From the Guidelines
The optimal oral prednisone regimen for a severe atopic dermatitis exacerbation is to use it as a short-term bridge therapy to other systemic, corticosteroid-sparing therapy, due to its potential for significant side effects and low evidence quality supporting its use 1.
Key Considerations
- The use of systemic corticosteroids, such as prednisone, should be reserved exclusively for acute, severe exacerbations and as a short-term bridge therapy to other systemic, corticosteroid-sparing therapy 1.
- There is low evidence quality supporting the use of systemic corticosteroids for atopic dermatitis, and their use is conditionally recommended against 1.
- The decision to initiate systemic therapies, including prednisone, should be made using shared decision-making between patients and clinicians, taking into account the severity of atopic dermatitis, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1.
- Alternate diagnoses such as allergic contact dermatitis and cutaneous lymphoma should be considered when atopic dermatitis is refractory to standard treatments, including topical therapy and systemic therapies 1.
Treatment Approach
- Emollients and prescription topical therapies are sufficient to achieve atopic dermatitis control for most people 1.
- Phototherapy or systemic therapies may be considered for people with more severe or widespread atopic dermatitis, or those with substantially impaired quality of life 1.
- Systemic immunomodulatory agents are indicated for the subset of adult and pediatric patients in whom optimized topical regimens and/or phototherapy do not adequately control the signs and symptoms of disease 1.
From the Research
Optimal Oral Prednisone Regimen for Severe Atopic Dermatitis Exacerbation
- The optimal oral prednisone regimen for a severe atopic dermatitis exacerbation is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, it is mentioned that systemic corticosteroids, such as prednisone, are rapidly effective but should only be used short-term for severe exacerbations due to their many long-term side effects 2.
- A study on the rebound phenomenon to systemic corticosteroid in atopic dermatitis suggests that systemic corticosteroids may exacerbate the acute phase of atopic dermatitis, mediated by IgE, accentuating the Th2 pattern in these patients 4.
- Another study on the reduction of relapses of atopic dermatitis with methylprednisolone aceponate cream twice weekly in addition to maintenance treatment with emollient found that corticosteroids can be effective in reducing relapses, but does not provide information on oral prednisone regimen 5.
- Expert perspectives on management of moderate-to-severe atopic dermatitis suggest that systemic steroids, such as prednisone, are not recommended by current guidelines and are commonly associated with disease rebound 6.
Key Considerations
- Systemic corticosteroids, such as prednisone, should only be used short-term for severe exacerbations due to their many long-term side effects 2.
- The use of systemic corticosteroids may exacerbate the acute phase of atopic dermatitis, mediated by IgE, accentuating the Th2 pattern in these patients 4.
- Corticosteroids can be effective in reducing relapses, but the optimal oral prednisone regimen is not explicitly stated in the provided studies 5.
- Current guidelines do not recommend systemic steroids, such as prednisone, for moderate-to-severe atopic dermatitis due to the risk of disease rebound 6.