What is the recommended initial dose of prednisone (corticosteroid) for pediatric contact dermatitis?

Prednisone Dosing for Pediatric Contact Dermatitis

For pediatric contact dermatitis requiring systemic therapy, start oral prednisone at 0.5-1 mg/kg/day (maximum 60 mg/day) and taper over 2-3 weeks to prevent rebound dermatitis.

When to Use Systemic Corticosteroids

Systemic prednisone is indicated when contact dermatitis is extensive or severe:

• Use systemic therapy when contact dermatitis affects >20% body surface area 1
• For rapidly progressive or debilitating dermatitis affecting >30% body surface area, prednisone 0.5-1.0 mg/kg/day is appropriate 1
• Mild to moderate contact dermatitis should be treated with topical corticosteroids as first-line therapy rather than systemic treatment 1

Specific Dosing Protocol

Initial dosing:

• Start at 0.5-1 mg/kg/day as a single daily dose 1
• Maximum dose: 60 mg/day 2
• For a typical child, this translates to approximately 0.5-1 mg/kg/day based on actual body weight 1

Duration and tapering:

• Minimum treatment duration: 2-3 weeks with gradual taper 1, 3
• Severe cases may require tapering over 3-4 weeks 1
• Begin tapering after achieving disease control, with dose decreases in small decrements 1

Critical Pitfalls to Avoid

The most common error is prescribing courses shorter than 2 weeks:

• Courses <2 weeks lead to rebound dermatitis 1, 3
• Rapid discontinuation of steroids causes rebound dermatitis, particularly in severe rhus (poison ivy) dermatitis 3, 4
• The 2-3 week duration is specifically designed to prevent this rebound phenomenon 4

Dosing considerations:

• For overweight children, consider dosing based on ideal body weight to avoid unnecessary steroid exposure 2
• Consider a maximum dose cap of 80 mg daily in significantly overweight children 2

Expected Response Timeline

• Relief should occur within 12-24 hours of starting systemic steroids for extensive allergic contact dermatitis 3
• If no improvement is seen within 5-7 days, reassess the diagnosis or consider inadequate dosing 5

Monitoring and Adjunctive Measures

Short-term risks to monitor:

• Hypertension, glucose intolerance, gastritis, and weight gain 1
• These are particularly relevant even in short courses

Essential adjunctive measures:

• Apply emollients regularly to maintain skin hydration 1
• Identify and eliminate the causative allergen or irritant 1
• Consider antihistamines for pruritus control 1

Special Pediatric Considerations

Important restrictions:

• Children should not receive systemic steroids for dermatitis unless required to manage comorbid conditions 1
• However, when contact dermatitis is extensive (>20% BSA) and severe, systemic therapy is justified 1
• Use lower potencies and shorter durations when possible in pediatric populations 6

Alternative Approach for Localized Disease

For localized acute allergic contact dermatitis:

• Use mid- or high-potency topical steroids such as triamcinolone 0.1% or clobetasol 0.05% 3
• Reserve systemic therapy for extensive involvement 3