Guide · Cortisone injection for acne
Cortisone injection for acne when a pimple injection helps, and when it does not
A cortisone injection, often called a pimple or cyst injection, can calm a large, painful acne lump within days. Here is how it works, who it suits, the risks in Asian skin, and why it is a rescue treatment rather than a cure for acne.
Quick answer
- A cortisone injection for acne is a tiny dose of a diluted corticosteroid, usually triamcinolone, injected by a doctor directly into a large, painful acne cyst or nodule. It damps down the inflammation so the lump flattens and hurts less, often within one to three days.
- It suits one or a few deep, swollen, tender lumps, not whiteheads, blackheads or small pimples, and it does not stop new acne forming. The American Academy of Dermatology's 2024 acne guideline lists it as an add-on for larger lesions, alongside treatment of the acne itself.
- The main risks are a small dent (atrophy) and a paler patch (hypopigmentation) at the injection site. These are uncommon with low concentrations and tiny volumes, and usually recover over months, but they can last and may be more noticeable in Asian skin.
- In Singapore triamcinolone is a prescription-only medicine, so the injection is given by a doctor. At IN Eternity Clinic, Dr Sin Yong assesses the lump and plans wider acne treatment, priced at consultation; SkinRev Lab does not inject, but offers HydraFacial for everyday congestion.
What it is
What a cortisone injection for acne actually is
An intralesional corticosteroid injection places a very small amount of steroid directly inside an inflamed acne lump. The steroid most often used is triamcinolone acetonide, diluted well below the strength used for joints or scars. In a survey of 100 dermatology practitioners, the most common concentration was 2.5 mg/mL and the most common volume about 0.05 mL per lesion, a few drops.
The aim is to switch off the local inflammation that makes a nodule or cyst swollen, red and painful. An older study found that triamcinolone at 0.63 mg/mL worked as well as 2.5 mg/mL for nodulocystic acne, which is one reason doctors favour low strengths.
It is not the same as draining a pimple, and it is not an antibiotic. Nothing is removed; the lump settles as the inflammation subsides.
How fast
How fast a pimple injection works
These timings reflect common clinical experience rather than large trials; the survey authors noted there is little published data or consensus on how it should be done. Results vary with how deep and how large the lump is.
If a lump has not improved after about a week, or is getting more painful, it should be reviewed. It may be infected, may need draining, or may be something other than acne, such as a sebaceous cyst.
| Time | What you may notice |
|---|---|
| Straight after | A brief sting; a small bump or blanching at the injection point |
| Within 24 hours | Pain and tightness often start to ease |
| Days 2 to 3 | The lump usually flattens noticeably |
| About 1 week | Most of the swelling has gone |
| Weeks to months | A flat red or brown mark may remain and fade gradually |
Who it suits
Who it suits, and who it does not
Tell the doctor if you are pregnant or breastfeeding, have diabetes, have had dents from previous injections, or are taking other acne medicines, as these affect the decision.
| Situation | Is an injection usually considered? |
|---|---|
| One or a few deep, painful acne nodules or cysts | Often, yes |
| A large inflamed lump before an important event | Sometimes, if it is a true inflamed nodule |
| Whiteheads and blackheads | No; these respond to retinoids, exfoliation and careful extraction |
| Small red pimples or pus spots | No; they usually settle on their own or with topical treatment |
| New nodules every month | Not on its own; the underlying acne needs treatment |
| A slow lump with a central pore that refills | Possibly a sebaceous cyst, which needs a different plan |
| A hot, spreading, very painful lump with fever | No; possible infection, so see a doctor promptly |
| A firm raised scar left after acne has healed | Possibly a keloid or hypertrophic scar, treated differently |
Risks
Risks: dents, pale patches and how they are kept low
The most commonly reported side effect is atrophy, a small dent where the steroid has thinned the fat or skin under the lump. The second is hypopigmentation, a lighter patch that is more noticeable on darker or tanned skin. In the practitioner survey, most respondents said fewer than 1% of their patients came back with an adverse effect, but about half reported that atrophy, when it did happen, lasted more than six months.
