How many days will it take to see a response in skin lesions after increasing the prednisolone (corticosteroid) dose to 30 mg per day?

Response Timeline for Prednisolone 30 mg Daily in Skin Lesions

You should expect to see initial response to prednisolone 30 mg per day within 5-7 days, with disease control defined as cessation of new lesion formation and onset of healing in existing lesions. 1

Expected Timeline Based on Condition Severity

For Pemphigus and Severe Autoimmune Blistering Disorders

• Initial response window: 5-7 days is the critical assessment point 1
• If no response is observed within this timeframe, the British Association of Dermatologists recommends increasing the dose by 50-100% increments 1
• Disease control is specifically defined as: no new lesions appearing AND the onset of healing in pre-existing lesions 1
• Treatment failure is formally defined as lack of disease control despite 3 weeks of therapy at 1.5 mg/kg per day (approximately 105 mg for a 70 kg patient) 1

For Moderate Inflammatory Dermatoses

• Response within 1-3 weeks is typical for conditions like bullous pemphigoid when using prednisolone 0.5 mg/kg per day (approximately 35 mg for a 70 kg patient) 1
• If no disease control is achieved within 1-3 weeks at this dose, guidelines recommend increasing to 0.75 mg/kg per day 1

For Severe Inflammatory Conditions (Acne Fulminans, Vasculitis)

• Resolution of systemic signs within 1 month with prednisolone 30 mg daily (given as 10-10-10 mg three times daily) 2
• >50% improvement in skin lesions within 1 month in 65% of patients 2
• For necrotizing skin lesions in vasculitis, eosinophilia may decrease rapidly, though severe tissue damage may persist 3

Critical Assessment Points

Week 1 (Days 5-7)

• This is your first decision point 1
• Look specifically for: cessation of new lesion formation and early signs of healing in existing lesions 1
• If no response, consider dose escalation rather than waiting longer 1

Week 2-3

• Secondary assessment window for moderate inflammatory conditions 1
• By this point, you should see clear improvement or consider the treatment inadequate 1

Week 4 (1 Month)

• Expected timepoint for substantial improvement in severe inflammatory conditions 2
• Systemic symptoms (fever, arthralgia) should have resolved by this point if present 2

Important Clinical Pitfalls

Dose Considerations

• 30 mg daily is considered a low-moderate dose for many severe dermatologic conditions 1
• For a 70 kg patient, this represents approximately 0.43 mg/kg, which is at the lower end of recommended dosing for severe disease 1
• The British Association of Dermatologists notes that standard practice for severe pemphigus typically starts at 1-2 mg/kg (70-140 mg for a 70 kg patient) 1

Avoiding Treatment Delays

• Do not wait beyond 5-7 days without response before reassessing 1
• Delayed dose escalation may prolong disease activity and increase cumulative steroid exposure 1
• Consider that 30 mg may be insufficient as initial therapy for extensive or severe disease 1

Monitoring for Inadequate Response

• Continued formation of new lesions after 5-7 days indicates inadequate disease control 1
• Lack of healing in existing lesions is equally concerning 1
• If prednisolone doses above 1 mg/kg per day are required, pulsed intravenous corticosteroids should be considered 1