Using Cortisone Injections to Treat Acne

Understanding the Benefits, Risks, and Limitations

Doctor preparing an injection

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In This Article

Cortisone shots involve the injection of a synthetic hormone closely related to the stress hormone cortisol. It is used to provide short-term relief of inflammation and is sometimes used to help shrink large acne cysts. Performed in the dermatologist’s office, cortisone shots can help reduce the redness, swelling, and pain of severe inflammatory acne breakouts within a few days.

The technical term for this procedure is intralesional corticosteroid injection, but most people just call them steroid shots, cortisone injections, or cyst injections.

Overview

Intralesional corticosteroid injections are used to treat deep nodules or cysts. A very dilute corticosteroid is injected directly into the blemish. Cortisone is an anti-inflammatory that shrinks the swollen wall of the cyst.

The needle used for intralesional cortisone injections is much smaller than what is used for vaccinations or blood draw. Called a micro-needle, it is barely larger than an acupuncture needle and is designed to slip into the skin with minimal pain.

The procedure is relatively quick. The injection itself is really only sore if the pimple is very large and painful. To reduce pain, your dermatologist may numb the area with topical lidocaine before getting started.

Cortisone can reduce inflammation quickly. Over the next 24 hours, you'll notice your blemish softening, shrinking, and flattening. While it may not completely disappear, the pimple will invariably be smaller and better able to heal itself within a week.

Corticosteroid injections can also be used to shrink hypertrophic and keloid scars.

Benefits

Cortisone shots don't work on your run-of-the-mill pimples or reduce the build-up of pus in the swollen pustules. Instead, the shots simply shrink tissues and are reserved for large cystic blemishes. Cortisone shots can be used to treat blemishes on both the face and the body.

Using cortisone in such cases reduces the chance of scarring. This is especially valuable if you are prone to hyperpigmentation (darkening of the skin) after a breakout.

Among the reasons to ask your dermatologist about cortisone injections:

  • You have had a massive, inflamed pimple for months that will not heal.
  • Your blemish is a more recent issue but is incredibly swollen and painful.
  • You have an important event coming up (like a wedding) and just developed a breakout.

Intralesional steroid injections along with comedone extraction (the removal of blackheads) do not alter the course of the disease but can significantly improve your appearance.

Side Effects

Intralesional cortisone injections may sound like a magic wand when it comes to healing big blemishes quickly. But this procedure must still be used with care as it can cause side effects.

The most common side effect is the pitting of the skin. This can occur if too much cortisone or too strong a dilution is used. If cortisone is overused, the skin around the injection site can experience atrophy (tissue death), leaving behind a visible depression. These depressions tend to go away on their own, but, in some cases, the loss of tissue may be permanent.

If you develop permanent pitting of the skin, it isn’t necessarily caused by the injections. Severe breakouts often cause pitting irrespective of the pitting. Dermal fillers can sometimes be used to restore the skin's normal appearance.

Cortisone shots can sometimes leave a lighter area or white spot on the skin, called hypopigmentation, especially for people with medium to dark complexions. This also tends to be temporary and will usually resolve on its own over time.

Additional Treatments

Cortisone injections have plenty of benefits, but there is one thing they just cannot do: clear up your acne. True, they help big breakouts heal up quickly, but they can't stop breakouts from occurring.

For that, you'll need to use a daily acne treatment medication. Your dermatologist will prescribe a treatment that is best for your skin. Options include topical retinoids, antibiotics, salicylic acid, and isotretinoin for severe cases.

If you have acne that is severe or recurs regularly, you will likely need prescription acne medications. For big blemishes, over-the-counter products just don't have enough strength.

A Word From Verywell

Cortisone injections are not meant to be used as a regular acne treatment. However, if you are prone to severe breakouts, give your dermatologist's office a heads-up if you feel an outbreak coming up. Most dermatologists have a long wait-time for appointments and can't squeeze in people for an emergency cortisone shot.

By being proactive and not waiting until the last moment to get a shot, you may be able to avert severe acne complications and reduce the risk of scarring.

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Article Sources

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  2. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-73. doi:10.1016/j.jaad.2015.12.037

  3. Premanshu B, Prateek M, Swarn L. Intralesional steroid injections: look before you leap!. Indian J Dermatol. 2014;59(4):410-1. doi:10.4103/0019-5154.135506