Rarely, pale or thinned skin can track in a line away from the injection site, thought to be the steroid spreading along lymphatic channels. Other possible effects include brief pain, bruising, small visible blood vessels and, uncommonly, infection. Repeated injections into the same spot raise the risk.
These risks are why a doctor uses a low concentration, a small volume and careful technique, and why injections are kept for the lumps that most need them.
- Low concentration and the smallest effective volume
- Injecting into the centre of the lesion, not too deep or too shallow
- Not repeating injections into the same spot too soon
- Avoiding injection into lumps that are infected or are not acne
- Reviewing any dent or pale patch rather than injecting it again
Why not every pimple
Why it is not for every pimple
Acne develops from oily skin, blocked pores, skin bacteria and inflammation, often driven by hormones. A cortisone injection quietens one lump; it does nothing to stop the next one forming. Using injections as the main treatment means repeated small risks of dents and pale marks without changing the course of the acne.
Small pimples also tend to settle by themselves within days, so the trade-off between benefit and risk does not favour injecting them. Think of the injection as a rescue for a particularly painful or prominent lump, while the real control comes from treating the acne itself.
Other treatments
What else treats cystic and nodular acne
The 2024 American Academy of Dermatology guideline strongly recommends benzoyl peroxide, topical retinoids, topical antibiotics and oral doxycycline, and strongly recommends oral isotretinoin for acne that is severe, scarring or not responding to other treatment. All of these except some over-the-counter products need a doctor's assessment and prescription in Singapore, and most take eight to twelve weeks to show their effect.
| Option | What it does | Notes |
|---|---|---|
| Topical retinoids (adapalene, tretinoin) | Unblock pores and prevent new spots | First-line; can irritate at first; avoided in pregnancy |
| Benzoyl peroxide | Reduces acne bacteria and inflammation | Often combined with a retinoid or topical antibiotic |
| Topical clindamycin | Antibacterial and anti-inflammatory | Used with benzoyl peroxide to limit resistance |
| Azelaic acid | Calms inflammation and helps marks | Gentler option; also used for PIH |
| Oral doxycycline or minocycline | Reduce inflammation in moderate to severe acne | Limited course, combined with topical treatment |
| Combined oral contraceptive pill or spironolactone | Reduce hormonal oil production in women | For suitable women, after medical assessment |
| Oral isotretinoin | Shrinks oil glands; long remission for many | For severe, scarring or resistant acne; needs pregnancy prevention and monitoring |
Keloids
Acne cysts vs keloids: a different use of the same medicine
A keloid is a firm, raised scar that grows beyond the edge of the original wound and can keep enlarging. Asian skin is prone to them, and the chest, shoulders, upper back and jawline are common sites, sometimes after acne spots. An acne cyst, by contrast, is a temporary inflamed lump that usually feels tender rather than hard.
Triamcinolone injections are also a mainstay of keloid treatment, but at higher strengths, repeated every few weeks and often combined with other measures such as silicone, pressure, laser or surgery with additional therapy. Because the doses and aims are different, a keloid injection plan and an acne cyst injection should not be confused.
If a spot on your chest or shoulder healed into a raised, itchy, growing scar, it should be assessed as a possible keloid.
When to see a doctor
When to see a doctor about acne
Do not squeeze deep lumps, and do not use steroid injections bought online or offered outside a medical clinic. Triamcinolone is a prescription-only medicine in Singapore, and injecting the wrong strength or depth is how dents happen.
- Deep, painful lumps or cysts, even if only a few
- Acne leaving scars or dark marks
- Acne on the chest, back or shoulders that keeps coming back
- No improvement after two to three months of good over-the-counter care
- Acne affecting your mood, confidence or daily life
- New adult acne with irregular periods or excess hair growth, which may need a hormonal check
- A hot, spreading, very painful lump or fever, which needs prompt review
On the day
At the appointment and afterwards
The doctor examines the lump to confirm it is an inflamed acne nodule or cyst, and looks at the wider pattern of your acne. The skin is cleaned and a fine needle places a few drops of diluted triamcinolone into the lesion; the injection itself takes seconds.
