Are fillers the only option for atrophy caused by a steroid shot?

Question

I had several pimples, one cystic and two smaller injected with hydrocortisone at my dermatologist. It is a week later and I am starting to get some atrophy at two of the spots. Is this likely to get worse as time goes on? Do fillers always work to correct the problem? And is there anything else to do other than fillers and time which will correct the issue? Thankyou

Brian Maloney, MD, FACS · Answer

Steroids are a common treatment for skin cysts. They can shrink a cyst and keep the patient from needing an excision of the cyst which will result in a scar. Is the hollowness from the steroid or just lost volume from the cyst. Hard to tell. Most doctors that inject the cysts use a very dilute steroid which generally has little effect on the surrounding tissues. If you do have a depression that is a concern, you certainly can add a filler. By the time the filler has worn off the depression will probably have refilled. If you do nothing, it should come back over time.

David Hansen, MD · Answer

A depression from a cyst which resolved is not uncommon if it is a big cyst or has been present a long time. That's why you see kids with depressed scars from bad acne cysts. The steroid shot only helps it go away faster.  It usually doesn't cause the depression. The good thing is that if you do get a depression after the cyst resolves from the steroid shot, then the depression self heals and fills in over the next 3-4 months without doing anything at all.  Fillers can fill it in if you are in the 20% that doesn't fill in itself. But wait for 3 months.

Joel M. Stewart, Jr., MD · Answer

My guess is that it takes longer than a week to demonstrate atrophy. I would wait some time before considering fillers in those areas.Give it some time. Perhaps it will improve with some more time. Ask your dermatologist for their opinion regarding atrophy.Good luck.

Stephen Nightingale, MD · Answer

You are correct, steroid injections can cause atrophy of both the skin and the fat that lies beneath the skin.  We can see this with cystic acne and acne scar steroid injections as well as steroid injections for tendonitis and scalp nerve blocks.  Typically it takes longer than a week to develop atrophy from a steroid injection. I'm wondering if you are actually seeing the acne cyst shrink and possibly leave a slight depression.   In my experience, fat atrophy may improve over time but it can take months.  Atrophy of the skin is more difficult to treat but may resolve if there are no further injections in that area.  Depending  on type of atrophy, a filler may help, but I would not try this until waiting 6-12 months to see how much this resolves on its own.  In the future, I would recommend using a laser to treat your cystic acne or photodynamic therapy.  Neither of these two treatment modatlities cause atrophy.  I hope this helps.

Rita Rakus, MBBS - Account Suspended · Answer

Hello it sounds unlikely this is from the steroid injection as you describe. I would leave this for a while to see how it progresses. Filler can be used in these areas but is short lived and laser would actually be a better option. Best wishes

Robert T. Buchanan, MD (retired) · Answer

Whether the atrophy worsens or not depends on the exact product injected. "Hydrocortisone" is actually rarely used, though many physicians use the term since it is one most patients recognize. Of the products actually used, the longevity of their action on the tissues depends on the particular product, so you need to know this. Once the product is no longer active, again dependent on the product, then, yes, fillers are a good option. Lumped with fillers is also fat grafting. Discuss this with your Dermatologist. If you do not get satisfactory answers, get the name and exact dose of what was used and see a plastid surgeon.

Are fillers the only option for atrophy caused by a steroid shot?

Answers (6)

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