What You Need to Know About Cortisone Shots for Acne
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No matter how thorough and personalized your skin-care regimen is — and how religious you are about sticking to it — there's always a small chance you'll wake up one morning with a deep, painful pimple the size of a nickel on your cheek. It'll seem like the spot becomes more inflamed if you simply look at it the wrong way, let alone touch it, and, of course, it will have sprouted out of your face the day before an important event. Cue the panic.
But when that nasty, random pimple pops up, you're not SOL — receiving a cortisone shot for acne from your dermatologist can help clear up the agonizing zit with lightning speed and generally with few side effects. Sound too good to be true? Here, dermatologists spell out why cortisone shots for acne can be a useful tool for quick relief, the types of blemishes they can treat, and what to expect at your injection appointment.
Do Cortisone Shots Treat Acne?
Yes, cortisone shots' zit-zapping sorcery is real. Corticosteroid shots are an effective treatment for individual, large acne nodules when injected directly into the pimple, and they can rapidly reduce pain and flatten the pimple, according to the Journal of the American Academy of Dermatology. Seriously, you could be back to being blemish-free in less than 48 hours, says Corey L. Hartman, M.D., F.A.A.D., a board-certified dermatologist in Birmingham, Alabama. "[If] you have that pimple, that nodule, that just won't get better…that is the perfect opportunity to hit it with a little cortisone to make it go down in a day or two," says Dr. Hartman. (ICYMI, acne positivity accounts are proving blemishes are nothing to be ashamed about.)
Refresher: Corticosteroids (i.e. cortisone, prednisone) are a type of synthetic anti-inflammatory drug commonly used to treat conditions such as rheumatoid arthritis, lupus, and inflammation of the blood vessels, according to the Cleveland Clinic. To combat acne, dermatologists inject triamcinolone acetonide — a type of corticosteroid specifically used to treat skin infections by reducing inflammation, according to the National Library of Medicine — though these shots are still commonly called cortisone injections.
What Types of Pimples Can You Treat with Cortisone Shots for Acne?
Given cortisone shots' speedy pimple-healing powers, you might be tempted to hit up your derm for an injection for every blemish on your face. But cortisone shots are primarily used for one-off nodular and cystic acne — painful types of breakouts that occur when a pore fills with enough excess oil, dead skin cells, and bacteria to cause inflammation deep into the skin, according to the American Academy of Dermatology Association.
Specifically, cystic acne contains pus, "and when you run your fingers or hands over the surface of the skin, you can feel basically a ball under the skin," says Lian Mack, M.D., a board-certified dermatologist and the owner of GlamDerm in New York City. With nodular acne, on the other hand, "you can squeeze them all day, and they can be painful, but they never really come to a head," says Dr. Hartman. "And the more you squeeze them, the angrier they get." Both types of acne can develop anywhere on the body, but both cystic and nodular tend to pop up on the lower portion of the face, adds Dr. Mack. (Um, can popping a pimple in the 'danger triangle' kill you?)
With either type of acne, a raised bump is a key factor in determining if cortisone shots are the right acne treatment for you. "When you inject something that's too flat, you have a higher risk of thinning the skin," says Dr. Mack. Treating a surface-level zit with a cortisone shot can also increase the risk of side effects such as skin indentions, discoloration, and lightening, which can make your breakout look even worse, adds Dr. Hartman. In these cases, your doctor may recommend treating your acne with oral antibiotics or topical gels and creams containing benzoyl peroxide, salicylic acid, or retinol, according to the Cleveland Clinic, but these methods aren't as fast-acting as a cortisone shot.
Even if your pimples check off those boxes, don't expect your derm to shoot up your entire face. Cortisone shots for acne are primarily used to heal just one to three stubborn, painful zits at a time, and they're seen as a "rescue" tool — not a treatment method to clear up acne for good, says Dr. Hartman. "Let's say I have a patient who's on topicals and [the acne is] pretty well-controlled, but they randomly get a very cystic breakout — we'll do cortisone shots for that," adds Dr. Mack. "But if a patient has acne all over their face — a ton of cysts all over their face — a cortisone shot wouldn't be the primary treatment for that." For the same reason, your doctor likely won't recommend receiving cortisone shots for acne, even if it's just a few one-off nodules, on a regular basis (think: more often than once every three months).
