Cortisone is a synthetic drug that belongs to a class of medications called corticosteroids, which are potent anti-inflammatory agents. While acne is characterized by clogged pores, its most painful and visible forms, such as cysts and nodules, are fundamentally inflammatory responses. Corticosteroids like cortisone can be utilized to manage these severe, inflamed lesions. This article explores how cortisone works to reduce acne inflammation and clarifies the differences between professional injections and over-the-counter creams.
How Cortisone Targets Inflammatory Acne
Acne lesions develop when hair follicles become clogged with oil and dead skin cells, often leading to a rupture beneath the skin’s surface. This rupture triggers a localized immune reaction, resulting in the redness, swelling, and pain characteristic of inflammatory acne. Cortisone works by suppressing this local immune response and stabilizing cell membranes to prevent the release of pro-inflammatory chemicals. Specifically, it inhibits the production of inflammatory mediators, such as prostaglandins and cytokines.
By reducing the activity of immune cells at the site of the lesion, cortisone rapidly diminishes swelling and redness. This mechanism makes cortisone highly effective against deep, severe lesions, such as painful nodules and cysts. Cortisone is purely a therapeutic tool used to mitigate the symptoms of severe inflammation and is ineffective for non-inflamed lesions like blackheads and whiteheads.
Injection vs. Topical Application for Acne Treatment
The method of cortisone delivery determines its effectiveness and safety profile for treating acne. Intralesional injection, a procedure performed only by a dermatologist, involves injecting a highly diluted corticosteroid solution directly into a large, inflamed nodule or cyst. This targeted application delivers a high concentration of the anti-inflammatory agent precisely where it is needed, leading to rapid shrinkage of the lesion. Patients often observe a significant reduction in the size, pain, and redness of the lesion within 24 to 48 hours. This technique is reserved for acute, severe spots and is frequently used to prevent permanent scarring that large, deep cysts often leave behind.
Conversely, the use of over-the-counter or prescription topical cortisone creams for acne is generally discouraged. Topical corticosteroids are weaker and have poor penetration, meaning they often fail to reach the deep inflammation of nodules and cysts. Furthermore, the prolonged or repeated application of topical cortisone can actually exacerbate acne, a condition known as steroid-induced acne. These topical products can interfere with the skin’s natural cell turnover and may increase sebum production, leading to clogged pores and new acne lesions. Therefore, topical cortisone creams are typically not a recommended treatment for any form of acne.
Potential Side Effects and Treatment Limitations
Although intralesional cortisone injections are highly effective for acute inflammation, they are associated with several specific side effects. The most common localized reaction is skin atrophy, which presents as a slight depression or thinning of the skin at the injection site. This pitting occurs due to the steroid’s effect on the underlying tissue and is often temporary, though it may take several months for the skin to return to its normal texture. Another possible side effect is hypopigmentation, which is the temporary lightening of the skin in the area of the injection. This effect is particularly noticeable and may persist longer in individuals with darker skin tones.
Cortisone injections are a treatment for existing inflammation, not a cure for chronic acne, and they do not address the root factors like hormonal fluctuations or bacterial colonization. If a patient has recurring acne, relying solely on cortisone injections is not a sustainable long-term strategy. The treatment must be viewed as a temporary measure for symptomatic relief, complementing a comprehensive acne management plan that targets the underlying causes. For topical cortisone use, the risk of developing steroid-induced acne is a major limitation, underscoring the importance of professional consultation before using any corticosteroid product for acne.