What is the recommended dosing for prednisolone (corticosteroid) in the treatment of contact dermatitis?

Prednisolone Dosing for Contact Dermatitis

For extensive or severe contact dermatitis affecting more than 20% of body surface area, start oral prednisolone at 0.5-1 mg/kg/day and taper over 2-3 weeks to prevent rebound dermatitis. 1, 2

Initial Dosing Strategy

• Mild to moderate contact dermatitis (<20% body surface area): Use topical corticosteroids as first-line treatment rather than systemic therapy 1
• Extensive or severe contact dermatitis (>20% body surface area): Initiate oral prednisolone at 0.5-1 mg/kg/day 1, 2
• Rapidly progressive or debilitating dermatitis affecting >30% body surface area: Prednisolone 0.5-1.0 mg/kg/day is appropriate 3
• Systemic steroids typically provide relief within 12-24 hours of initiation 2

Duration and Tapering Protocol

The critical element is adequate treatment duration with gradual taper—not abrupt discontinuation:

• Minimum treatment duration: 2-3 weeks with gradual taper 1, 2, 4
• Severe rhus (poison ivy) dermatitis: Taper over 2-3 weeks specifically to prevent rebound dermatitis 2, 4
• Short tapering courses over 3-4 weeks may be necessary for severe cases 3
• The rationale for 2-3 week duration is primarily to prevent rebound dermatitis, which occurs with rapid discontinuation 4

Tapering Schedule

• Begin tapering after achieving disease control (no new lesions, healing of existing lesions) 5
• Decrease dose in small decrements at appropriate intervals until reaching the lowest effective dose 6
• Avoid rapid discontinuation to prevent disease flare and adrenal insufficiency 7

Important Precautions and Pitfalls

Common pitfall: Prescribing courses shorter than 2 weeks leads to rebound dermatitis 3, 2, 4

• Limit systemic corticosteroid use to 1-2 weeks for mild dermatitis flare-ups, but extend to 2-3 weeks for severe contact dermatitis 3
• Avoid long-term or chronic intermittent use of systemic corticosteroids for dermatologic conditions 3
• A tapering schedule is essential regardless of treatment duration to prevent adrenal suppression 3

Monitoring for Adverse Effects

Short-term risks include:

• Hypertension, glucose intolerance, gastritis, and weight gain 3

Long-term risks include:

• Decreased bone density, adrenal suppression, and emotional lability 3

Adjunctive Measures

• Apply emollients regularly to maintain skin hydration 1
• Identify and eliminate the causative allergen or irritant 1, 2
• Consider antihistamines for pruritus control 1
• Use soap substitutes for cleansing affected areas 1
• Follow up within 1 week to assess response and monitor for steroid-related adverse effects 1

Special Populations

• Children: Generally should not receive systemic steroids for dermatitis unless required to manage comorbid conditions 3
• Pediatric dosing when necessary: 0.14 to 2 mg/kg/day in three or four divided doses 6
• Pregnant patients: Avoid all antihistamines if possible, especially during the first trimester 3

When Topical Therapy is Sufficient

• Localized acute allergic contact dermatitis lesions are successfully treated with mid- or high-potency topical steroids (triamcinolone 0.1% or clobetasol 0.05%) 2
• Reserve systemic therapy for extensive disease (>20% body surface area) 1, 2