Reader Question: What To Do When Retinol Makes Me Break Out?

 love getting reader questions! This one is from Lithuania.

Dear Nicki,

I’m a big fan of FutureDerm and a long-term Facebook follower. I purchased your FutureDerm Time-Release Retinol 0.5 product — three bottles, since I don’t live in the U.S. I was totally eager to try it and get hooked, but I noticed that it really make me break out. I have normal skin and have never had acne or any breakouts in my life. Therefore, I’m a bit confused. Each time it happens, I stop using your cream for two or three days, and my skin gets back to normal. The I try it again, and it happens again. I wonder: can it be a reaction to alcohol in your cream? Maybe it evokes such a reaction? I’d appreciate your opinion on this, as I intend to try your other products, too, plus, I still hope I can use your retinol.

-Vilnius, Lithuania

Dear Vilnius,

Ah, the infamous retinol break out scenario. This is actually called purging, and it is quite common.

Why Purging Occurs

In normal skin, there is natural exfoliation at the hair follicle: your skin produces sebum, but every couple of weeks your cells turnover and essentially rid themselves of the debris.

There are two main reasons why people get acne from using retinol.

The first group of people have a condition known as retention hyperkeratosis, where their skin doesn’t turn over cells as quickly as other people’s cells in their age range typically do. This causes a build-up that is actually sticky and gooey at the microscopic level (ewww, I know). People with hypothyroidism, or underactive thyroid, typically get dry skin and clogged pores due to retention hyperkeratosis. It also increases with age.

[Read more: 11 Things That You Never Knew about Retinol and Retinoids – Until Now]

The second group of people simply produce too much sebum. This is trigged by many factors, including genetics, stress hormone (cortisol), neuropeptides, and dihydroxytestosterone/testosterone production. The degree to which each plays a role varies from person to person. This is why some people note that they get relief from acne when they cut dairy, and others don’t – dairy contains trace amounts of insulin growth factor-1 and other cytokines that can cause an increase in testosterone. Some people have skin that is sensitive to these hormones; others don’t.

What You Can Do About It

The best course of action to treat retinol-based skin purging is to simply use retinol for 8 weeks. Typically, cell turnover occurs every 21 days in an average, middle-aged, healthy adult. This means 8 weeks will give you a nice run of a full two (nearly three) cell turnover cycles to clear out the vast majority of the sebum and debris in your pores.

The next best course of action is to continue to use retinol in a manner that is appropriate for your skin. Don’t just start using retinol every night! Retinol is strong, even when delivered in a microencapsulated, slow-sustained release formula such as in our FutureDerm Time-Release Retinol 0.5. I recommend the following dosages and application schedule:

Lastly, you can spot-treat the acne until it goes away, and continue to use the retinol. The difficulty here is that retinol deactivates benzoyl peroxide and vice versa. Retinol also shouldn’t be used with acids, discounting the other anti-acne powerhouse, salicyclic acid.

[Read more: Product Review: Which OTC Retinol Treatment is the Best?]

So you essentially have two options for treating acne: first, you can treat the acne by day and use FutureDerm Time-Release Retinol 0.5 by night. Use a salicyclic acid-based cleanser and a 10% benzoyl peroxide as an on-the-spot treatment during the day. Continue to use the retinol at night, according to the schedule.

Alternatively, you could use a non-acidic form of salicyclic acid by night together with the retinol. One I have that I like is Unagel ($33.95, Amazon.com), which contains 10% of a non-acidic form of salicyclic acid. It’s compatible with retinoids as a result. When using it with FutureDerm Time-Release Retinol 0.5, I apply the Unagel first because it is a thinner, lighter formula than the retinol. There is no need to wait between applying each product. If your skin is dry, follow up with a light oil-free moisturizer of your choice. (In April, we will have our FutureDerm Customizable Moisturizer System back up and running in all of its glory, so I’d be happy to formulate one for you then!)

[Read more: How Do I Use a Retinoid with AHAs/BHAs Together?]

Bottom Line

Help – retinol makes me break out!

Well, Vilnius, I’m so glad that you and so many of our other loyal fans have purchased our FutureDerm Time-Release Retinol 0.5! And I thank you for reaching out to me with your questions. The fact that is making you breakout is unfortunately part of the process when you have either tendency for your pores to clog up (retention hyperkeratosis) or too much sebum. The key is to be patient with it – give it at least 8 weeks – and treat the acne, either by using salicyclic acid/benzoyl peroxide by day and the retinol at night, or using a non-acidic salicyclic acid that won’t inactivate the retinol like Unagel. Either way, please stick with the product, and let me know if you ever have any other issues or questions. I’m more than happy to answer.