Are extractions of active acne safe?

Dr. Ellen Marmur, MD
Extractions of active acne (whether it is the pustule type we call a pimple or a comedone, which we refer to as a blackhead) are tricky and unnecessary and can be unsafe too. Although extractions seem to miraculously (and sometimes painfully) take away the gunk in your pores, it's basically a manual form of exfoliation (extracting the keratin plug from your pore). Putting so much pressure on the hair follicle (or pore) to pop out the dead keratinocytes squeezes the base of the follicle. In the case of a comedone (a type of acne referred to as a "blackhead" or "whitehead"), this can push the oils and benign bacteria so far down the follicle shaft that they burst out the bottom into your skin tissue. That rupture can cause inflammation and ultimately leave a scar or a cyst on your skin, especially on darker skin types. Often, blackheads on the nose are just hair follicles, so trying to extract something from them is ineffectual and could cause scarring or hyperpigmentation. Dermatologists are trained to look at the skin using a microscope, so we truly see it with X-ray vision. We can tell a whitehead, or comedone, from a benign cyst and a blackhead from a hair follicle. Even the best, most skilled facialist doesn't understand the skin microscopically and isn't a medically trained diagnostician.

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