Cortisone Shots for Acne: Here's How It Works
Roman Shalenkin / Stocksy
Medically reviewed by Julia A. Siegel, MDFact checked by Anna Harris
If you've ever dealt with cystic acne, you know deep and painful it can be. But fortunately, dermatologists say there is a quick fix that can be used sparingly, and that fix is a cortisone shot at your dermatologist's office. When injected into the right kind of pimple, a cortisone shot can deflate a cystic breakout in as little as a day, but the treatment comes with side effects.
Meet the Experts
Corey L. Hartman, MD, is a board-certified dermatologist and founder of Skin Wellness Dermatology in Birmingham, Alabama.
Joshua Zeichner, MD, is an associate professor of dermatology and director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City.
Loretta Ciraldo, MD, is a board-certified dermatologist who practices in Miami and the founder of Dr. Loretta skincare.
What Is a Cortisone Shot for Acne?
Definition
Cortisone shots involve using a diluted corticosteroid that is injected into an acne nodule, or cyst, in order to quickly reduce inflammation and pain so the blemish heals faster.
"A cortisone shot is a steroid, typically Kenalog, that is injected directly into a cystic acne nodule," Hartman explains. "Inflammatory acne causes redness, swelling and pain that are all alleviated with the injection of a dilute form of corticosteroid."
Cortisone shots aren't intended for blackheads or whiteheads, the kind of blemishes that go away in a matter of days with topical treatment. Instead, they're meant for those large, painful, underground cysts that laugh in the face of drugstore zit creams. "I usually recommend that my patients get cortisone shots if they have red, tender pimples," says Zeichner. "These deep pimples are the ideal candidate for a cortisone injection."
Benefits of Cortisone Shots for Acne
According to Ciraldo, the pros of cortisone shots for acne include:
Reduced discomfort from painful cystic blemishes
Diminished redness and inflammation
Faster healing time
Lowered risk of scarring from the blemish
For cysts that are very swollen or painful, or don't seem to be healing on their own, steroid shots are a quick fix. But these injections are really meant for special cases (like when a pimple pops up the day before your wedding), Ciraldo says, not as part of your regular acne treatment plan.
"These are best for people who have just one or two lesions that are much more advanced than the rest of their acne," she cautions. "For people who have more widespread cystic and inflamed acne lesions, a more systemic or global therapy is necessary."
How Long Does It Take to Work?
If you're itching to make a super-swollen pimple disappear, a cortisone injection is the closest thing to a magic wand; for some, blemishes deflate completely within 24 to 48 hours of a cortisone shot.
Types of Pimples That Qualify for Cortisone
Cortisone shots are not for treating surface-level breakouts like blackheads and whiteheads. Instead, they're for those deep, inflamed, painful cysts that haven't quite breached the surface of the skin just yet.
Cysts you've had longer-term can also be treated. "If instead the acne lesion is not very inflamed but instead it's persistent and not showing signs of resolution, with a duration of two to three weeks or more, that is good timing to seek the dermatologist's opinion on advisability of a cortisone shot," she suggests.
How to Prepare for a Cortisone Shot
One important part of prep: finding a qualified medical professional to stick you. "Definitely find an experienced, board-certified dermatologist to do these injections," Ciraldo insists. Ask the derm how many of these injections she has done in the past, and how long she has been doing them. "If they don't have a lot of experience in the injections, or you sense that they are not in favor of giving you the injection, don't get it," she says.
There's no need to prep your skin in any way before the appointment, but if you have an inkling you want to get a cortisone shot in days to come, cut out booze as well ibuprofen, aspirin, and the like. "If you schedule a cortisone injection, it is better to refrain from any nonsteroidal anti-inflammatories or alcohol, both of which will increase risk of bruising, for three days before you get the shot," Ciraldo explains.
What to Expect During a Cortisone Shot
Another reason dermatologists do a lot of cortisone shots? They're fast—which is pretty ideal for doctor and patient. "The entire treatment lasts just minutes," Ciraldo says. Zeichner estimates the actual injection time as about 30 seconds.
During the shot, "you should be placed in a comfortable position, preferably reclining," Ciraldo explains. "It is important to stay as still as possible since movement during the injection is more likely to result in bruising."
If you're scared of needles, rest assured the one that goes into a cyst for a cortisone shot is teeny tiny. "Generally, a very small, 30-gauge needle is used so the pain can be minimal," Ciraldo says. "If the lesion itself is painful, ask the doctor to mix in some anesthetic with the cortisone so that you will be pain-free immediately after the injection."
After the injection, your derm may apply a little Band-Aid and send you on your way. Within a few hours, even the angriest cysts begin to go down; within a day or two, they usually disappear completely. Sounds pretty great, right? Well, yes—but there are some caveats.
Potential Side Effects
So what can possibly go wrong with cortisone shots for acne? Aside from bruising, there are two main risks:
Lightened Skin: "In some cases, the skin can become a bit lighter. This is because the cortisone interferes with pigment production," Zeichner explains. "This is more of an issue in people who have darker skin tones as opposed to those [whose] skin is lighter." Fortunately, any skin lightening from cortisone injections usually improves without treatment within a few months, he says.
Indentations in Skin: Cortisone shots can also leave depressions in the skin due to atrophy of the skin's collagen, but Hartman says this isn't a common side effect. "When steroid atrophy occurs, it usually appears one to two months after the injection and can last for two to three months," Hartman continues. "I have never seen an example of steroid atrophy last has lasted indefinitely, though I’m sure they happen."
The Cost
If you're uninsured or the treatment is not covered at your dermatologist's office, cortisone shots for acne will cost you about $50 to $100, depending on where you live. (Ciraldo says she charges $75 at her Miami practice.) This is relatively affordable compared to other dermatological treatments like Botox.
But the good news is, getting cortisone shots for acne can usually be done on your insurer's dime, minus your co-pay. "Most insurance plans will cover the cortisone shot for acne if you go to a dermatologist who takes your insurance," Ciraldo says.
The Final Takeaway
Properly administered on an emergency-only basis, cortisone shots are a good option for putting acne cysts on the fast track to healing. Risks of long-term scarring and skin hypopigmentation are low, but they exist. Remember: Cortisone shots are for special cases only, and shouldn't replace a skincare routine or acne treatment plan provided by a dermatologist.
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