Treatment of closed comedones--comparisons of fulguration with topical tretinoin and electrocautery with fulguration.

Two consecutive studies were performed with the aim of clearly defining the optimal physical treatment for closed comedones. The first 10 patients with clinically significant numbers of facial comedones were treated with fulguration under EMLA anaesthesia on one side of the face and topical tretinoin on the opposite side. At the end of the study fulguration was shown to be significantly (p = 0.005) superior to topical tretinoin. A direct comparison of light electrocautery using EMLA anaesthetic with fulguration without anaesthesia was then performed on 12 patients. The comedones were subdivided by size into those that were approximately 1 mm or less in diameter and those of greater dimensions. In the treatment of larger comedones electrocautery was shown to be significantly superior to fulguration (p = 0.025), but there was no significant difference in the efficacy of the treatments for the smaller lesions.