Instead, your doctor will help you find a treatment (i.e. antibiotics, isotretinoin) that addresses the root cause of your acne — not give you a Band-Aid solution like a cortisone shot. "You can't come in and have 20 [nodules] and say, "I want an injection" — that's not how it works," says Dr. Hartman. "That means that the foundation of your acne regimen is not great." (Related: Should You Be Taking Probiotics for Acne?)
What to Expect When Getting Cortisone Shots for Acne
If a tender, lobster-red bump sprouts on your jawline two days ahead of a major work presentation, don't hesitate to call your derm and ask for a cortisone shot consultation ASAP. You'll want to call your derm as soon as you notice a new cystic or nodular pimple, says Dr. Hartman. "They pop up quickly, and you usually need it gone quickly," he says. The entire injection process is so speedy, that Dr. Mack calls cortisone shots for acne "quick hits," so your doctor may be able to squeeze you in for an appointment that day or the next.
If your dermatologist examines your breakout and confirms it's appropriate to treat with a cortisone shot, tell your doctor if you have a sensitivity to needles (think: you pass out when you get your blood drawn) so they can put you in a safe position in the chair before the injection, says Dr. Mack. Then, they'll clean your skin with alcohol and dilute the steroid. "When you're injecting a cyst on the face, you don't want it to be so strong," she explains. "If you have a really strong strength of cortisone and you inject it on the face, that can cause thinning to the skin. So we mix it or dilute it down to a very low strength so that it's safe to inject." (FTR, cortisone shots for joints are generally diluted with an anesthetic, while those for acne are mixed with saline.) From there, they'll inject the steroid directly into the nodule, apply some pressure with gauze to minimize any potential light bleeding, and you're good to go, she says. "Two to three days later, it's significantly better, if not gone," adds Dr. Hartman.
Following your treatment, avoid applying acne spot treatments or zit stickers over the injected blemish and using harsh exfoliants, which can irritate the skin, suggests Dr. Mack. "??Harsh exfoliants and zit stickers are only going to dry the overlying skin, not help with the inflammation that's living under the skin, and that's what the cortisone shot does," she explains. In the 24 hours post-injection, avoid applying makeup to the blemish, as concealer, foundation, and other products that are potentially contaminated with bacteria can increase the risk of infection. For the same reason, you'll also want to wear a fresh face mask out of the office (and throughout that 24-hour period), says Dr. Mack.
Potential Side Effects of Cortisone Shots for Acne
Receiving cortisone shots for acne is a simple procedure, but there are a few potential side effects, says Dr. Mack. You might experience pain, hypopigmentation (lightening of the skin), or indentation at the injection site, adds Dr. Hartman. If the skin indents, the steroid concentration may have been too high or the injection was placed inappropriately, he explains. Thinning of the skin can also occur, particularly on flat or tiny blemishes, says Dr. Mack. This hypopigmentation can take six months to two and a half years to go away, while the skin indentation generally lasts six months to a year post-injection, research shows.
That said, in a survey of dermatologists, a majority of respondents stated that less than one percent of their patients returned for appointments to address negative side effects from cortisone shots for acne. Translation: If you do experience skin changes, they'll likely resolve on their own. And to reduce the chances of developing those side effects, make sure you receive your cortisone shots for acne from a board-certified dermatologist who has experience performing the injections.
How Often Can You Get Cortisone Shots for Acne?
In a single session, your dermatologist likely won't inject more than three blemishes, says Dr. Hartman, and they may not recommend injecting them more than once. "I personally do not like to inject an acne cyst multiple times," says Dr. Mack. "Let's say you came to me on a Monday, I injected one lesion on your chin, and it hadn't completely resolved by Thursday. I wouldn't inject it again because that would increase the risk of thinning of the skin." (Related: How to Safely Use a Comedone Extractor on Blackheads and Whiteheads)
On the same token, if you have cystic or nodular acne that would benefit from an injection popping up more often than every three months, cortisone shots probably aren't the best treatment for you. Instead, you'll need to talk with your dermatologist about how to adjust your skin-care routine to prevent them in the first place. "If you're getting [this acne] more frequently than that, then you need a better regimen," says Dr. Hartman. "You want to maximize everything, so you're working on [your acne] at every level and then use the shots as a tool if you need it."
