An acute myopathy has been reported with the use of high doses of corticosteroids, most often occurring in patients with disorders of neuromuscular transmission (., myasthenia gravis), or in patients receiving concomitant therapy with anticholinergics, such as neuromuscular blocking drugs (., pancuronium). This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis. Elevations of creatine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years.
For acne cysts on the face, it is safer to use 1 to 2 mg/mL to make sure that atrophy does not occur. On the trunk consider using 2 to mg/mL of triamcinolone. Enough suspension should be injected to see and feel the cyst become distended, but no more than mL is needed for any one cyst. One injection site per acne cyst should be adequate. If the cyst is large and soft, do not inject more volume because that can lead to atrophy. If there is a lot of purulent material inside the cyst, a quick incision and drainage (with lidocaine and a No. 11 scalpel) before injecting the steroid may be helpful.
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