Beyond the Surface - Skin Community - Treatment induced acne flare / purging

"Conclusion: It is unlikely that acne worsens or "flares" due to the initiation of topical retinoids. Some acne patients may have worsening of acne during the first week or two as part of the natural disease process." Yentzer, Brad A et al. “Do topical retinoids cause acne to "flare"?.” Journal of drugs in dermatology : JDD vol. 8,9 (2009): 799-801. "Almost twice as many study participants with mild acne at baseline demonstrated a 10 percent or greater increase in number of inflammatory lesions as compared to subjects in the vehicle arm (15.4% vs 8.7%)" https://discord.com/channels/1169738819688468501/1268905964375900190

Initial worsening: "In about 20% of patients, crops of new pustules and papules suddenly appeared during the initial weeks of therapy."
Inflammatory "explosion": The authors describe that under the influence of vitamin A acid, previously inert comedones suddenly "blew-up", leading to inflammatory lesions. They state: "This acceleration of the natural acne process often resulted in a worsening of the clinical picture during the first six weeks of therapy."
Misinterpretation risk: "If final drug evaluations had been made at this time, we could have come to quite the opposite conclusions regarding the value of vitamin A acid."
Irritation: The study describes vitamin A acid as "a fairly potent irritant" causing redness and scaling within 48 hours. This irritation could be mistaken for or contribute to inflammatory acne.
The authors mention that some patients, particularly those with "persistent nodular and cystic forms may even be made worse."

10:13 PM

A summary of purging research available on reddit: [Research] Summaries of studies on purging / acne flares https://www.reddit.com/r/SkincareAddiction/comments/c2ht6n/research_summaries_of_studies_on_purging_acne/

Chip changed the channel name: Treatment induced acne flare / purging 2/08/2024 10:37 PM

For topical retinoids, it mentions that an exacerbation of acne, called a "retinoid flare", may appear at the beginning of treatment: "The exacerbation of acne, the so-called 'retinoid flare' may appear at the beginning of treatment, usually in the first weeks of therapy and persist for several weeks." The document also notes that for some treatments, side effects like skin irritation tend to be worst in the first few weeks and then improve: "The intensity of skin irritation related to topical treatment with adapalene increases in intensity to a maximum at week 2 of treatment and regularly decreases to week 12." For azelaic acid, it states: "According to the reports, the frequency and duration of local reactions are highest in the first 4–8 weeks of treatment. Those unpleasant symptoms usually decrease after a continued use." Otlewska, A., Baran, W., & Batycka-Baran, A. (2020). Adverse events related to topical drug treatments for acne vulgaris. Expert Opinion on Drug Safety, 19(4), 513–521. doi:10.1080/14740338.2020.17576