What is the recommended steroid dose for treating poison ivy?

From the Guidelines

For treating poison ivy, a short course of oral prednisone is typically recommended, starting with 40-60 mg daily for 5 days, followed by a gradual taper over the next 5-7 days. This approach is based on the principle of reducing inflammation and suppressing the allergic reaction to urushiol, the oil in poison ivy that causes the rash 1. Some key points to consider when treating poison ivy include:

• Washing with soap and water can remove up to 100% of poison ivy oils if done immediately after contact, with effectiveness decreasing over time 1
• Topical corticosteroids are often recommended for symptomatic treatment of local symptoms, but those that have been demonstrated to improve local symptoms are not available over the counter 1
• A tapering dose of steroids is important to prevent rebound symptoms that can occur if steroids are stopped abruptly
• While using steroids, continue to clean the affected area with mild soap and water, and consider calamine lotion or cool compresses for additional symptom relief It's also worth noting that the effectiveness of topical steroids for poison ivy treatment has been questioned in some studies, with one randomized, blinded trial involving 92 cases of Toxicodendron dermatitis finding no significant improvement in symptoms with 0.2% hydrocortisone lotion, 1.0% hydrocortisone ointment, 2.5% hydrocortisone ointment, and 2.5% hydrocortisone cream 1. However, oral prednisone remains a commonly recommended treatment option, with a typical regimen consisting of 40 mg for 5 days, then 30 mg for 2 days, 20 mg for 2 days, and 10 mg for 2 days 1. For children, the oral prednisone dose should be adjusted to 1-2 mg/kg/day (maximum 60 mg) with a similar tapering schedule.

From the Research

Recommended Steroid Dose for Poison Ivy

The recommended steroid dose for treating poison ivy can vary depending on the severity of the condition and the specific treatment approach.

• For severe poison ivy dermatitis, a study published in the Journal of Clinical Medicine Research 2 found that a 5-day regimen of 40 mg oral prednisone daily, followed by a prednisone taper, was effective in treating the condition.
• Another study published in the American Family Physician 3 recommends that oral prednisone should be tapered over two to three weeks for severe rhus dermatitis to avoid rebound dermatitis.
• A retrospective claims-based analysis published in The Western Journal of Emergency Medicine 4 suggests that treatment with oral corticosteroids for at least 14 days is recommended, and that shorter durations may be associated with return visits.
• A study published in Cutis 5 notes that systemic corticosteroids can be added in more severe cases of poison ivy dermatitis, but does not specify a particular dose or duration.

Treatment Duration and Dose

• The study in the Journal of Clinical Medicine Research 2 used a dose of 40 mg oral prednisone daily for 5 days, followed by a taper.
• The American Family Physician study 3 does not specify a particular dose, but recommends tapering over two to three weeks.
• The Western Journal of Emergency Medicine analysis 4 found that most emergency clinicians offered oral corticosteroid treatment for shorter durations (1-13 days), but recommends treatment for at least 14 days.
• The Cutis study 5 does not provide specific guidance on dose or duration.

Comparison of Treatment Approaches

• The Journal of Clinical Medicine Research study 2 compared a short course (5 days) to a long course (15 days) of oral prednisone and found that the long course was associated with less use of other medications.
• The Western Journal of Emergency Medicine analysis 4 found that shorter durations of oral corticosteroid treatment were associated with return visits, and recommends treatment for at least 14 days.
• The American Family Physician study 3 recommends tapering oral prednisone over two to three weeks to avoid rebound dermatitis.