I consider acne flare ups an emergency as changes in our complexion can be very distressing for the patient. Unfortunately, others can form a negative impression about a person based on their acne. Unlike other medical conditions, acne is visible to the world and can be very difficult to disguise. Most importantly, a severe acne flare especially with cysts can lead to permanent scars. It is my policy to always ensure that patients can be seen for same day appointments for emergency dermatology issues especially acne flare ups. Intralesional kenalog is my treatment of choice for acne cysts. This involves using a very small gauge needle (30 gauge) and injecting the acne cysts with a dilute amount of steroid (3mg/cc of kenalog). Patients describe the level of discomfort from the injection as no worse than a mosquito bite. The steroid works immediately over 1-2 days to decrease the inflammation and resolve the cyst. Acne cysts are not true cysts, meaning that they have no cystic sac that must be removed. Essentially, the acne cysts are pockets of inflammation around the pilosebaceous unit. Attempting to “pop” them out only leads to scarring. Even if they are left undisturbed, they can still lead to scarring. Weddings, proms, special events can all cause stress leading to acne flares, so intralesional steroid injections are the most expeditious treatment for resolving these acne flares.
