Is it better to extract closed comedones before starting Tretinoin? (photo)

I've heard anecdotally that if you apply tretinoin topically on closed comedones, they will all come to a head, resulting in a face filled with whiteheads or more inflamed pimples. That's why you should always have your closed comedones extracted before using tretinoin. Is there any truth to this claim? I have dozens of closed comedones on my cheeks and chin, & I will soon begin a prescribed regimen of 9% Azelaic Acid, 1% Clindamycin, & 0.009% Tretinoin. Picture below is similar to what I have

Doctor Answers 1


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A topical retinoid makes the skin cell turnover more rapidly and helps open and get rid of both blackheads and whiteheads otherwise known as comedones. The topical retinoid can make the acne slightly worse before gets better. Many dermatologist start a retinoid right away. I tend to wait a few weeks. In terms of extractions it is always easier to do extractions after the retinoid  has been used as opposed to before. Either way as possible I prefer to do mine after especially on the closed comedones. Ask your dermatologist and work with them as a team on your skin to improve it. 

Paramus Dermatologic Surgeon
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