If you’ve ever suffered—and really, the word is suffered—from one of those deep, painful, throbbing under-the-skin acne cysts, then you’ll know just how desperate one can feel to get rid of them. Nestled deep within the skin, cysts have a bumpy, raised appearance that makes them difficult to cover with makeup. Left untreated, these painful, unsightly cysts can last for weeks or months, and are prone to scarring or leaving depressions on the skin—and that’s if you manage to keep your hands off. Because cystic pimples are so deep in the pore, topical treatments don’t always get the job done. In fact, unless you’re using topicals proactively, there’s little chance they’ll affect the condition of the cyst at all.
You may have heard of cortisone shots as an emergency fix, something you should get before a prom, wedding, or other big event if you’ve got a nasty pimple and know all eyes will be on you; cortisone shots can also be a great resource for those who fall victim to cysts, particularly the hormonal type that come just before you get your period. And while we’d prefer to be left in the dark and just think of cortisone as some unknown magical component—the tears of the acne deities?—it’s actually a chemical our bodies generate in response to inflammation. Our natural cortisone, however, is short-acting, and doesn’t enable hasty healing, says dermatologist Joshua Zeichner, Director of Cosmetic and Clinical Research at the Department of Dermatology at Mount Sinai Medical Center, which is where the shot comes in. The steroidal hormone, found naturally in the adrenal gland, comes more concentrated in a cortisone injection, dramatically reducing inflammation and speeding up healing time by days, or even weeks, Zeichner told me.
I found myself two days before my best friend’s wedding with a honker on my chin so large that I sent a photo of it to our group chat and could basically hear them gasp via text; I didn’t even get out of bed before I emailed Zeichner for back up. After sending him a photo, he told me to come in ASAP—and the same goes for you, by the way: If you find yourself with a cystic breakout big enough to warrant a needle, get thyself to a dermatologist, stat. They’re the only ones who should be responsible for administering a cortisone injection, as in, this should by no means be your next DIY project, no matter how skilled you think you are with syringes.
The procedure is so simple that I can barely even call it that: Zeichner surveyed the area, numbed it a bit, and when right on in. It only hurt in that he was injecting an already inflamed and painful pimple with a needle, but it was over in two or three seconds. Within about an hour, the cyst went down enough that my boyfriend could finally speak to me without staring directly at it, and within 12 hours, it was totally cover-able with makeup, which Zeichner says is safe. But he did warn me about two possible side-effects, though: “First, the injection can cause a dent or a dip in the skin,” he said. “I use a very diluted concentration to reduce your risk—enough to work, but never more than you’d need. If a dent occurs, it’s temporary. It takes several months to dissipate, but most of the time it doesn’t come back, especially if it’s a mild dent.” Dark-skinned patients may notice some hypopigmentation at the site of the injection, but that should also go away with time. Plus, “early treatment reduces your risk for scar by minimizing inflammation,”says Zeichner, so you’ll be less likely to see an acne mark than if you’d just left it there—or worse, picked at it. After about a day, you could barely tell there was a violent, one-centimeter-wide mound of terror where a teeny scab now lay on my chin. I’d call that a success story.
And sure, it was a little weird and seemingly overdramatic (at least to my boyfriend) to run to the derm for a cortisone shot, but it was worth it 10 times over. Despite massive cystic pimples often feeling like the end of the world, or at least the end of your social life (never leaving the house again!), there’s a way to treat them quickly and easily in a harmless, fast-acting procedure that takes five minutes. There aren’t many other things we can say that about.