What is the recommended prednisone (corticosteroid) taper for severe poison ivy?

From the Guidelines

For severe poison ivy, a recommended prednisone taper is 0.5–1.0 mg/kg daily, with a maximum of 80 mg daily, in tapering doses over 1–2 weeks, as this approach helps control the severe inflammatory reaction while minimizing rebound symptoms. This recommendation is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 1.

Key Considerations

• The taper should begin promptly after exposure for maximum effectiveness.
• Patients should take the medication with food to reduce stomach irritation and complete the entire course even if symptoms improve early.
• Prednisone works by suppressing the immune system's overreaction to urushiol, the oil in poison ivy that triggers the allergic contact dermatitis.
• Topical treatments like calamine lotion and cool compresses can be used alongside the oral prednisone for symptom relief.
• If the rash involves the face, eyes, genitals, or covers more than 25% of the body, or if there are signs of infection, medical attention should be sought immediately.

Additional Guidance

• Washing with soap and water can remove up to 100% of poison ivy oils if done immediately after contact, and topical corticosteroids may be recommended for symptomatic treatment of local symptoms 1.
• However, the usefulness of over-the-counter topical steroids and antihistamines to alleviate local symptoms from poison ivy is uncertain 1.
• Cool compresses and oatmeal baths may be considered for relief of local symptoms from exposure to poison ivy, oak, or sumac 1.

From the Research

Recommended Prednisone Taper for Severe Poison Ivy

• The recommended prednisone taper for severe poison ivy is not universally agreed upon, but a study published in 2014 2 suggests that a longer course of prednisone may be beneficial in reducing the need for additional medications and saving patients' time.
• This study compared a 5-day regimen of 40 mg oral prednisone daily to a 15-day regimen that included a taper of 30 mg daily for 2 days, 20 mg daily for 2 days, 10 mg daily for 2 days, and 5 mg daily for 4 days.
• Another study published in 2022 3 found that shorter duration oral corticosteroids were associated with an increased risk of return visits to healthcare clinicians, and recommended treatment with oral steroids for at least 14 days.
• The American Academy of Dermatology does not have specific guidelines for the treatment of poison ivy, but other studies suggest that systemic corticosteroids can be effective in treating severe cases 4.
• It is worth noting that the use of prednisone should be individualized and based on the severity of the patient's symptoms, as well as their medical history and other factors 2, 3.

Treatment Duration

• A study published in 2022 3 found that most emergency clinicians offered oral corticosteroid prescriptions for a duration of 1-13 days, but recommended treatment for at least 14 days.
• Another study published in 2014 2 found that a 15-day regimen of prednisone was effective in reducing the need for additional medications and saving patients' time.

Additional Treatments

• Other treatments for poison ivy include washing the affected area with soap and water, applying calamine lotion or hydrocortisone cream, and taking oral antihistamines to relieve itching and reduce the risk of infection 5, 4.
• Some studies have also suggested that saponin-containing extracts, such as those found in jewelweed, may be effective in preventing poison ivy dermatitis 6.