When my doc first prescribed tretinoin, I did my due diligence and researched on the Internet. I got terrified 'the purge' would happen to me, as I had a bad experience with clindamycin in high school and I broke out pretty badly. I put off using T for weeks. But my boyfriend said to me one day, "You'll never know if you don't try it out - why would else this treatment be so popular if it didn't work?"
Here's some background: I am a 23 y/o Asian female with moderate acne since middle school, mostly painful and swollen papules/pustules that come up around my menstrual cycle. I'd have 2-3 big pimples on my face at a given time (mostly around my T zone), and some other random zits would pop up here and there. But the worst were the red marks that got left behind - I'd pop my zits (bad habit, I know) and then the marks would just not go away! My skin is naturally pretty oily, with some dry patches here and there bc of my eczema, but my complexion was always reddish and when I drank alcohol I'd always get Asian glow and my face would look splotchy. I had bad hyperpigmentation and the only way to improve my complexion was to first stop the acne. I was sick of having to rely on makeup and foundation daily to hide the zits, it was especially hard because I love to exercise and hated working out because I had to remove my makeup.
When I started T, I started VERY slowly. I used it twice a week for 3 weeks. The first three weeks my face flaked a bit, especially around the chin/mouth area. But I'd exfoliate every now and then and it'd take care of the flakiness. It never got to the point where I had patchy or broken skin, I found that moisturizing multiple times a day helped to control the dryness. I didn't experience a purge. The worst it ever got with the T was a few small whiteheads around my chin/mouth. But since T speeds up the rate of skin cell production, the zits went away and faded pretty quickly - a trend that would happen in the months to come, which was awesome. I didn't experience any 'purge' at any point in time. My skin started getting better, and by week 5-6 you could start to see some results. I stopped getting those painful hormonal zits that I usually get a few times a month, and it felt great. I was also taking minocycline for the first month I was on T, but I stopped after a while as I didn't think it was really making any impact.
After 3 weeks of 2x/week, I upped the T to 3x/week for another 3 weeks. Then I upped to 4x/week for 3 weeks. Now I'm at 4-5x a week, and my skin has adjusted pretty well. I'm 13 weeks in now. There's no flaking at all now and my complexion has improved so much. I stopped getting painful, swollen zits. I have virtually no acne anymore. At times there's a small whitehead or two, but those almost always fade after 2-3 days. My hyperpigmentation has improved as well, though that takes a bit longer to see big improvements for complexion. I've also started buffering now, as I'm getting a little lazy with having to wait every time I use T, so I'll mix moisturizer and T together and apply right after I wash. The other day, I went to work without using foundation! That was definitely a first for me, and it felt great.
I highly recommend using this product for acne, but you MUST be diligent about using it the correct way. I always see people say things like "I started T 2 weeks ago and I have been using it 3x week, my skin broke out!" Well, of course it would break out - you're not using it correctly. The key is to start slowly to make sure your skin adjusts, and to use it in a regimented scheduled way, making sure to wait at least 25 min between applications of T and moisturizer.
Here's my skin regimen, if that's of interest:
MORNING
Cerave or Neutrogena Ultra Gentle Creamy Cleanser
Moisturize with CeraVe Lotion
makeup
EVENING
Nights with T:
Cerave or Neutrogena Cleanser
---Wait at least 25min
pea-sized amount of T
---Wait at least 25min but I like it give it up to an hour if I have time
Cerave Lotion and 3 drops jojoba oil (I use Now Foods Organic Jojoba Oil, it's actually great for oily skin. I would highly recommend this product to hydrate skin, it makes your complexion incredibly supple the morning after)
Other products
Panoxyl 4% benzoyl peroxide face wash, on days I do not use T (bp and T counteract each other so do not use on days you use T)
Philosophy Microdelivery Vitamin C Peel: for hyperpigmentation, this stuff is expensive but does wonders. I would only recommend this after your skin has adjusted to T (at least 3 months into treatment). I only use this every 1-2 weeks or so.
Good luck!