Intralesional Corticosteroid Injection for Acne: A Comprehensive Medical Guide
- monami yoneda
- Nov 15, 2025
- 7 min read
Dealing with painful, inflamed acne lesions can be frustrating, especially when they persist despite topical treatments. Intralesional corticosteroid injection—commonly referred to as pimple injection or steroid injection for acne—represents a targeted medical intervention that dermatologists use to address specific types of acne lesions. This evidence-based guide explains how this treatment works, who may benefit from it, and what patients should realistically expect.
Understanding Intralesional Corticosteroid Injection
Intralesional corticosteroid injection is a medical procedure in which a diluted corticosteroid solution (typically triamcinolone acetonide) is injected directly into inflammatory acne lesions. This treatment is primarily used by dermatologists for nodular or cystic acne—deep, painful lesions that do not respond adequately to topical medications or oral antibiotics.
The procedure differs fundamentally from cosmetic dermal fillers or other aesthetic injections. Instead, it serves as a therapeutic intervention targeting the inflammatory cascade within the acne lesion itself. The medication works at the cellular level to reduce inflammation, though the exact timeline and degree of improvement varies considerably among individuals.
The Scientific Mechanism Behind Corticosteroid Injections
When a corticosteroid is injected into an inflamed acne lesion, it exerts multiple anti-inflammatory effects. The medication suppresses the activity of inflammatory cells, including neutrophils and macrophages, which contribute to the swelling, redness, and pain associated with cystic acne. Additionally, corticosteroids reduce the production of inflammatory mediators such as prostaglandins and cytokines.
The localized delivery of medication allows for higher concentrations at the treatment site while minimizing systemic exposure. This targeted approach is why intralesional injection can address individual lesions more effectively than systemic oral medications in certain clinical scenarios. However, it is important to understand that this treatment addresses the inflammatory component of existing lesions but does not prevent new acne formation or address underlying causes such as hormonal factors or sebaceous gland activity.
Clinical Evidence and Treatment Efficacy
The use of intralesional corticosteroids for acne has been documented in dermatological literature for several decades. Clinical studies have demonstrated that this intervention can reduce the size and inflammation of nodular and cystic acne lesions. A systematic review of acne treatment modalities notes that intralesional corticosteroid injection is particularly useful for isolated, painful nodules or cysts, though evidence quality varies across studies.
It should be noted that while many patients experience visible improvement within several days, response rates and timelines differ significantly. Some lesions may resolve more quickly, while others show gradual improvement over one to two weeks. In certain cases, a single injection may not provide complete resolution, and follow-up treatments may be considered by the treating physician based on clinical response.
Who Should Consider Pimple Injection Treatment
Appropriate Candidates
Intralesional corticosteroid injection may be suitable for patients who present with:
Large, painful nodular or cystic acne lesions
Inflammatory acne that has not responded adequately to topical or oral medications
Individual lesions requiring urgent intervention (such as before important events)
Acne nodules at risk of significant scarring
This treatment is typically reserved for specific types of acne lesions rather than widespread inflammatory acne, which is usually better managed with systemic therapies or comprehensive topical regimens.
When This Treatment May Not Be Appropriate
This procedure is generally not recommended for:
Non-inflammatory acne (comedones, blackheads, whiteheads)
Superficial inflammatory papules or pustules
Patients with contraindications to corticosteroids (such as certain infections at the treatment site)
Cases requiring treatment of numerous lesions simultaneously
Patients with a history of keloid formation or hypertrophic scarring should discuss this with their dermatologist, as corticosteroid injections are sometimes used therapeutically in such cases, but individual assessment is necessary.
The Treatment Process: What to Expect
Initial Consultation and Assessment
Before any procedure, a thorough consultation with a qualified dermatologist is essential. During this assessment, your doctor will:
Evaluate the type, severity, and distribution of your acne
Review your medical history and any previous acne treatments
Discuss realistic treatment expectations and potential risks
Determine whether intralesional corticosteroid injection is appropriate for your specific case
Explain alternative or complementary treatment options
The Injection Procedure
The actual injection process is relatively brief and typically follows these steps:
Cleansing: The treatment area is cleaned with an antiseptic solution to minimize infection risk
Preparation: The corticosteroid solution is prepared at an appropriate dilution (commonly 2.5-5 mg/mL of triamcinolone acetonide)
Injection: Using a fine needle, the medication is injected directly into the center of the acne lesion
Post-procedure care: The injection site may be gently compressed, and aftercare instructions are provided
The injection itself is generally quick, though some patients may experience brief discomfort during needle insertion and medication delivery. The level of discomfort varies among individuals and depends partly on the depth and sensitivity of the lesion being treated.
Post-Treatment Course and Follow-Up
After the injection, most patients can resume normal activities immediately. The treated lesion may initially appear slightly more swollen due to the fluid volume injected, but this typically subsides within hours. Over the following days, patients often notice gradual reduction in lesion size, redness, and tenderness, though individual timelines vary.
Your dermatologist will provide specific aftercare instructions, which typically include avoiding manipulation of the treated area and continuing any prescribed topical or oral acne medications. Follow-up appointments may be scheduled to assess treatment response and determine whether additional interventions are needed.
Potential Side Effects and Complications
While intralesional corticosteroid injection is generally considered safe when performed by qualified medical professionals, potential side effects exist and should be understood before proceeding with treatment.
