We’ve all been there: You wake up in the morning—usually on a day when you have to lead an important meeting or give a toast at your friend’s wedding—with a red, angry, throbbing pimple. You need it go away fast, and you’re at a loss on how to make that happen. Did you know you could possibly get it taken care of with a shot? Steroid injections, also known as glucocorticoid steroid injections, intralesional corticosteroid injections, and intralesional triamcinolone injections, are one of the tools dermatologists have in our arsenal in the fight against acne. And they can offer fast relief—and I’m talking minutes in some cases. But not every pimple can be treated with a cortisone shot—and there are a few risks involved. Here’s what I want you to know about cortisone shots for pimples. 

How cortisone shots for acne work

Basically, these steroids are anti-inflammatory: They minimize the appearance of acne by calming the inflammation associated with pimples. We often do these cortisone shots for nodules and cysts (meaning those deep, under the skin lesions) that we worry might scar. But we do them in emergency situations, too. I’m talking about those times when having an enormous zit on your face is just not an option. In those cases, I’ll inject a smaller amount of the steroid into the pimple with a syringe. It’s fairly routine—I would say I inject about 10 lesions a week, and it’s a lunchtime procedure with no downtime. But you should think of this as an occasional rescue—not a treatment method. What’s far better is seeing that patient way in advance of a big event and having a great regimen in place beforehand. 

Which pimples are good candidates for a cortisone shot?

As I mentioned above, acne that’s inflamed can be treated with an injection. That means knots, also called nodules or cysts, which you can usually feel under your skin when you put your finger over them. That’s the inflammation we can target. And if you have a new pimple that’s incredibly painful, come in if you can. We’d rather see if we can help than have you suffer.

When not to get an injection for acne

When you can’t feel a knot under the acne lesion—if it’s completely soft to the touch like a small whitehead—that’s a sign that we can’t inject it without risking an indentation. That’s because part of the way these injections work is by atrophying the lesion to flatten it. But if it starts out flat and you put steroids in it, you're going to end up with a divot which can potentially stick around for a long time.

In fact, a 2020 study of doctors in the Journal of Clinical Aesthetic Dermatology found that though only a small percentage of patients returned for adverse results following an acne shot, 48 percent of those who did found that their atrophy lasted more than six months. In other words, if you go in and your doctor says she won’t inject a certain spot, thank her because what she’s saying is the risk-to-benefit ratio isn’t ideal. 

"I would say I inject about 10 lesions a week, and it’s a lunchtime procedure with no downtime."

Are steroid injections for pimples covered by insurance?

Usually. Sometimes there’s a charge for the injection but not the visit. It will depend on your doctor and your insurance. To be sure, call your doctor’s office and ask before you book the appointment to get an injection for your acne. 

Make sure you know the risks of cortisone shots for acne

Beyond the possibility of indentations, steroid injections may also cause a thinning of the skin and a lightening of skin tone in the area. That’s why dermatologists don’t like to inject the same area repeatedly too soon. Again, this is the reason we consider cortisone shots an occasional treatment, not as an everyday procedure.