Based on internal data from AcneClinicNYC
Abstract
Objective: To evaluate the most common clinical trajectories of acne clearance in response to topical therapy and to assess the frequency, duration, and outcome of purging episodes during treatment.
Methods: A retrospective review was conducted on 350 clients (ages 17–42) with varying acne types, all of whom achieved full clearance under a supervised topical regimen at AcneClinicNYC. Data was categorized based on visible treatment response patterns.
Results: Three distinct clearance trajectories were identified: (1) stable improvement without purging (77%), (2) purging followed by improvement (20%), and (3) initial improvement, then purging, followed by further improvement (3%). All clients included in the analysis reached complete skin clearance.
Conclusion: While purging is a recognized response to active topicals, it occurs in less than one-quarter of cases. The majority of clients achieved stable improvement without a flare. These findings highlight the predictable and effective nature of ingredient-based acne therapy when applied through a structured, individualized protocol.
Introduction
Acne vulgaris is a multifactorial skin condition often treated with a combination of topical agents that target follicular hyperkeratinization, inflammation, and bacterial proliferation. Despite well-established mechanisms of action, individual skin responses can vary widely. One such response, known as purging, may lead to confusion or premature discontinuation of effective treatment if not properly anticipated.
At AcneClinicNYC, we conducted an internal clinical review to better understand the most common patterns of skin response among clients treated exclusively with active topicals. The goal was to improve treatment transparency and set realistic expectations during the clearance process.
Definitions
- Purging: A transient worsening of acne due to accelerated epidermal turnover, which expedites the emergence of existing microcomedones.
- Stable Improvement: A gradual reduction in acne lesions with minimal or no flare activity.
- Improvement–Purging–Improvement: A biphasic pattern involving early progress, a short-term flare, and subsequent resolution.
- Purging Then Improvement: Initial worsening prior to entering a consistent improvement phase.
Methods
A total of 350 clients aged 17–42 were included in this retrospective analysis. All participants were diagnosed with acne (comedonal, inflammatory, or cystic) and followed a customized topical protocol. No systemic treatments (e.g., antibiotics, isotretinoin, spironolactone) were used during the observation period. Only those who completed the treatment protocol and achieved full clinical clearance were included in this report.
Results
1. Stable Improvement – 77%
No purging observed. Clients showed consistent reduction in lesion count over a 3–5 month period, with minor fluctuations.
2. Purging Followed by Improvement – 20%
Flare activity began approximately 2 weeks after introducing exfoliating agents or retinoids. The purging phase lasted up to 6 weeks, resolving spontaneously without intervention.
3. Improvement, Purging, Then More Improvement – 3%
This rare pattern included an initial improvement in the first month, followed by a transient purging period (usually around week 6), and final resolution by months 4–5.
Conclusion
This internal study reinforces the efficacy of well-structured topical therapy in acne management. While purging may occur in a subset of clients, it is typically brief, self-limited, and followed by favorable long-term outcomes. Notably, 100% of clients in this cohort achieved full clearance, emphasizing the importance of consistency, proper guidance, and tailored formulations in successful acne treatment.
