Are topical or oral steroids good for severe inflammatory acne?

It is leant that oral steroids are a preferred choice in very severe inflammatory acne because a short course will immediately reduce the number of inflammatory lesions. In fact, it is an approach that will help kick start and get quick control of our severe inflammatory acne condition. As with topical steroids, oral steroids can have a significant positive psychologic effect for acne sufferers that go beyond the reduction in severe cystic lesions and to reduce the pain and/or itching associated with them.

When oral steroids are used, they are usually given along with oral acne antibiotics or isotretinoin. As with any medications, the doctor will review with us the potential side effects that may go beyond the skin, it is noted that when the topical or oral steroids are used in high enough doses over long periods of time, what ensue is the possibility of the risk of developing cataracts (i.e. an opacity in the eye that obstructs vision) and suppression of our body's own production of cortisols (i.e. a stress hormone that helps us through whatever is at hand) under periods of stress, which is something very serious. It is reported that side effects associated with strong topical corticosteroids (i.e. a group of anti-inflammatory drugs that often used to inhibit allergic reactions or to treat severe inflammation) included thinning of the skin, stretch marks, new blood vessel formation in the skin (commonly called broken blood vessels), papulopustular flares of acne, and skin addiction to the steroid (i.e. a rebound flare of the acne when withdrawn from use).

In this respect, an injection of the steroid called cortisone in various concentrations directly into inflammatory lesions is used for large inflammatory lesions. This treatment is best done early on in the inflammatory process to both minimize the acne inflammation and help clear the lesion more quickly. Also, other acne treatments can be continued without interruption. However, there is a slight risk of localized thinning of the skin, which may or may not resolve within a few months. Studies have also shown that the injections are especially useful for those occasional flare of inflammatory acnes or the few lesions that often come with monthly menstrual periods in an otherwise successful acne management routine.

From the acne clear and acne care perspective, if we find that we need to go in weekly for injections, then it is time to reconsider our overall acne regimen.