Is It Better to Drain an Acne Cyst or Do a Cortisone Injection to Reduce Skin Atrophy/scarring?

I've had successful cortisone shots from my dermatologist before, but when visiting my plastic surgeon, with a large cyst, he insisted on trying to drain it first, saying a cortisone shot could cause atrophy. He used a sterile needle, but squeezed it pretty hard without success & had to inject it anyway. It was swollen and bloody and now a month later I have a huge depression and some red scarring. I wish I'd just had the injection and wonder if the squeezing ruined my skin. What to do now?

Doctor Answers 3

Treating Acne Cysts and Scarring

This is a great question and something that most of us dermatologists think about daily when we have a patient with cystic acne. We, as dermatologists, are much more likely to inject a cyst with a cortisone preparation because we have been doing this for years and know what appropriate concentrations of cortisone to inject to minimize the risk of a depression or atrophy of the skin. Some of our colleagues may notdilute their cortisone as we do.

Remember as well, if we do one procedure, we charge for that one procedure. If we do two procedures, we charge for two procedures. Board-certified dermatologists are adept in determining an appropriate medical routine and use adjuncts like cortisone injections to minimize one’s inflammatory acne. We can also use some sophisticated lasers and light sources, when needed, but remember that is an added expense.

If the cyst is amenable to injections, that is the way to go first.

Nashville Dermatologic Surgeon
4.0 out of 5 stars 18 reviews

Injecting and draining an acne lesion may both be necessary

Cystic acne lesions sometime require both drainage and injection with cortisone.  Acne is a plumbing problem.  It starts with a small keratin plug (microcomedone) that prevents a pore from draining.  Skin cells and oil build up may result in rupture of the hair follicle deep in the skin which then causes an inflammatory reaction (cyst).  These deep lesions are more likely to scar.  Steroid injections work by reducing the inflammatory reaction.  Drainage helps remove some of the pus and the keratin plug.  Sometimes all it needs is drainage.  Sometimes and additional injection with cortisone is required. a side effect of a cortisone injection may be a depressed or lighter area.  A severe acne lesion can also cause  a depressed area.  Board-certified dermatologists are the experts in the treatment of acne and are the best choice to provide treatment.

Dina D. Strachan, MD
New York Dermatologist
3.3 out of 5 stars 10 reviews

Treating an Acne Cyst

It is very difficult to answer this question as it really depends on how big the lesion is and what it looks like.  There are situations where the acne cyst needs to be drained (incised and drained) first and then injected with cortisone and then are times when the cyst doesn't really have anything that needs to be drained, and so a cortisone injection suffices. There are also lesions which are too small and shouldn't be injected with cortisone as it can leave atrophy. I am sure your plastic surgeon has good reason to drain the lesion first.  A depression one month out will likely fill on its own in another month or two as the atrophy is usually temporary. 

Channing R. Barnett, MD
New York Dermatologist
4.1 out of 5 stars 8 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.