What I Wish I’d Known Before I Got My First Cortisone Shot
And what you should know, too.
I grew up having nearly perfect skin. Don’t get me wrong, I got occasional pimples but they were nothing my trusty Mario Badescu Drying Lotion couldn’t handle.
When I was around 20, my skin turned on me and erupted with cystic acne—I’m talking big, deep, painful, recurring cysts. As someone who has always been diligent about skincare, I freaked out, naturally. Then I called my dermatologist, who recommended I get cortisone shots for my acne.
Cortisone shots are like the dermatological nuclear option for acne. Injected into the right kind of pimple—there is a right kind; more on that later—a cortisone shot can get rid of an absolute unit of a zit within days, even hours. But this instant gratification can come with a price.
Keep reading to learn about my experience with cortisone shots—and everything I wish I had known before I got poked.
What Is a Cortisone Shot for Acne?
What Is a Cortisone Shot?
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.”
If you’re itching to make a super-swollen pimple disappear, a cortisone injection is the closest thing to a magic wand; in some cases, blemishes deflate completely within 24 to 48 hours of cortisone shots.
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 Shot 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 quick fixes for those embarrassing (and potentially disfiguring) blemishes. But these injections are really meant for emergency use, 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 to Prepare for a Cortisone Shot
Part of prepping for a cortisone shot is knowing when to get it. Good news: If you wake up with a whopper, you can hit the dermatologist to get it dealt with the same day.
“If you get a lesion that is like a previous lesion that resulted in scar formation, you can go to the dermatologist as soon as you see the lesion develop,” Ciraldo says.
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.
Another important part of prep: finding a qualified medical professional to stick you. “Definitely find an experienced 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.
My first experience with cortisone injections was when I woke up with a zit I can only describe as monstrous. I had never experienced a breakout of this magnitude, so I immediately turned to a professional.
My personal dermatologist assessed the situation and said I was pretty much a textbook example of why someone would need a cortisone shot. It had only been a few hours since my pimple appeared, not a few months, but it really was massive and painful. I jumped at the chance for a quick solution. One pinch of a needle later, I was done.
The shot worked like a dream. I was ready to show my face in public again by evening. But I didn’t stop with that one cortisone shot; for awhile, I routinely turned to the needle for cysts on my chin and nose.
If I went HAM on cortisone shots, my dermatologist certainly never discouraged me from getting them. I didn’t get every blemish that surfaced injected, but my trips to the dermatologist weren’t infrequent, either. Once you’ve watched a pimple disappear before your eyes, it’s hard to go back to waiting weeks for it to vanish.
Potential Side Effects
So what can possibly go wrong with cortisone shots for acne? Aside from bruising, there are two main risks.
“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 and people who have darker skin tones as opposed to those skin is lighter.” Fortunately, any skin lightening from cortisone injections usually improves without treatment within a few months, he says.
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.”
Well, against all odds, I racked up quite a few of those indentations after getting cortisone shots. Frankly, they looked a lot like acne scars—pitted, icepick-type scars on my chin and one side of my nose, and round indentations resembling boxcar scars on the other side of my nose.
I asked Ciraldo why these pitted marks occur. It turns out that cortisone is actually used to dissolve collagen in thick, raised scars. When diluted cortisone is injected into skin, it takes down swelling without damaging skin’s collagen. That dilution is what you want in order to knock out a nodule.
But striking that balance is more difficult than it sounds. Skin depressions can result from physician error—using too strong a dilution of cortisone—but not always, Ciraldo says.
“The range of dosing to be sure an acne lesion resolves without depression can vary even from person to person,” she explains. A typical anti-inflammatory dose to knock out a cyst is 1.5 to 2.5 milligrams per cubic centimeter, she says, but even 1.5 milligrams is too much for some patients. So dose that’s just big enough to flatten a cystic zit on one patient can leave a pitted mark on someone with thinner skin.
Plus, she points out, what some patients may perceive as scars from cortisone injections could just be caused by the acne itself; when cortisone shots are properly done, they actually reduce the risk of scarring.
If you want cortisone shots for your acne but you’re worried about the prospect of post-injection pits, Ciraldo suggests telling your dermatologist to go easy on dosage. “Ask the dermatologist if they can make the shot weaker and you will return if you need a second injection to not run the risk of depression,” she says. “Also, you can ask what are your risks of getting a depression. If the dermatologist says that you have more than a five percent chance, I would not do it!”
At a certain point, I decided I’d collected enough of these annoying pockmarks on my chin and nose. I slowly weaned myself off injections—and got a new dermatologist. Then, I patiently waited for the depressions to disappear.
Good news: If you have health insurance, 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.
Uninsured? Cortisone shots for acne are relatively affordable, at least compared to most other procedures done at a derm’s office. Expect to pay about $50 to $100, depending on where you live, for a cortisone shot; Ciraldo says she charges $75 at her Miami practice.
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.
As for me, I regret getting cortisone shots for my acne. It has been a few years since my last injection and I’m still waiting for the depressions on my chin and nose to disappear. Luckily, most people probably don’t notice them unless they’re standing super-close to my face.
But I notice them. Every day. No amount of exfoliation or retinol has helped them. Every time a professional looks at my skin, they ask what happened, and when I tell them the reaction is always the same: a sigh and a knowing shake of the head.
I’m still exploring my options; for example, Ciraldo says microneedling treatments can minimize the look of my scars over time, and hyaluronic acid injections can fill the pitted areas temporarily. Hopefully, I’ll be able to report back with a happy ending to my story. For now, I’m just staying far away from needles.