“Is a cortisone shot safe to use for treating cystic pimples? Should I be worried about pitted skin?”
We all know there’s acne, and then there’s acne. Of course it’s not that simple, but when considering a needle to handle your skin woes, it’s important to define the various types of acne so you can develop a healthy level of perspective about your own. In general, smallish black and white spots (comedonal acne) and red or pink spots (inflammatory acne) on the surface of your skin are treatable topically, with retinoids or blue light therapy. But sometimes, pea-sized (or larger) nodules develop deep within the skin. This acne, called cystic or nodular acne, can linger for months. There are a variety of treatments, but some sufferers of cystic acne turn to cortisone shots.
In honor of acne-awareness month (June), we asked Dr. Diane Berson, MD, general and cosmetic dermatologist with a special focus on adult acne, to help us investigate:
Are cortisone shots worth it?
“Cortisone shots basically work for cysts, which are the inflamed tender spots. Women especially tend to get cysts on their chin and lower face premenstrually, and cortisone is basically an anti-inflammatory. So if a cyst is painful, it will decrease the pain; if a cyst is itchy, it will decrease the itching, but most importantly it will also shrink it down. So it may not totally take it away but it certainly makes it much smaller, usually within 24 to 48 hours. So a cortisone shot is something you do if you want to decrease the appearance of a cyst rapidly.”
What Are the Pros?
“The cortisone shot will decrease the itching, the inflammation, the pain, and the cyst itself.”
What Are the Cons?
“If too much is injected, it can leave a little bit of an indentation in the skin after the cyst resolves, but that indentation is usually not permanent. It will usually fill in. But the risk you take is that if you do it, if you put too much in there or if the concentration is too strong, it can basically shrink the skin itself and leave you with a little divot.”
What Are the Alternatives to a Cortisone Shot?
“Obviously, being on a very good dermatologist-prescribed acne regimen will make you less likely to get the cysts. So if you’re on a regimen you’re going to be less likely to break out than someone who’s not on a regimen. If you’re getting the cysts every month when your hormones fluctuate, going on a hormonal treatment such as the birth control pill may help decrease the outbreak of cysts. This also works preventatively: you can take the pill or another hormonal treatment prescribed by a dermatologist to prevent the appearance of cystic acne in the first place. Another alternative to just shrink it fast is to use an ice pack or an ice cube that will just basically bring down some of the swelling. In terms of making it look less noticeable, ice compresses also reduce inflammation. But that’s really very temporary. It’s not a way to treat it, it’s just that if you find yourself with something inflamed and swollen, ice will reduce swelling.”
Are Preparation H or Toothpaste Safe Alternatives?
“Those are both drying. Though Preparation H reduces swelling a little bit, I’m not going to advocate doing that for a pimple. It might reduce swelling for a few minutes, but it’s not a long-term fix. I don’t recommend toothpaste either. There are much better topicals to dry out pimples, but the cortisone injection does not dry out a pimple, it shrinks cysts.”
With Repeated Use, Will Resistance to Cortisone Increase?
“You don’t build up a resistance, but that’s why you want to have it done by someone who knows what they’re doing. You don’t want to inject it too often in the same area, or you could get an indentation. There’s no such thing as a resistance to cortisone. Basically, I recommend being cautious about what concentration and what volume is used in a given area so you don’t wind up with an indentation. ”
The Bottom Line: Cortisone Shots Provide Immediate Relief, Not a Long-term Solution
“If the cysts come in a cyclical pattern, I recommend a hormonal solution like the pill. But the best solution is a dutifully-followed acne regimen, of course.”
Charlotte Knows:
At every age, acne is one of the most publicly difficult, excruciating skin issues. It can seem debilitating, and the desire for immediate gratification is almost unbearable, but hopefully you’ll use cortisone shots only in the most dire situations after reading Dr. Berson’s recommendations. In general, some of the best topical acne antidotes contain vitamin A or B, antibacterials, retinoids, sulphur, or benzoyl peroxide.
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