From the FDA Drug Label
The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. In situations of less severity lower doses will generally suffice, while in selected patients higher initial doses may be required The initial dosage should be maintained or adjusted until a satisfactory response is noted. If after a reasonable period of time there is a lack of satisfactory clinical response, PredniSONE should be discontinued and the patient transferred to other appropriate therapy IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT
The patient is a 9-year-old male with extensive contact irritant dermatitis who failed prednisone solution. To give another round of prednisone, the approach should be to:
- Re-evaluate the dosage: Consider increasing the dosage, but keep in mind that the dosage requirements are variable and must be individualized based on the disease and the patient's response.
- Monitor the patient's response: Adjust the dosage until a satisfactory response is noted.
- Consider alternate day therapy: If long-term therapy is anticipated, alternate day therapy may be an option to minimize undesirable effects.
- Gradually taper the dosage: If the patient has been on prednisone for a long time, it's recommended to gradually taper the dosage to avoid withdrawal symptoms 1, 1.
Key considerations:
- The patient's age and disease severity should be taken into account when determining the dosage.
- The patient's response to the previous treatment should be evaluated to determine the best course of action.
- Regular monitoring is necessary to adjust the dosage and prevent potential side effects.
From the Research
For a 9-year-old male with extensive contact irritant dermatitis who failed an initial course of prednisone solution, I recommend a second course of oral prednisone at a higher dose of 1-2 mg/kg/day (typically 20-40 mg daily for a child this age) for 5-7 days, followed by a more gradual taper over 7-10 days. The previous regimen may have been insufficient in dose or duration for extensive disease. When restarting prednisone, consider dividing the daily dose into two administrations to maintain steady blood levels. Some studies suggest that lower doses of prednisone can be effective in certain conditions, such as rheumatoid arthritis, with minimal side effects 2, 3. However, in the case of extensive contact irritant dermatitis, a higher dose may be necessary to achieve sufficient immunosuppression. Concurrent treatment should include:
- Identifying and removing the irritant
- Applying medium-potency topical corticosteroids like triamcinolone 0.1% ointment twice daily to affected areas
- Maintaining skin hydration with fragrance-free moisturizers Monitor for side effects including mood changes, increased appetite, and elevated blood glucose. If this second course fails, referral to a pediatric dermatologist would be appropriate to consider alternative treatments such as topical calcineurin inhibitors or phototherapy. The higher dose and longer taper are justified because contact dermatitis involves inflammatory pathways that require sufficient immunosuppression to break the cycle of inflammation. It is also important to note that the use of prednisone in children should be carefully monitored due to potential side effects, and the benefits of treatment should be weighed against the risks 4.