From the Research
Oral prednisone for severe dishidrotic eczema should be prescribed at 0.5-1 mg/kg body weight per day, with a higher dose of 20-40 mg daily for adults, followed by a gradual taper over 2-3 weeks, as recommended by recent studies 1, 2. The medication should be taken in the morning with food to minimize gastrointestinal side effects and reduce interference with sleep. Prednisone is generally reserved for acute, severe flares that haven't responded to topical treatments, as long-term use can cause significant side effects including weight gain, mood changes, increased blood sugar, bone loss, and adrenal suppression. During treatment, continue using moisturizers and avoid triggers that worsen your condition. A short-term course of prednisone works by reducing inflammation and suppressing the overactive immune response that causes the blistering and itching in dishidrotic eczema. Some key points to consider when treating dishidrotic eczema include:
- Topical corticosteroids should be used once daily rather than twice daily, as suggested by recent evidence 2
- Topical calcineurin inhibitors are useful for sensitive sites, as shown in studies 3, 4
- Oral antihistamines, oral or topical antistaphylococcal treatments for infected eczema, and probiotics for treating eczema are not recommended due to lack of evidence 2
- Nonpharmacological treatments including silk clothing, ion-exchange water softeners, and emollient bath additives have not been shown to benefit eczema patients, and emollients from birth may even result in harms such as increased skin infections and food allergy 2 After completing the prednisone course, maintenance therapy with topical corticosteroids, calcineurin inhibitors, or phototherapy is usually necessary to prevent recurrence, as supported by recent studies 4, 5. If flares happen frequently, consultation with a dermatologist about other systemic options like immunosuppressants may be warranted, considering the comparative safety of systemic immunomodulatory medications in adults with atopic dermatitis 1.