What is the appropriate oral steroid treatment for vesicular lesions on both hands and ankles?

From the Guidelines

For vesicular risk on both hands and ankles, the appropriate oral steroid treatment is prednisolone 1 mg kg-1 per day, with the option to increase in 50–100% increments every 5–7 days if blistering continues, as suggested by the British Association of Dermatologists' guidelines for the management of pemphigus vulgaris 1. The treatment should be tailored to the individual patient's needs, with consideration of the severity of the disease and the potential for side effects.

• The initial dose of prednisolone can be adjusted based on the severity of the disease, with milder cases potentially starting at 0.5–1 mg kg-1 per day.
• It is essential to monitor the patient's response to treatment and adjust the dose accordingly, with the goal of inducing remission and maintaining it with the lowest possible dose of prednisolone.
• The patient should be assessed for the risk of osteoporosis immediately and measures taken to prevent it, such as calcium and vitamin D supplementation.
• The treatment should be combined with an adjuvant immunosuppressant, such as azathioprine or mycophenolate mofetil, to help maintain remission and reduce the dose of prednisolone required.
• The patient should be closely monitored for adverse effects, including mood changes, increased blood glucose, fluid retention, and hypertension, and the treatment adjusted as necessary to minimize these risks.
• The dose of prednisolone should be tapered once remission is induced and maintained, with the aim of reducing to 10 mg daily or less, to minimize the risk of long-term side effects.

From the FDA Drug Label

The initial dose of prednisolone sodium phosphate oral solution, (15 mg prednisolone base) may vary from 1. 67 mL to 20 mL (5 to 60 mg prednisolone base) per day depending on the specific disease entity being treated. In situations of less severity, lower doses will generally suffice while in selected patients higher initial doses may be required.

The appropriate oral steroid treatment for vesicular risk on both hands and ankles is not explicitly stated in the provided drug label. However, based on the information given, the initial dose of prednisolone sodium phosphate oral solution may vary from 5 to 60 mg per day, depending on the specific disease entity being treated.

• The dose should be individualized based on the disease under treatment and the response of the patient.
• It is recommended to start with a lower dose and adjust as needed until a satisfactory response is noted.
• The patient's condition should be constantly monitored to determine the lowest dosage that will maintain an adequate clinical response. 2

From the Research

Oral Steroid Treatment for Vesicular Risk

There are no research papers provided that directly address the appropriate oral steroid treatment for vesicular risk on both hands and ankles.

Available Information on Steroid Treatment

• The provided studies discuss the use of topical corticosteroids and immunomodulators for treating atopic dermatitis 3, 4, 5 and vitiligo 6, as well as plaque psoriasis 7.
• These studies do not provide information on oral steroid treatment for vesicular risk on hands and ankles.
• The studies focus on the efficacy and safety of topical treatments, including corticosteroids and immunomodulators, for various skin conditions.

Limitations of Available Evidence

• The available evidence does not address the specific question of oral steroid treatment for vesicular risk on hands and ankles.
• The studies provided are focused on topical treatments for various skin conditions, and do not provide information on oral steroid treatment.