Acne nodule and cyst

Nodules and cysts are large acne lesions (5mm or more in diameter) and are both commonly referred to as “cystic acne.” These lesions are deep within the skin and are therefore sometimes resistant to topical treatment. Nodules and cysts can last for weeks or even months if left untreated, and can scar.

Cortisone shot for acne

If you have a nodule or cyst and you have a big event on the horizon like prom, your wedding, etc., a cortisone shot is a way to quickly reduce swelling and heal the lesion. A cortisone shot can also help reduce scarring.1 Cortisone shots need not be reserved for special occasions. Feel free to make an appointment with your dermatologist or doctor for injections on an as-needed basis.

Cortisone is a natural chemical, which is released by the adrenal glands in response to stress. One of its functions is to fight inflammation.1 For this reason, cortisone is sometimes injected directly into an area of inflammation, where it can reduce inflammation quickly.

Cortisone can dramatically reduce inflammation and speed up wound healing. With cystic acne lesions, healing usually begins immediately. Despite doctors regularly using cortisone in a local manner to help one acne lesion at a time, no studies have ever been performed on these local cortisone injections with regards to acne lesion healing. However, two studies in 1954 evaluated the effect of intravenous cortisone on acne as a whole. One study showed that intravenous cortisone reduced acne in all six patients who were enrolled.2 The other study reported that systemic cortisone reduced acne in only 5 of 17 patients studied, although they did not report how cortisone was administered.3 Both of these studies used a very small sample size and are outdated, so the results should be interpreted with caution. Despite this lack of published evidence that supports the use of local cortisone shots to treat acne, in the real world, dermatologists routinely use cortisone shots with consistently good results.

Cortisone shot atrophyExample of atrophyA cortisone shot can be somewhat painful, but your doctor can use a topical anesthetic to numb the area before the shot if desired.

Most notably, a cortisone injection can produce atrophy of the fatty tissue surrounding the injection. The injection area can end up looking sunken or depressed. This atrophy is temporary, but can take several months to return to normal.

Repeated use of cortisone shots can impair the skin’s ability to repair itself, and can cause thinning of the skin.4-5

Since cortisone is naturally produced in the body, other side effects are rare, but may include hypopigmentation (white spot) at the site of injection in darker-skinned individuals.

Cortisone shots cannot be used as preventative treatment, so other preventative measures must be taken. Proper topical treatment can prevent nodules and cysts from forming in the first place. If you have an extreme case of acne that is deeply scarring and widespread, you may wish to learn more about Accutane (isotretinoin).

  1. Cole, B. J. & Schumacher, H. R., Jr. Injectable corticosteroids in modern practice. J Am Acad Orthop Surg 13, 37–46 (2005).
  2. Farber, E. M. & Claiborne, E. R. Acne conglobata; use of cortisone and corticotropin in therapy. Calif Med 81, 76–78 (1954).
  3. Didcoct, J. W. Observations on the effect of cortisone in acne vulgaris. J Invest Dermatol 22, 243–247 (1954).
  4. Levy, L. L. & Zeichner, J. A. Management of acne scarring, part II: a comparative review of non-laser-based, minimally invasive approaches. Am J Clin Dermatol 13, 331–340 (2012).
  5. Fisher, D. A. Adverse effects of topical corticosteroid use. West J Med 162, 123–126 (1995).