From the FDA Drug Label
PRECAUTIONS General The lowest possible dose of corticosteroid should be used to control the condition under treatment, and when reduction in dosage is possible, the reduction should be gradual Since complications of treatment with glucocorticoids are dependent on the size of the dose and the duration of treatment, a risk/benefit decision must be made in each individual case as to dose and duration of treatment and as to whether daily or intermittent therapy should be used.
The prescription of systemic steroids in nodular prurigo should be done with caution, using the lowest possible dose to control the condition. A risk/benefit decision must be made in each individual case, considering the size of the dose and the duration of treatment. The dosage should be gradually reduced when possible. 1
Key considerations:
- Use the lowest possible dose
- Gradually reduce dosage when possible
- Make a risk/benefit decision for each individual case
- Consider the size of the dose and duration of treatment
From the Research
Systemic steroids for nodular prurigo should be prescribed as a short-term intervention, typically using oral prednisone at 0.5-1 mg/kg/day (usually 30-60 mg daily for adults) for 2-4 weeks, followed by a gradual taper over several weeks to prevent rebound. This approach is based on the most recent and highest quality study available, which emphasizes the importance of a multimodal approach to target both immune and neural mediated aspects of the disease 2. When prescribing systemic steroids, it is essential to consider the potential side effects and contraindications, such as uncontrolled diabetes, hypertension, glaucoma, osteoporosis, active infections, and psychiatric disorders. Some key points to consider when prescribing systemic steroids for nodular prurigo include:
- Starting with a higher dose for severe cases, then tapering by 5-10 mg every 5-7 days
- Morning dosing is preferred to minimize adrenal suppression
- Monitoring for side effects including glucose elevation, fluid retention, mood changes, and insomnia
- Using systemic steroids as a bridge therapy while implementing longer-term treatments like topical steroids, antihistamines, or immunomodulators
- Considering steroid-sparing agents such as cyclosporine, methotrexate, or phototherapy to prevent long-term steroid complications, as suggested by recent studies 3, 4, 5, 6. It is crucial to counsel patients about potential side effects and the importance of not stopping treatment abruptly, ensuring a comprehensive and patient-centered approach to managing nodular prurigo.