Information request regarding cortisone induced atrophy

[Elene]

Dr. Rockoff,
On December 7, 2006 I had a cortisone injection in a raised bump/pimple on my left cheek (over my cheekbone). I had a terrible break out. I’m not sure that what I actually had was a cyst, but it was a raised bump, which was painful and not filled with anything? The physician’s assistant who saw me that day very casually told me that she would give me shot of cortisone to calm it down. I know that I had one in my late teens and it was successful (no dents, that is). Furthermore, she proceeded to state, “we have to get the right amount of solution, too much can cause a dent.” I was alarmed that she was only telling me this as she injected the site. Needless to say, about two weeks after the injection, I noticed a dent on my cheek. The dent is about the diameter of the end of my pinky finger and shallow. (It looks like modeling clay that has been pushed in with a finger). It looks similar to a “pock mark.” The thing that frustrates me is that I never have had bad enough acne to get “pock marks.” I cannot believe that my only one has been caused by a procedure from my dermatologist’s office. When I went back in for the follow up visit the physician’s assistant said that she had one on her chin and before she knew it she couldn’t notice it anymore. She further stated that I have young skin (I am 30 years old) and the collagen should build back up.
I felt like she was very casual about the whole thing, which made me initially feel better, but as the weeks have gone by I have seen no improvement. It is very difficult to find clear information. I saw your name and this forum come up time and time again regarding this issue. Thus, I am writing to you in the hopes that you can give me some clarity about what exactly my body is going through as a result of the cortisone injection and also I would like your professional opinion on what are the chances that this dent will resolve itself? Here are my questions. Of course I know that it is difficult for you to say without seeing me:
• In layman’s terms what happens to the skin when injected with cortisone
• How does the body repair itself from this type of injury?
• Why is it permanent for some people are not for others?
• Does age have a factor?
• Does history of scaring come in to play?
• Does the shallowness/depth of the dent give any indication of healing/flattening potential?
• Is it as simple as waking up one morning and it being gone?
• Are there statistics on the percentage of dents that heal?
Thank you for your time and understanding. I am very upset about this imperfection, especially because I go to my dermatologist for assistance with issues, not to have them created. Thus, had I been informed that this was a potential side affect I would have absolutely said no. My pimples always heal with time. Now my frustration has been extended indefinitely.

[Alan Rockoff, MD]

What you're describing is atrophy ("skin thinning").  This is entirely reversible, but takes about 6 months, which is why you haven't seen much change yet.  Age and scarring history don't play a role; what does is the concentration of cortisone, which is diluted to make the indenting less likely.  I presume that in your case the injection was diluted, but apparently not enough.  To be fair, it is not always possible to predict indenting even if the standard dilution was used.  The shallowness of the dent is a good sign, but the healing doesn't happen overnight.  It does happen, though, pretty much all the time.

When to inject is a matter of judgment--on the part of both patient and treater.  We do it frequently, primarily to help large, unsightly pimples go away faster than the weeks it would take on their own.  How large is "large," depends a lot on the person who has it.

I hope this information helps.

Dr. Rockoff

[MsSkinProblems]

A related discussion, Cortison Dent and Fat Transfer was started.