What steroid, such as prednisone, is appropriate for treating cellulitis?

Steroids Are NOT Appropriate for Treating Cellulitis

Steroids should not be used to treat cellulitis itself—antibiotics are the definitive treatment. However, systemic corticosteroids may be considered as an optional adjunct in highly selected non-diabetic adults with uncomplicated cellulitis to potentially shorten healing time by approximately one day, though the evidence is weak and limited 1.

Why Steroids Are Not Standard Treatment

The question appears to conflate cellulitis management with conditions where steroids are primary therapy. For cellulitis specifically:

• Beta-lactam antibiotics are the standard of care, with success rates of 96% for typical uncomplicated cellulitis 2
• Prednisone or prednisolone are NOT first-line treatments for cellulitis—they are primary therapy for inflammatory conditions like bullous pemphigoid (0.3-1.0 mg/kg daily) 3 or Crohn's disease (prednisolone 40 mg daily) 3, but these are entirely different diseases

When Corticosteroids Might Be Considered as Adjunct Therapy

If you are specifically asking about adjunctive corticosteroid use in cellulitis (not as primary treatment):

Patient Selection Criteria

• Only consider in non-diabetic adults with uncomplicated cellulitis or erysipelas who are already receiving appropriate antibiotic therapy 1
• Absolute contraindications: diabetic patients, pregnant women, children under 18 years, patients with systemic toxicity, SIRS, or suspected necrotizing infection 1

Suggested Regimen (If Used)

• Prednisone 40 mg daily for 7 days OR prednisolone 30 mg daily with an 8-day taper 1
• This is based on a single 2005 trial showing median healing time shortened by only 1 day 1

Evidence Quality

• The evidence is weak (single trial, limited data) and this represents a weak recommendation with moderate evidence at best 1
• A 2024 meta-analysis found that oral NSAIDs (not corticosteroids) as adjunct therapy may improve early clinical response at day 3, but this benefit is not sustained beyond 4 days 4

Critical Distinction: Orbital Cellulitis vs. Skin Cellulitis

The research evidence provided relates primarily to orbital cellulitis (a sight-threatening infection around the eye), where corticosteroids have shown benefit in reducing inflammation after initial antibiotic response 5, 6, 7. This is a completely different clinical entity from typical skin cellulitis and should not be extrapolated to routine skin infections.

Essential Adjunctive Measures (More Important Than Steroids)

Instead of focusing on steroids, prioritize these evidence-based interventions:

• Elevation of the affected extremity promotes gravity drainage of edema and inflammatory substances—this is strongly recommended and often more beneficial than steroids 1
• Treat predisposing conditions: tinea pedis, venous eczema, toe web abnormalities, venous insufficiency, and lymphedema 1

The Correct Answer for Cellulitis Treatment

For typical cellulitis, the appropriate treatment is:

• Oral beta-lactams: cephalexin 500 mg four times daily, dicloxacillin 250-500 mg every 6 hours, or amoxicillin for 5 days 2
• Add MRSA coverage only if specific risk factors present: penetrating trauma, purulent drainage, injection drug use 2
• Duration: 5 days if clinical improvement occurs, extending only if symptoms have not improved 2, 1

Steroids are not the answer to this question unless you are specifically asking about a rare adjunctive role with very limited evidence.