It is not uncommon for skin to behave badly when you start a new active ingredient. This is especially true for acne clearing treatments which can be quite hard to digest. This is often in the form of a flare up in breakouts and congestion. What’s particularly hard is figuring whether this is due to a temporary process like skin purging or if the skin is genuinely breaking out. This difficulty comes from the fact that purging and breakouts can look remarkably similar. Both involve spots and blotchiness, both can feel uncomfortable and both can make the skin appear worse before it settles. Yet the causes are very different and they often need a different treatment approach. In this article, we explore the difference between purging vs breakouts and how to tell them apart. We’ll also review how to properly treat each one.
What is Purging?
Purging is a temporary flare in spots that can occur when you introduce active ingredients that speed up cell turnover. It most commonly occurs in people who have acne prone skin. Treatments such as retinoids, exfoliating acids or strong vitamin C serums encourage the shedding of older skin cells and bring underlying clogged pores to the surface more quickly. These clogged pores are called microcomedones and represent the earliest stages of acne. To be clear, they were already present beneath the skin and would have appeared eventually and become acne. The active ingredient simply accelerates the process.
Purging usually shows up as small whiteheads, blackheads or mildly inflamed bumps in areas where you typically break out. Although annoying, this can be a normal stage of adapting to a new treatment. Usually purging looks similar or milder to your usual acne type and may resolve more quickly. Whether you need to do anything about them depends on whether the skin is otherwise tolerating the skin products (ie no irritation) and how severe the purging is.
What are Breakouts?
Acne breakouts usually occur when the skin becomes congested or inflamed due to blocked pores, irritation or changes in oil production. They come in a variety of forms and severities. Breakouts may range from mild non inflammatory comedones (e.g. white heads or black heads) to inflammatory lesions such as pimples, pustules, cyst or nodules. Although breakouts are a normal part of untreated acne, they can also be triggered when something disrupts the balance of the skin. This includes comedogenic or irritating skincare or beauty products that damage the skin barrier, disrupt the microbiome or clog pores. Hormones, stress and fluctuations in weather can also increase oil production and make the skin more prone to breakouts.
Breakouts can look the same or different from your normal acne pattern depending on the trigger. They may also be deeper, more painful or unusually widespread if severe. It is usually necessary to treat breakouts as they don’t necessarily go away by themselves. Not only can breakouts persist, but they can also get worse and leave behind severe scars or hyperpigmentation.
How to Tell the Difference Between Purging vs Breakouts
The features of purging and breakouts overlap but a few clues can help differentiate between the two. Paying attention to the pattern and behaviour of the spots can offer useful insight.
- Location: Purging usually shows up in areas where you normally tend to break out. Breakouts can also appear in new or unusual places.
- Timing: Generally, purging begins within the first 3 weeks of introducing an active such as a retinoid, exfoliating acid or strong vitamin C serum. Breakouts usually start immediately after a trigger and tend to become progressively worse with continued exposure.
- Appearance: Purging tends to cause small whiteheads, blackheads or minor inflamed bumps that resemble a milder form of your usual acne. Breakouts can be deeper, cystic, painful or unusually large.
- Duration: In general, purging settles as the skin adjusts to treatment (often within 6-8 weeks but can be longer). Breakouts can persist or escalate over time.
- Trigger: Only certain types of skincare (usually those that increase cell turnover) cause purging. Hydrating serums, moisturisers, sunscreens and oils do not physiologically trigger purging. If these cause spots, it is likely they’re triggering a breakout.
When figuring out whether you have purging vs breakouts, please keep in mind that it may be neither or both! There is also overlap between purging, breakouts and irritation which can cause even more confusion. For example, perioral dermatitis, rosacea and facial seborrehic dermatitis can look a lot like purging or breakouts but are very different in terms of the underlying condition and treatment. Skincare and changes to the environment can also aggravate or trigger them. Even more confusing, purging and breakouts can also co-exist with irritation in conditions like rosacea. If you’ve started a new product and are developing small spots, redness, blotchiness and itching then you may be experiencing irritation. So if the symptoms are severe, unusual or not improving, it is best to seek medical help to ensure you get the right treatment.