Afterwards, avoid squeezing or picking the lump, keep makeup off the puncture point for a few hours, and carry on with gentle skincare. If you notice a dent or pale patch in the following weeks, tell the doctor rather than having it injected again; most improve gradually over months.
Where to go
Cortisone injections and acne care in our network
Cortisone injections for acne are a medical treatment. At IN Eternity Clinic, 9 Scotts Road, #12-01 Pacific Plaza, beside Orchard MRT, Dr Sin Yong assesses whether a lump is suitable for injection and, where needed, plans treatment for the acne itself. Treatment is priced at consultation by the clinic; WhatsApp +65 8815 3008.
SkinRev Lab, at CityLink Mall #B1-28 by City Hall MRT, does not inject. HydraFacial Syndeo (S$288 to S$438 before GST; WhatsApp +65 8266 9585) can help clear blackheads, whiteheads and oily congestion, but it is not a treatment for cysts or nodules, and inflamed lumps are not extracted. If you are taking or have recently stopped isotretinoin, exfoliating facials are postponed until your doctor says it is safe.
Sources
References & sources
- Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1-1006.e30.
- Gallagher T, Taliercio M, Nia JK, Hashim PW, Zeichner JA. Dermatologist use of intralesional triamcinolone in the treatment of acne. J Clin Aesthet Dermatol. 2020;13(12):41-43.
- Levine RM, Rasmussen JE. Intralesional corticosteroids in the treatment of nodulocystic acne. Arch Dermatol. 1983;119(6):480-481.
- Friedman SJ, Butler DF, Pittelkow MR. Perilesional linear atrophy and hypopigmentation after intralesional corticosteroid therapy. Report of two cases and review of the literature. J Am Acad Dermatol. 1988;19(3):537-541.
- Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids: a 2020 update of the algorithms published 10 years ago. Plast Reconstr Surg. 2022;149(1):79e-94e.
- NHS. Acne.
Common questions
Your questions,
answered
Does a cortisone injection work for acne?
For a large, inflamed acne nodule or cyst, yes, it usually reduces the swelling and pain within a few days. It does not treat acne as a whole or prevent new spots, so it is meant to be used alongside treatment for the underlying acne.
How long does a cortisone shot take to work on a pimple?
Many people notice the pain easing within a day and the lump flattening within two to three days. Larger or deeper nodules may take about a week. If there is no improvement after a week, the lump should be reviewed.
Do cortisone injections for acne leave dents?
They can. A small dent, called atrophy, is the most commonly reported side effect. It is uncommon with low concentrations and small volumes, and most improve over months, but some last longer than six months. That is why injections are kept for lumps that really need them.
Can a pimple injection cause a white mark?
Yes, a paler patch (hypopigmentation) can appear at the injection site and is more noticeable on darker or tanned skin. It usually recovers gradually. Tell the doctor if it happens, rather than having the same spot injected again.
Is a cortisone injection safe for Asian skin?
It is widely used in Asian skin, but dents and pale patches are more visible on medium to darker skin tones, so low strengths, tiny volumes and careful technique matter. Flat brown marks after the lump settles are usually post-inflammatory pigmentation and fade with sun protection.
Can I get a pimple injection before an event?
Often, if the lump is a true inflamed nodule or cyst, and ideally two to three days beforehand to allow it to settle. It will not help whiteheads or small pimples, and makeup should be kept off the puncture point for a few hours.
How much is a cortisone injection for acne in Singapore?
Costs vary by clinic and by how many lumps are treated. At IN Eternity Clinic it is priced at consultation, after Dr Sin Yong has examined the skin and discussed whether wider acne treatment is needed.
Can a facial salon give a pimple injection?
No. Triamcinolone is a prescription-only medicine in Singapore and the injection must be given by a doctor. Beauty and facial centres, including SkinRev Lab, do not inject.
Is a cortisone injection for acne the same as a keloid injection?
The medicine can be the same, but the use is different. Keloid injections use higher strengths, repeated every few weeks, often with other treatments. Acne cyst injections use a much weaker dilution, usually once per lump.