Common Side Effects
Skin atrophy: Thinning of the skin at the injection site, which may appear as a small depression or "divot". This occurs more frequently with higher corticosteroid concentrations or repeated injections in the same area
Hypopigmentation: Temporary or, rarely, permanent lightening of the skin at the treatment site, particularly noticeable in individuals with darker skin tones
Telangiectasia: Development of small visible blood vessels near the injection site
These effects are generally related to the local pharmacological action of corticosteroids on skin tissue. The risk can be minimized through appropriate medication dilution, injection technique, and limiting the frequency of treatments in the same location.
Less Common Complications
Infection at the injection site (rare when proper sterile technique is followed)
Allergic reaction to the corticosteroid medication (uncommon)
Systemic effects from corticosteroid absorption (very rare with single-lesion injections at therapeutic doses)
Duration and Reversibility of Side Effects
Skin atrophy, when it occurs, is often temporary and may gradually improve over several months as collagen remodeling occurs. However, in some cases, particularly with repeated injections or higher concentrations, changes may be prolonged or permanent. Hypopigmentation similarly may resolve over time, though complete recovery is not guaranteed.
It is crucial to discuss these potential risks with your dermatologist and to weigh them against the expected benefits for your specific clinical situation.
Evidence-Based Context: Limitations of Current Research
While intralesional corticosteroid injection is a well-established procedure in dermatological practice, it is important to acknowledge the limitations in the current evidence base. Much of the literature consists of expert opinion, case series, and clinical experience rather than large-scale randomized controlled trials specifically comparing intralesional steroids to other interventions for acne.
According to systematic reviews of acne treatments, intralesional corticosteroids are generally considered effective for individual inflammatory lesions, but the quality of evidence varies. Patients should understand that while many dermatologists routinely use this treatment based on clinical experience and observed patient outcomes, the degree of improvement and the exact timeline cannot be precisely predicted for any individual patient.
Cost Considerations and Accessibility
The cost of intralesional corticosteroid injection varies depending on several factors:
Number of lesions treated in a single session
Geographic location and clinic setting
Whether the procedure is part of a comprehensive treatment plan
In Singapore, patients should consult directly with their dermatology clinic for accurate pricing information, as costs may differ substantially between facilities. Some insurance plans may cover this treatment when it is deemed medically necessary for severe acne, though coverage policies vary.
Long-Term Acne Management: Beyond Single Interventions
It is essential to understand that intralesional corticosteroid injection is typically one component of a broader acne management strategy rather than a standalone solution. While this treatment can effectively address individual problematic lesions, comprehensive acne care usually requires:
Consistent use of appropriate topical medications (such as retinoids or benzoyl peroxide)
Consideration of systemic therapies for moderate to severe cases
Gentle skincare practices that do not exacerbate acne
Addressing contributing factors such as hormonal imbalances when relevant
Regular follow-up with a dermatologist to adjust treatment as needed
Patients should work collaboratively with their dermatologist to develop a personalized treatment plan that addresses both active acne lesions and prevention of future breakouts.
Frequently Asked Questions
How quickly does a pimple injection work?
Many patients notice visible reduction in inflammation and size within 24-48 hours, with continued improvement over the following week. However, individual response varies, and some lesions may require longer or may benefit from repeat treatment.
Is the injection painful?
Most patients experience brief discomfort during the injection, which is generally tolerable. The level of pain depends on individual pain sensitivity, the depth and inflammation of the lesion, and injection technique. The discomfort typically lasts only seconds.
Can all types of acne be treated with injections?
No. This treatment is most appropriate for deep, inflammatory nodules or cysts. Superficial pimples, blackheads, and whiteheads are better addressed with topical treatments or other interventions.
How many injections will I need?
Many patients see improvement with a single injection, but this depends on the size and severity of the lesion. Some cases may benefit from a follow-up injection after one to two weeks if the initial treatment provides incomplete resolution.
Will the injection prevent future breakouts?
Intralesional corticosteroid injection treats existing inflammatory lesions but does not prevent new acne formation. Ongoing preventive treatment with topical or systemic medications is typically necessary for patients with recurrent acne.
Are there any restrictions after the injection?
Most patients can resume normal activities immediately. Your dermatologist will provide specific aftercare instructions, which typically include avoiding touching or picking at the treated area and continuing prescribed skincare routines.
Conclusion: Making an Informed Treatment Decision
Intralesional corticosteroid injection represents a valuable tool in the dermatologist's arsenal for managing specific types of acne lesions—particularly painful, inflamed nodules or cysts that require targeted intervention. When performed by qualified medical professionals using appropriate technique and dosing, this treatment can provide meaningful improvement for selected lesions.
However, it is crucial to maintain realistic expectations and to understand both the potential benefits and risks. Treatment outcomes vary among individuals, and side effects, while generally manageable, can occur. This procedure is most effective when integrated into a comprehensive acne management plan tailored to your specific skin type, acne severity, and medical history.
If you are struggling with painful acne lesions that have not responded to conventional treatments, consult with a qualified dermatologist to determine whether intralesional corticosteroid injection or alternative therapies may be appropriate for your situation. An individualized assessment is essential for optimal treatment outcomes.
Note: This article is for educational purposes only and does not constitute medical advice. Individual treatment plans should be developed in consultation with qualified healthcare professionals. Treatment outcomes vary from person to person, and no guarantee of results is intended or implied. All professional treatments mentioned should be performed by licensed medical practitioners in Singapore, using HSA-approved or otherwise MOH-approved products, devices, and techniques, as applicable.