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Nodular Acne: Is The Cortisone Shot Worth The Risk Of Getting A Divot?
Expert Q/A

Are Cortisone Shots Worth The Risk Of Getting A Divot?


July 27, 2016

A note from CB Founder, Robin Shobin:

Having suffered many nodular acne issues throughout my life, I’m no stranger to cortisone shots. They do work really well, and your painful cyst has largely deflated within 24 hours. It’s magical—and that’s why the easy way out is so appealing. But, unlike this Elle video may suggest, there are some cons and they should not be taken lightly. A cortisone shot can lead to divots or indentations in your skin, and so, in my opinion, they should only be used sparingly and only in the event of a skin emergency. They also don’t address the underlying problems of nodular acne. This CB reader wrote in with similar concerns, pitted skin among them.

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 nodular acne turn to cortisone shots.

Is The Cortisone Shot Worth It?

Dr. Diane Berson, a general and cosmetic dermatologist with a special focus on adult acne, weighs in. “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.”

Dr. told RealSelf, “One potential side effect of the cortisone shot is leaving a depression or indentation in the skin. The steroid injection can also leave an area of discoloration. While these are uncommon side effects, they can happen in any patient. In general, these adverse effects will improve over a number of weeks and sometimes months.”

What Are the Pros?

According to CB experts, the cortisone shot will decrease the itching, the inflammation, the pain, and the cyst itself.

What Are the Cons? (Hint: This Is Where The Divots Come In)

Dr. Berson adds, “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 divot.”

Related Read: #AskCharlotte: What Are the Best Exfoliants for Oily, Sensitive Skin?

What Are the Alternatives to a Cortisone Shot?

Obviously, being on a very good dermatologist-prescribed acne regimen and the right diet will make you less likely to get the cysts. But Dr. Berson adds, “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 nodular 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?

Dr. Berson tells us that both are drying, but says she doesn’t advocate either one. “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 shot does not dry out a pimple, it shrinks cysts,” she says.

Related Read: This Simple Betadine Cure for Pimples and Nodular Acne Will Surprise You

What Happens If I Use Cortisone Over And Over?

“There’s no such thing as a resistance to cortisone,” Dr. Berson assures us. But, while you won’t build up a tolerance, you can create a higher risk of indents or divots in your skin if you have the same area injected. Obviously this is why Dr. Berson stresses the importance of going to a qualified physician, “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 For Nodular Acne

Cortisone shots are safe and effective but they should not be used repeatedly or as a long-term solution for nodular acne problems. “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,” Dr. Berson concludes.


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. For more skincare advice, consult The Book to find a qualified cosmetic doctor in your neighborhood.


Charlotte’s Book is a trusted place to find and share information on the best in skincare, anti-aging, aesthetics, and wellness. Ask Charlotte your beauty or wellness question, and we’ll call upon one of the experts in The Book to provide you with the most up-to-date information.


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