentation, treats sun-damaged skin and reduces pore size. Sounds like the stuff of skincare dreams, but, inevitably, there’s a catch. A clear complexion at the hands of such a strong retinoid isn’t achieved without enduring the 'retinoid uglies', aka the purging stage.
You can't Google prescription retinoid journeys without coming across reports of the famous tretinoin purge: a period of red, inflamed skin often subjected to more breakouts than you had before. Search results include a host of message boards, videos, blog posts, and articles dedicated to the phase. Dermatologist and founder of Dr Nyla Skincare, Doctor Nyla Raja, explains that 'skin purging refers to a reaction when an active ingredient increases skin cell turnover rate which can cause old skin to shed. This can lead to flakiness and dryness when first using tretinoin or another active ingredient.' In short, things may just get a whole lot worse before they get better. 'If this happens to you, don’t panic – this is a normal process in the journey to clearing your skin and is known to occur in up to a quarter of people with acne,' assures Dr Esdaile. For me, the end goal was worth it. Or so I thought.
Knowing that the treatment would be a shock to my sensitive skin I went in slow and steady, but I still wasn't prepared for what happened next. My face felt raw, looked inflamed and red, and felt somehow greasy yet impossibly dry and tight at the same time. Worst of all, I had more breakouts than before and the flaking was extreme. Never had I gone through moisturiser quite as quickly, using bottle after bottle of Bioderma Atoderm Ultra-Nourishing Cream. I learned first-hand that when they say it gets worse, it really does get worse. At the point where my skin was sore to the touch, I decided to change my strategy, cutting down application to once a week and upping my moisturiser usage. Still, there were no signs of my dream skin: if anything the end goal seemed further away.
My optimism quickly plummeted. I didn’t know how much longer I could go through the tretinoin purging stage. But, after speaking to the dermatologist on-hand at Skin + Me and watching endless 'tretinoin purge' videos online, it was clear I had to persevere. But, how do you distinguish between a purge and a straight-up bad reaction? 'The difficulty is that a "purge" is a form of reaction: the industry has just decided to name it something else,' explains Dr Nyla. 'Typically, when a treatment is too strong for your skin, you will know. The skin won't just flake but it will feel painful, sore and very sensitive to touch. With tretinoin, skin redness, dryness, and mild burning may occur in the first few weeks of medication.'
However, it's not all bad news when it comes to tretinoin. In fact, it's super effective for a lot of people. 'I first heard about tretinoin in 2015,' says Nassima Iggoute, Senior Talent Manager at Modest Visions. 'It was supposed to be the answer to all skincare problems but like a lot of things, not easily accessible in the UK. So when Skin + Me launched with an easy service to prescribe it, I jumped at the chance. Starting with a gentle and low dose, I quickly saw results.' Like thousands of others, tretinoin, was coming true on its promise to deliver clear skin. 'However, it does take your skin some time to adjust, so a secure skincare routine is very important. Think: barrier repair and hydration. Once your skin adjusts, you are left free of breakouts and the acne scars left behind,' Iggoute adds.
What had been sold as 'good skin in a tube' apparently came with a side dose of hardship. 'As with all medications, digestible or topical, there can be side effects and it shouldn't be used when pregnant,' says Dr Nyla. 'Tretinoin can be uncomfortable and is generally not the first port of call for acne.' For me, the baby step approach just wasn't working and I had to conclude that my skin simply didn’t agree with tretinoin. I decided to stop. Instead, I switched to a minimalist skincare routine. It took a while but now my skin is back to a much calmer, happier state.
While there is no disputing that on the whole tretinoin works if you stick with it long enough, the journey isn't for everyone. Social media perpetuates the idea that skincare is a one size fits all situation, but this was certainly not for me. We've been told 'Pain is beauty' but does it have to be? My advice if you're considering tretinoin - proceed with caution.
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