Procedure

Cortisone Injection

A tiny shot of diluted steroid into one inflamed acne cyst. It flattens that spot in a few days. It treats the bump, not the acne.
Dr. Schwarz, MD · Board-certified dermatologistLast reviewed August 23, 2026
A gloved clinician injecting a raised lump on a patient's shoulder with a small syringe

Start here

This is the fastest fix in acne and the most oversold. A cyst that would take three weeks usually flattens in two to four days, but it treats one bump and does nothing for the acne underneath or the next cyst. Two things you will not read elsewhere — in the United States this is off-label for acne, and the whole published trial evidence is one 1983 study of nine patients. The trade-off to understand is dose, because too strong leaves a small dent, which is uncommon but not reliably temporary, so a lower concentration and a slightly slower result is the better deal.

— Dr. Schwarz, Board Certified Dermatologist

Key Facts

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Also calledIntralesional steroid injection, intralesional triamcinolone, cortisone shot
Drug usedTriamcinolone acetonide, diluted — usually 2.5 to 5 mg/mL for a facial acne cyst
DowntimeNone. You can go back to work straight away
SessionsOne injection per cyst, as needed
Typical costAbout $50 to $250 per visit in the US; varies by city and by how many spots are treated
Results timelineSoftening in 24 to 48 hours, mostly flat by day 3 to 5
PainA brief sting, a few seconds
Skin tone safetySuitable for all skin tones. On deeper skin tones, too strong a dose can leave a lighter patch that takes months to fade

What It Is

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A tiny amount of diluted steroid, usually triamcinolone acetonide, injected straight into one swollen acne cyst. It is not a steroid pill or cream — the dose stays in that one bump. Dermatologists use it when a single deep spot is painful, large, or will not settle.

How It Works

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A cyst swells because your immune system attacks clogged, bacteria-filled oil deep in the skin. Steroid shuts that reaction off locally, so pressure drops and the bump shrinks. It also breaks down the thickened tissue around it. It does not kill bacteria, unclog the pore or cut oil, so a spot can return in the same place.

Skin is about two millimetres thick on the face. How deep a treatment reaches decides what it can change, and whether it treats all of the skin or scattered columns of it decides how long you take to heal.

How it works
Compare
Skin basics
EPIDERMISDERMISFAT0.05 mm — pigment0.5 mm — texture + pores1.0 mm — collagen1.5 mm — deep dermisPEELNEEDLINGNON-ABLATIVE LASERABLATIVE LASERREACHES THE DEEP DERMIS

This goes through the full thickness of the skin, past the collagen and down to where hair bulbs, larger vessels and glands sit. At this depth a treatment can reach structures creams never touch, and it is also where scarring becomes a real risk if it is done badly.

A peel or a scrub takes the skin off evenly from the surface down. Everything above the line goes and nothing below it is touched, which is why peels suit surface pigment and rough texture, and why the whole face flakes for a few days after.

Needles make hundreds of separate channels and leave the skin between them untouched. That untouched skin is what heals the rest, so recovery is quick — but a needle only injures the skin to start repair. It removes nothing.

The light passes through the surface and heats a column underneath it. The surface stays whole, so you leave red rather than raw — and it takes a course of sessions rather than one.

The laser removes columns of skin outright: the white gaps here are tissue that is gone, and new skin grows in from the sides. The strongest of the four, and the longest to heal.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

What It Treats

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Close-up of the cheek, nose and mouth of an adult with light skin, turned three-quarters away from the camera against a pale blue background. The surface of the cheek is uneven, dimpled with shallow depressions and small pits that catch the light. There are no active spots — the change here is in the texture of the skin rather than its color.
Acne Scarring
Strong evidence
The mainstay for raised and keloid scars. Steroid injected into the scar flattens and softens it, usually over a series of injections four to six weeks apart. It does nothing for indented scars, and too much in one place can leave a dip or thinned, pale skin.
Close-up of a cheek with inflamed acne. Raised pink-red bumps, a few with yellow-white heads, sit in a patch of redness, and the skin between them is dry and flaking.
Acne
Moderate evidence
Deals with one stubborn painful lump, not the condition. It settles in a day or two and is the safe alternative to squeezing it. It does nothing to prevent the next one.
Epidermal Inclusion Cyst
Epidermal Inclusion Cyst
Moderate evidence
A small injection of steroid into an inflamed cyst early in a flare, which settles the swelling and pain over a few days. It is for the flare, not the cyst — the sac and its lining are still there afterwards. It works best in the first day or two, before the lump has come to a head.
Ingrown Hairs
Moderate evidence
A steroid injected directly into a firm raised or keloid scar left by old bumps. It flattens and softens the scar over a series of visits a few weeks apart. It treats what is already there and does nothing to prevent the next one, and repeated injections can leave a pale or dented patch.

