What is the oral steroid treatment for generalized dermatitis?

From the Guidelines

Oral steroids should be avoided for the treatment of generalized dermatitis due to their potential for serious side effects and the availability of safer alternatives, as recommended by the American Academy of Dermatology guidelines 1. When considering treatment options for generalized dermatitis, it is essential to prioritize the patient's quality of life, morbidity, and mortality. The use of oral steroids, such as prednisone, may provide short-term relief, but their long-term use can lead to severe side effects, including osteoporosis, adrenal suppression, and increased infection risk. Some studies, such as the British Association of Dermatologists' guidelines for the management of bullous pemphigoid 1, suggest the use of oral steroids as a treatment option. However, these guidelines are outdated, and more recent evidence, such as the American Academy of Dermatology guidelines 1, recommends against the use of systemic corticosteroids due to their potential risks. Instead, the guidelines recommend the use of alternative treatments, such as dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib, which have been shown to be effective in managing generalized dermatitis with fewer side effects 1. Key points to consider when treating generalized dermatitis include:

• Avoiding the use of oral steroids due to their potential risks
• Considering alternative treatments, such as biologics or Janus kinase inhibitors
• Using topical treatments and moisturizers to manage symptoms and prevent recurrence
• Prioritizing the patient's quality of life, morbidity, and mortality when making treatment decisions.

From the FDA Drug Label

The initial dosage of methylprednisolone tablets may vary from 4 mg to 48 mg of methylprednisolone per day, depending on the specific disease entity being treated. IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT

The oral steroid treatment for generalized dermatitis with methylprednisolone may vary from 4 mg to 48 mg per day, and the dosage requirements must be individualized based on the disease and patient response 2.

• The initial dosage should be maintained or adjusted until a satisfactory response is noted.
• The dosage may need to be adjusted based on changes in clinical status, patient's individual drug responsiveness, and exposure to stressful situations.
• After a favorable response, the maintenance dosage should be determined by decreasing the initial drug dosage in small decrements at appropriate time intervals.

From the Research

Generalized Dermatitis Steroid Oral Treatment

• Oral corticosteroids are commonly prescribed for atopic dermatitis, with 5.9% of patients receiving them as part of their treatment regimen 3.
• Systemic corticosteroids are rapidly effective for severe atopic dermatitis, but their long-term use is limited due to potential side effects, and they should only be used short-term for severe exacerbations 4.
• In cases where oral corticosteroids are necessary, pulse glucocorticoid therapy, which involves high doses of glucocorticoids administered over a short period, may be considered 5.
• Alternative treatments, such as cyclosporin A, azathioprine, and methotrexate, may be used in chronic cases to reduce the need for long-term oral corticosteroid use 4.
• The use of oral corticosteroids may be more common in certain patient populations, such as males aged 20-39 and 40-59, who had the highest rates of oral steroid prescriptions at 9.2% and 9.8%, respectively 3.

Treatment Considerations

• The decision to use oral corticosteroids should take into account the potential risks and benefits, as well as the availability of alternative treatments 4, 3.
• Topical corticosteroids, such as methylprednisolone aceponate, may be effective for managing atopic dermatitis and reducing the need for oral corticosteroids 6, 7.
• Emollients and other non-steroidal treatments may also be used to manage atopic dermatitis and reduce the need for oral corticosteroids 6, 3.