From the Research
Viral rashes generally do not respond well to oral corticosteroids, and these medications are not typically recommended as first-line treatment. Most viral rashes are self-limiting and resolve on their own without specific treatment. Using oral steroids like prednisone or methylprednisolone for viral rashes may actually be counterproductive as they suppress the immune system, potentially prolonging the viral infection or allowing it to worsen 1. Instead, symptomatic treatment is preferred, including:
- Antihistamines (such as diphenhydramine 25-50mg every 6 hours or cetirizine 10mg daily) for itching
- Acetaminophen or ibuprofen for discomfort
- Topical calamine lotion for soothing the skin Cool compresses and lukewarm oatmeal baths can also provide relief. Oral corticosteroids might occasionally be prescribed for severe cases of certain viral rashes that cause significant inflammation, such as severe cases of erythema multiforme or when there's a substantial allergic component, but this should only be done under medical supervision 2. The reason steroids aren't recommended is that they interfere with the body's natural immune response to the virus, which is necessary to clear the infection, and they can mask symptoms while allowing the underlying viral cause to persist.
In the case of erythema multiforme, treatment is highly variable, depending on the etiology, the involvement of mucosal sites, and the chronicity of the disease 2. If the etiology or causal medication/infection is identified, then the medication is stopped and/or the infection is treated prior to initiating symptomatic treatment. Systemic therapies, including corticosteroid therapy, may be considered for recurrent EM, but this should be tailored to individual patients and done under medical supervision.
It's essential to note that the use of systemic steroids for EM major remains controversial, as there is evidence both for and against treatment, and no randomized controlled trials have been done 3. Therefore, the decision to use oral corticosteroids for viral rashes should be made on a case-by-case basis, considering the severity of the rash, the presence of any underlying conditions, and the potential risks and benefits of treatment.