In addition to topical and oral medications, physical modalities exist for treating acne. Comedone extraction can provide prompt cosmetic results. The keratinous debris of the open comedo may be extracted by using the Schamberg, Unna, and Saalfield types of comedo extractors. The closed comedo can also be removed by extraction but must first be nicked with an 18-gauge needle or an #11 blade. Extraction should not be attempted on an inflamed comedo or pustule due to the risk of scarring. Electrocautery and electrofulguration have also been reported as effective treatment for comedones. These means are often useful for treating large comedos, also known as macrocomedos. Macrocomedos are often resistant to topical retinoids.
Intralesional triamcinolone can be utilized to decrease both the size and pain of inflammatory cysts or nodules. Triamcinolone acetonide (2-5 mg/ml) is injected into these lesions using a 30-gauge needle. The steroid should be injected until the lesion blanches. The maximum amount of steroid used per lesion should not exceed 0.1 mL. Excess triamcinolone injected into a lesion may result in hypopigmentation, atrophy, telengiectasias, and needle tract scarring.