Cortisone Shots for Acne: How They Work, The Risks, and the Benefits

What You Need to Know About Intralesional Corticosteroid Injections

Preparing an injection
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Cortisone shots are used to help shrink large, inflammatory acne cysts. Done in your dermatologist’s office, this treatment quickly reduces inflammation, flattens and heals the breakout in just 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.

How Cortisone Shots Work

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.

Don’t worry, it's a small needle. The needle used for intralesional cortisone injections is much, much smaller than what is used for, say, vaccinations. Called a micro-needle, it's quite small and fine.

The whole procedure is quick and, while it may not be completely painless, it's not incredibly painful. Most people describe it as a little pinch. Although if your zit is very painful, it can smart a bit when the needle is inserted. Your dermatologist may numb the area before getting started, in certain cases. Either way, the entire process is over in just a few seconds.

The cortisone reduces inflammation quite quickly. Over the next 24 hours, you'll notice your blemish softening, shrinking, and flattening out. While they may not completely disappear, they will be noticeably smaller and definitely less red and painful. Most blemishes heal within a week after treatment.

Corticosteroid injections are also used to help shrink hypertrophic and keloid scars that you may already have.

When to Get a Cortisone Injection

Cortisone shots don't work on your run-of-the-mill pimples or pustules. Cortisone doesn't do anything for the pus that makes up the core of a pimple. Instead, it shrinks inflamed tissue. So cortisone shots are reserved for large, cystic blemishes. Cortisone shots can be use to treat blemishes on both the face and the body.

And healing those big zits quickly isn't strictly for looks—it also lessens the chance that the blemishes will cause scars. This is especially valuable if you are prone to scarring or hyperpigmentation.

Some reasons you may want to ask your dermatologist about a cortisone injection:

  • You've had a massive, inflamed zit for months and it's not healing.
  • Your blemish is a more recent issue but it's large, swollen, and incredibly painful.
  • You've got an important event coming up (like, say, your wedding day) and you've just developed a big breakout.

Possible Side Effects

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

The most common is pitting of the skin. This can happen if too much cortisone or too strong a dilution is used. The skin around the injection site can atrophy, leaving a depressed area or divot.

Fortunately, these depressions usually go away. This can take a long time, though (up to 6 months). Sometimes, this loss of tissue is permanent.

Incidentally, if you develop permanent pitting of the skin, it isn’t necessarily caused by the injections. Severe breakouts often cause depressed or pitted acne scars. Dermal fillers may be a good solution in these cases.

Cortisone shots can sometimes leave a lighter area or white spot on the skin (called hypopigmentation) especially for people with medium to dark complexions. Again, this tends to be temporary and fades away aver time.

Cortisone Injections Aren't Long-Term Acne Treatments

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

For that, you'll need to use a daily acne treatment medication. Your dermatologist will prescribe a treatment that is best for your skin. Some options: topical retinoids, combination acne medications, or even isotretinoin (depending on how severe your acne is). 

Unless you only get a random big zit very occasionally, you'll need a prescription acne medication. For those big blemishes, over-the-counter acne products just don't have enough strength.

Using an acne medication daily stops breakouts from forming so, ideally, you won't need cortisone injections at all anymore.

A Word from Verywell

Cortisone injections are not meant to be used as a regular acne treatment, Instead, treat them as a way to shrink big zits fast.

If you're prone to big breakouts, give your dermatologist's office a heads-up that you have a big event coming up and let them know you may be needing a cortisone shot. This way it's more likely they'll be prepared to squeeze you in, if need be.

And do make sure you already have a working relationship with a dermatologist before calling to get an emergency cortisone injection. Waiting until the day you need a blemish treated to call a dermatologist that you've never seen before, and you'll likely be out of luck. Most dermatologists have a long wait-time for appointments and can't squeeze in those who aren't regular patients for an emergency cortisone shots.

Remember, too, that cortisone shots aren't just for cosmetic reasons. If you have an inflamed breakout that isn't healing, or is very painful, cortisone injections are very helpful.

Even if cortisone injections aren't the perfect procedure for you, your dermatologist will have additional options that can help you heal big pimples and get acne breakouts under control.

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