The Model’s Secret Revealed: Cortisone Shots for Acne Cysts

What is a cyst?

One manifestation of acne that can be both painful and distressing is the acne  cyst. These are larger balls of inflammation that occur deeper in the skin and can persist for several weeks. They are often very painful nodules and because they persist for so long, these cysts can add up and produce great cosmetic concern. Additionally, because of the inflammatory nature of acne cysts, they can produce prominent scarring leaving brown spots and sometimes even indentations in the skin. Often, cysts are resistant to treatment with topical creams and acne medications. They respond to treatment with oral antibiotics but may still take several days to weeks to improve. In our offices, we see patients daily who are models, actors, and busy professionals who simply cannot tolerate having cysts either because of the pain or for other professional and personal reasons. They look to us for a quick fix: the cortisone or steroid shot!

What is a steroid shot?

When we discuss treating acne with cortisone or “steroid” shots, we are referring to the process of gently placing a very dilute quantity of a “glucocorticoid” steroid into the cyst (this is called intra-lesional injection).  Glucocorticoids are a class of steroid molecules that are naturally produced by our bodies and have numerous functions including the regulation of human metabolism, immunity, and inflammation.  They have very potent anti-inflammatory effects so they are often used to treat inflammatory diseases in medicine. They can be formulated as creams to treat skin rashes or as pills to treat systemic disease. They can also be injected directly into local areas of inflammation such as in arthritic joints and inflamed acne cysts.  Within one or two days of injection into a cyst, the steroid will shrink the inflammation producing relief of pain and almost immediate cosmetic improvement. Note that topical steroid creams do not work because they do not penetrate deep enough in the skin to affect the cyst.

Is it painful?

Steroid shots are routinely performed with very fine needles that are barely perceptible when placed in the skin. However, because the cyst itself may be painful, any manipulation of the cyst can be associated with some discomfort. However, this is generally not more painful than the pain associated with the cyst itself.

Is it safe? 

When performed properly, intra-lesional injections are very safe and effective. Because the steroid is injected locally, there should be no systemic side effects. However, there can be local side effects with over-aggressive treatment including atrophy or indentation of the skin or skin lightening in the area of injection. Make sure that you are treated by a dermatologist or a physician with ample experience in treating acne cysts as utilizing improper dosages and technique is more likely to produce side effects. These risks are exceedingly low when performed with a gentle, conservative technique.  In the long run, intra-lesional injection of steroids will benefit your skin because it will reduce inflammation promptly and reduce the risk of scarring and pigmentation.

Now you too know the secrets of the stars!

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8 responses

    • Thanks for your comment Janet. You are correct – long term use of topical steroids can be harmful to the skin. But these quick little occasional injections are MAGIC for erasing ugly inflammed cystic pimples!

      • Dr Tareen
        Have you successfully treated sports related Keloids on the shoulders of young adults?

    • Janet, how can that be? Dr Tareen says that topical DONT WORK because they dont penetrate deep enought where the cyst is. That is why steroid is injected into the cysts, the needle goes deep into the skin layers.

      • Yes, a very small amount is delivered precisely to the cyst to help resolve the inflammation. I wish it could work topically, unfortunately, the intralesional is the most effective.

  1. Major dilemmas! Currently I have a few cystic acnes the size of giant pea right below my left eyes and other spot of my face. I’ve had cortisone shots for cystic acnes like this before and it works fine. Except now I’m 5 months pregnant and can’t find any more resource or studies about the side effects of cortisone shot on pregnant women.

    My ob/gyn said, “no, not recommended”, but my dermatologist said, “yes, it’s safe”. Help. It’s been a week and it’s still there. I know if i don’t treat it, they’ll be there for a few more weeks. It not just the look, but the pain that’s hard to ignore.

    Any links or studies regarding cortisone shots and pregnancy will be appreciated. Thank you for your time.

    • Thank you for your comment. In general, most dermatologists are likely to defer to the advice of the obstetrician. Although injections of weak steroid solutions locally into the cysts are generally regarded as relatively safe (obviously there are no absolutes in medicine!), I will only treat a patient if explicit approval is given by the Ob. For your knowledge, if you do an internet search of the terms “corticosteroids” and “pregnancy”, you will find a lot of information on the subject. Best wishes to you!

      • Thanks Dr. Iyer for your reply. It was not a hard decision after doing some more research that baby’s health is greater than anything else. I just want to understand all the risk before making my final decision.

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