Not the Best For

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Psoriasis
Psoriasis
Limited evidence
A small amount of steroid injected directly into one thick plaque that has refused to shift, or into the nail fold for nail psoriasis. It works where cream cannot get through. It is used sparingly, because repeated injections can leave a dent or a pale mark in the skin, and it is not a treatment for anything widespread.
Scalp Psoriasis
Scalp Psoriasis
Limited evidence
Steroid injected directly into one or two thick patches that have refused everything applied on top. It flattens them within a few weeks. It is done in clinic, it stings, and it is not a plan for a whole scalp — repeated injections in the same spot can leave a dent in the skin.
Hidradenitis Suppurativa
Hidradenitis Suppurativa
Limited evidence
A small amount of steroid injected straight into a single painful lump, which usually settles it within a day or two. It is the fastest thing available for one bad flare and it avoids cutting. It treats that one lump only, and repeated injections in the same spot can thin the skin, so it is not a plan on its own.
Close-up of a cheek with inflamed acne. Raised pink-red bumps, a few with yellow-white heads, sit in a patch of redness, and the skin between them is dry and flaking.
The rest of your acne
Doesn't work
The injection settles the single lump it goes into. It does nothing for the other spots on your face and nothing for next month's breakout.
Close-up of pink raised bumps, some with small white tips, on flaking skin
Everyday pimples
Doesn't work
It is kept for a large, painful cyst or nodule, usually one that needs to settle quickly. Ordinary spots are not worth a needle and the risk of a dent.
Two skin close-ups side by side, labeled Whitehead (Closed Comedone) and Blackhead (Open Comedone)
Stopping acne coming back
Doesn't work
This is a rescue treatment, not a plan. Whatever caused the cyst is still there afterwards.

Pros and Cons

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Pros
  • Speed A cyst that would take weeks is flat in days.
  • Pain relief Pressure eases within a day.
  • Scar prevention Cutting inflammation short lowers the scar risk.
Cons
  • It treats one spot A rescue, not a plan.
  • Cost and access Needs an appointment, often at short notice.
  • Dents and light patches Too high a dose leaves a dip or pale halo.
  • Thin evidence One randomized trial, nine patients, 1983.

What Happens

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ArrivingThe treatmentLeaving
Arriving
The provider checks that the spot is an inflamed acne cyst and not a boil. Photos may be taken. No numbing, since numbing cream takes longer than the injection itself. Some offices use a cold pack or a vibrating device first. Your provider will ask about these things.
The treatment
The skin is wiped with alcohol. A very fine needle goes just into the bump and a small amount of fluid goes in, under 10 seconds per spot. The sting is sharp for a few seconds, worse if the cyst is already tender, but most people rate it lower than they expect. Numbing does not help much — the needle stick is the whole procedure.
Leaving
A tiny red dot, sometimes a small raised bleb that flattens within an hour. Makeup and exercise are fine within an hour.

Recovery

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First few daysDays 1 to 2Days 3 to 7
First few days
A pinprick mark, sometimes a small bruise, fading over a few days.
Days 1 to 2
The bump softens and the ache fades. Redness lags behind the swelling.
Days 3 to 7
Most cysts are flat. A flat brown or red mark can stay for weeks — post-acne pigment, not a failed injection.

Aftercare

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1 hourSame dayNext day
Makeup
1 hour
Fine once the needle site closes, about an hour.
Exercise
Same day
No restriction.
Actives
Next day
Restart retinoids, benzoyl peroxide and acids tomorrow.
Sun
No restriction, but daily sunscreen fades the leftover mark faster.

Risks

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Side effects are uncommon at these low doses. In a survey of 100 dermatologists, nearly 89% said fewer than one in a hundred patients came back with a problem.

Dent in the skin
A shallow depression where fat and collagen have thinned. It is dose-related, which is why a low concentration goes on the face, and it often improves over months. About half the clinicians who see it report it lasting past six months, and it can be permanent.
Lighter patch of skin
A pale ring or spot, more visible and slower to fade on deeper skin tones. It usually recovers, but can take many months and can persist.
Visible small vessels
Fine red lines after repeated injections into the same spot.

