Does Prednisone Increase Sweating?
Yes, prednisone can cause increased sweating—this is a recognized dermatologic adverse effect listed in the FDA drug label. 1
Evidence from FDA Drug Label
The FDA-approved prescribing information for prednisone explicitly lists "increased sweating" among the dermatologic adverse reactions associated with the medication 1. This appears alongside other skin-related side effects including acne, hirsutism, and impaired wound healing that occur in the context of corticosteroid therapy.
Clinical Context and Mechanism
While the FDA label confirms increased sweating as an adverse effect, the clinical literature provides additional nuance:
Cosmetic and dermatologic changes are extremely common with corticosteroid therapy, occurring in approximately 80% of patients after 2 years of treatment 2, 3. These include facial rounding, weight gain, acne, and hirsutism—sweating fits within this constellation of dermatologic effects.
The sweating effect appears to be dose-dependent and related to duration of therapy. Guidelines discussing corticosteroid side effects emphasize that severe complications typically emerge after protracted therapy (>18 months) at higher doses 2, 3.
Important Clinical Considerations
Distinguish from withdrawal phenomena: One case report describes fever and potential autonomic symptoms during the "drug-free" period of alternate-day prednisone therapy 4, suggesting that sweating could theoretically occur as part of a withdrawal syndrome rather than direct drug effect. However, this is distinct from the increased sweating that occurs during active treatment.
Not a primary concern for dose adjustment: While increased sweating is documented, it is not among the severe complications (osteoporosis, diabetes, hypertension, psychosis) that typically necessitate dose reduction or drug discontinuation 2, 3. Cosmetic changes including sweating contribute to treatment discontinuation in some patients, but this represents a minority.
Practical Management
If a patient reports bothersome sweating on prednisone:
- Confirm the symptom is attributable to prednisone rather than underlying disease activity or other medications
- Consider whether dose reduction is feasible based on the underlying condition being treated
- Reassure patients that this is a recognized side effect
- Symptomatic management with appropriate antiperspirants may be helpful, though this is not specifically addressed in the guidelines
The evidence clearly establishes that prednisone can increase sweating as a dermatologic adverse effect, though it is generally not among the most clinically significant complications of corticosteroid therapy.