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Dermatology (Expert Forum)
cortisone injection / atrophy / accutane
Answered by
Alan Rockoff, MD - dermatology, Child Skin Problems
The Rockoff Dermatology Center
Brookline - MA
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cortisone injection / atrophy / accutane
by DaveLlewellyn, Nov 25, 2003 12:00AM
Greetings. I finally went on Accutane this past Sept. after many years of trying to handle my cystic acne with antibiotics, sometimes succesfully, and sometimes and ultimately NOT. In the last months I controlled it with some EXTREME diet modification but that too failed me eventually. The good news is the accutane works and I already seem to be in the clear just a little over 11 weeks in... the bad news is that I have some pretty bad atrophy from an injection I recieved in August. I'm an actor/singer and I was performing with a group in Disney World when a cyst started brewing to the side of my chin... Now it wasn't the worse I'd had by any means, but I feared its growth and with a performance 2 days away decided to find someone to give me an injection, something I'd had done many times before by my dermatologists. At any rate this doctor at an immediate care place said he could do it no problem, but he injected me with more steroid than I'd ever had done by far and also, strangely, held the needle inside, squishing it around for several seconds. I was concerned immediately but then grateful as the cyst quickly subsided in time for the show... then came the atrophy.
So now its been over three months and I've seen little to no improvement in the pronounced indentation left behind. There is also discoloration both, dark in the deepest part, and some whitening to the side (and I'm fair skinned to start). I've read from you and heard from others that in time, the atrophy WILL heal (around 6 months you say). But I'm very worried about the timing of all this and have some questions:
1. Could the accutane be impeding the healing in anyway (save the discoloration which it probably does slow)?
2. Just to clarify, I've had several injections in that area, though never before causing atrophy I noticed, but can such atrophy ever be permanent??
3. **MOST importantly, I'm an actor and my face is part of how I make my living. Is there ANY THING AT ALL that can be done to either speed the healing process, or temporarily remove/reduce the indentation, without impeeding ultimate healing, and while being on Accutane??**
4. Finally, in the unlikely event that this does not heal completely can you tell me what you know of the laser treatment for filling in indented scars and how long would I have to wait after finishing my course of accutane?
I appreciate very much your taking the time to respond to these concerns. I do have a dermatologist who, when I last went in for accutane follow up, was rather non-challant about it saying that, yes in time it would "probably" fill all the way back in. I'm writing you b/c I'd like to have some more details and another, and thoughtfully written opinion (as you seem to do so consistently) would be very helpful.
Thanks again,
Best --David
So now its been over three months and I've seen little to no improvement in the pronounced indentation left behind. There is also discoloration both, dark in the deepest part, and some whitening to the side (and I'm fair skinned to start). I've read from you and heard from others that in time, the atrophy WILL heal (around 6 months you say). But I'm very worried about the timing of all this and have some questions:
1. Could the accutane be impeding the healing in anyway (save the discoloration which it probably does slow)?
2. Just to clarify, I've had several injections in that area, though never before causing atrophy I noticed, but can such atrophy ever be permanent??
3. **MOST importantly, I'm an actor and my face is part of how I make my living. Is there ANY THING AT ALL that can be done to either speed the healing process, or temporarily remove/reduce the indentation, without impeeding ultimate healing, and while being on Accutane??**
4. Finally, in the unlikely event that this does not heal completely can you tell me what you know of the laser treatment for filling in indented scars and how long would I have to wait after finishing my course of accutane?
I appreciate very much your taking the time to respond to these concerns. I do have a dermatologist who, when I last went in for accutane follow up, was rather non-challant about it saying that, yes in time it would "probably" fill all the way back in. I'm writing you b/c I'd like to have some more details and another, and thoughtfully written opinion (as you seem to do so consistently) would be very helpful.
Thanks again,
Best --David
Doctor's Answer
by Alan Rockoff, MD, Nov 25, 2003 12:00AM
, Nov 25, 2003 12:00AM
1. No, I don't think Accutane will impede healing.
2. I don't think one can say "never" about anything, but I think permanent indentation is at all likely. It may take more than six months, but the indent should fill in.
3. Perhaps you can consider a collagen injection to give you a temporary fill. I'd suggest consulting a reputable dermatologist who injects fillers like collagen.
4. I don't see much if any role for laser treatment, during Accutane or after.
Hang in there. Time is on your side. But consider looking into colagen.
Best, and thanks for your comments.
Dr. Rockoff
2. I don't think one can say "never" about anything, but I think permanent indentation is at all likely. It may take more than six months, but the indent should fill in.
3. Perhaps you can consider a collagen injection to give you a temporary fill. I'd suggest consulting a reputable dermatologist who injects fillers like collagen.
4. I don't see much if any role for laser treatment, during Accutane or after.
Hang in there. Time is on your side. But consider looking into colagen.
Best, and thanks for your comments.
Dr. Rockoff