Combining Treatments

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Same day
Topical acne creams
Retinoids and benzoyl peroxide continue as normal.
Same day
Oral acne medicines
Antibiotics, spironolactone and hormonal birth control continue.
Same day
Isotretinoin
Often used early in a course, when flares are common.
Same day
Extractions
Same visit is fine.
Until healed
Peels and lasers
Wait until the cyst is flat.

Insurance Coverage

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Insurance often covers it, since acne cysts count as medical rather than cosmetic. Coverage still depends on your plan and deductible.

Ask Your Doctor

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If you are pregnant or breastfeeding
Ask the doctor managing your pregnancy or breastfeeding before having it.
If you have a dent from a past injection
Injecting the same thinned area again risks a deeper, longer-lasting dent.
If it is for a child
Reported cases of steroid acting on the whole body after intralesional injection are mostly in children. A facial acne dose is a fraction of that, but keep the total low and space treatments out.
If you have diabetes
Steroid can raise blood sugar briefly. The dose is tiny, but tell your provider.
If you have a deeper skin tone
The risk here is a lasting lighter patch, more visible and slower to fade. Ask for 2.5 mg/mL or less on the face. This is a dose conversation, not a reason to avoid treatment.
If several spots are injected at once
That raises the total steroid dose. Ask what the total will be if a large number is planned.
If you need several injections a month
The acne needs a daily prevention plan rather than repeated shots. Ask about starting one.

At-Home Versions

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There is no home version
Bad alternative
Injectable steroid is prescription-only and must be dosed and placed by someone trained. Injecting yourself risks infection, permanent dents, and injury.
Hydrocolloid patches
Okay alternative
They flatten surface whiteheads and stop picking. They do nothing for a deep cyst.
Ice plus benzoyl peroxide or salicylic acid
Okay alternative
Modestly calms a spot over several days. Slower and less reliable, but free and safe.

How It Compares

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Incision and drainage
Different job
Opens the cyst and empties it rather than calming it. Relieves pressure straight away, carries more scarring risk, and is kept for cysts too large or too fluid-filled to settle with a shot.
A short course of oral steroid
Different job
Calms many inflamed cysts at once instead of one, with body-wide effects. Used for a widespread flare, not a single spot.
Isotretinoin
Different job
Treats the acne that keeps producing the cysts, over months. An injection buys days — this is the answer to needing several of them.
Oral antibiotics
Different job
Bring down widespread inflammation over weeks. Slower than a shot on any one spot, and aimed at the whole problem rather than the bump.

Finding a Provider

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Board-certified dermatologists, and the physician assistants and nurse practitioners working with them, do this routinely.

Ask what concentration they use. For facial acne the guidelines suggest 2.5 to 5 mg/mL; 10 mg/mL and above is for keloids and thick scars, and is more than a facial cyst needs. The dose evidence is unusually clear — in alopecia areata, doubling from 5 to 10 mg/mL bought no extra benefit and took skin thinning from about 3% to about 20%.

A provider who injects every spot at every visit, or who will not discuss a daily acne plan, is not treating the acne.

Questions Patients Ask

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How fast does a cortisone shot work on a cyst?

Softening begins within 24 to 48 hours and most spots are flat by day three to five. That figure traces back to one small 1983 trial — it matches what dermatologists see but has never been tested at scale. The mark left behind takes weeks longer, and the injection does not speed that up.

Will it leave a dent?

It can. A shallow depression happens when the dose is too strong, so a lower concentration is the main protection. It is uncommon — most dermatologists see it in well under one patient in a hundred — and it often fills in over several months. But it is not reliably temporary. About half the clinicians who do see it report it lasting more than six months, and occasionally it is permanent. That is why you ask what concentration is being used.

Can I get one before an event?

Yes, the most common reason people ask. Aim for three to five days ahead so the swelling has time to drop. A same-day injection rarely looks better by that evening.

Does it stop acne from coming back?

No. It treats only the spot it is injected into. Preventing the next cyst needs a daily treatment plan, and the guidelines call this an add-on.

Is it safe on deeper skin tones?

Yes. The risk is a lighter patch at the site, more noticeable and slower to fade on deeper skin tones. A lower concentration reduces it, so ask.

Is this approved for acne?

Not in the United States, strictly speaking. The FDA labeling lists intralesional use for keloids, alopecia areata, discoid lupus and others. Acne is not on it. Off-label use for an acne cyst is routine, legal and recommended by the American Academy of Dermatology, but almost nobody says it out loud. In the UK, NICE withdrew its recommendation in 2026 after UK-licensed triamcinolone injections stopped being available — a supply and licensing decision, not a safety one.

References

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