Medical Care
Sun protection may be of benefit in preventing progression. Advise the patient to avoid sun exposure, particularly between 10:00 am and 2:00 pm. Select sunscreen to provide good protection throughout the UV-A and UV-B range. Sunscreens containing micropulverized titanium dioxide or Parsol 1789 provide the best protection throughout the UV-A range. Smoking cessation also is critical. Application of salicylic acid or topical retinoids including tretinoin, adapalene, or tazarotene in various bases, loosens the comedones and assists in the extraction of individual comedones. [16, 17, 18]
Surgical Care
Comedo extraction is effective. However, these comedones are more difficult to extract than are those seen in acne vulgaris. The concomitant use of topical retinoids assists in the extraction process. [19]
Dermabrasion of the affected area has been reported to produce variable cosmetic results. [20]
The comedones can be removed via careful curettage with good cosmetic results. [21]
Chemical peels, laser peels, and staged excision of the involved area have been reported, but the cosmetic result is highly variable.
Treatment with carbon dioxide laser has been reported. Mavilia et al evaluated 50 patients with a superpulsed carbon dioxide laser in an attempt to vaporize epidermis. [22] They then extracted both cystic and comedonal material via soft pressure with a pair of forceps. The laser treatment was performed without topical or intralesional anesthetics, as no pain was reported using the laser parameters they described. The technique proved to be safe and effective in all of the patients treated, assuring an excellent cosmetic result. Rai et al, using a similar approach, confirmed these findings. [23]
Long-Term Monitoring
Follow up all cases to note the effect of topical retinoids and for subsequent removal of remaining comedones. Carefully observe the patient to note the development of skin cancers and pre-cancers in view of the association with actinic damage.
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Multiple comedones, dilated and plugged follicular infundibula, and epidermal cyst formation. Courtesy of DermNet New Zealand and Pathlab Bay of Plenty (https://www.dermnetnz.org/assets/Uploads/pathology/t/figure2favrerac.jpg).