What to Do if You Think You’re Purging
If the pattern resembles your usual breakouts and you have recently started a new active, a gentle and supportive approach often helps the skin settle. It is usually possible to to reduce and prevent purging with a few simple steps:
- Go Slow: Reduce frequency of your active 2-3 times a week or less until your skin adapts. After that slowly go upwards.
- Barrier Support: Incorporate hydrating serums and moisturisers with ceramides or fatty acids to keep the skin comfortable. Some people find sandwiching actives like retinoids in between two layers of moisturiser helps to reduce purging.
- Skin Streaming: Simplify your skincare routine and avoid layering multiple strong actives at the same time.
- Protection: Use a daily broad-spectrum sunscreen with that least SPF 30 to help reduce inflammation and prevent dark marks from healing spots.
If purging continues beyond eight weeks or becomes increasingly uncomfortable, reassess your skincare routine or consider switching to a gentler lower strength product. If you are using a prescription treatment such as tretinoin and develop purging, seek help from your medical provider straight away,.They will diagnose whether it is purging vs a breakout or something else and advise you on best approach moving forward.
How to Manage a Breakout
If you’re experiencing a breakout then it is important to realise that it might not have any relation with a new product that you started. So for example, it may be you started a new acne treatment but happen to be having a flare up of your breakouts due to something else like stress or hormone imbalance.It is also possible that the new skin product might be triggering a breakout but there might also be an underlying additional cause of your flareup. So you’ll need to keep this in mind and act early to treat breakouts. Below are some of the key steps to follow when dealing with a breakout:
- Identify Triggers: Take a moment to consider what might have set off the flare. Breakouts can be triggered by stress, hormones, illness, disrupted sleep, diet changes, friction from clothing, makeup, haircare or even environmental shifts. A new skincare product may play a role, but it is rarely the only cause. Understanding what else is happening in the background helps you respond more effectively.
- Do No Harm: Picking or squeezing spots can worsen inflammation and increase the risk of scarring or post-inflammatory hyperpigmentation. Try to keep your hands away from your face and avoid harsh scrubs or tools that can irritate the skin further.
- Simplify Routine: Start with a gentle cleanser, moisturiser and sunscreen for a few days. This reduces background irritation and makes it easier to see how the skin is responding. Rich creams, certain oils, heavy makeup and fragranced skincare may worsen congestion. Haircare that transfers onto the face can also contribute, so keep an eye on leave-in products or styling creams.
- Support Barrier: Use moisturisers with ceramides, fatty acids or squalane to keep the skin comfortable. A well-hydrated barrier reduces reactivity and helps active treatments work more effectively.
- Active Treatments: Breakouts are a flare of acne, so they benefit from targeted treatment rather than just calming measures. Once your skin can tolerate them, bring in acne fighting products containing things like benzoyl peroxide, salicylic, retinoids and hypochlorous acid to target inflammation and clogged pores. Start slowly and avoid adding multiple new actives at once in order to avoid also triggering purging.
- Lifestyle Measures: Stress, poor sleep and hormonal fluctuations can all trigger breakouts. Diet may also play a role for in triggering breakouts for some people. Improving sleep, managing stress and keeping to a balanced diet can help support the skin during this period.
- Get Help: If breakouts keep returning, become deeper or take a long time to settle, consider seeking medical help. Prescription retinoids and targeted medical treatments may be necessary for persistent or severe acne.
It can be difficult to distinguish between purging vs breakouts but recognising the difference is important. Even more so because they can co-exist and also be confused for infective or reactive skin conditions. However, being able to tell them apart can help you find an effective treatment. It also reduces the risk of post acne redness, dark marks and scars. If in doubt, seek medical help to ensure that you get a correct diagnosis and management plan.
At City Skin clinic, we are passionate about personalised skincare. Our virtual skin clinic offers safe and effective custom skin treatments. Where appropriate our doctors use ingredients such as Tretinoin and Hydroquinone to treat skin conditions like acne, hyperpigmentation, melasma and skin ageing. Start your online consultation today. The journey towards great skin starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any medical concerns or questions you might have.
