What is the recommended prednisone (corticosteroid) taper regimen for treating contact dermatitis caused by poison ivy (Toxicodendron radicans)?

From the Guidelines

A typical prednisone taper for poison ivy would start with 20-30mg daily for 5 days, then decrease by 5mg every 2-3 days until completion, lasting about 2-3 weeks total, as doses of prednisone of 0.5–0.75 mg/kg per day are suggested for extensive disease 1. When creating a prednisone taper for poison ivy, it's essential to consider the patient's response to the treatment and adjust the dose accordingly.

• The initial dose of 20-30mg daily is based on the suggested dose of 0.5–0.75 mg/kg per day for extensive disease 1.
• The tapering schedule should be adjusted to reduce the dose by 5mg every 2-3 days, allowing the patient's body to adjust to the decrease in steroid dosage.
• The total duration of the taper should be around 2-3 weeks, with the goal of minimizing the risk of adrenal insufficiency.
• It's crucial to monitor the patient's response to the treatment and adjust the dose as needed, as earlier reduction of corticosteroid doses may be possible in some cases 1.
• Patients who do not achieve disease control within 1–3 weeks with the initial dose may require an increase in the dose of prednisone to 0.75 mg/kg per day, despite the absence of evidence in the literature 1.
• During the taper, patients should continue topical treatments like calamine lotion and cool compresses to help manage the symptoms of poison ivy.
• It's essential to instruct patients to take the medication with food to minimize stomach irritation and to contact a healthcare provider if the rash worsens, spreads to the face or genitals, or if they develop a fever, as they may need a different treatment approach.

From the FDA Drug Label

The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small increments at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached. If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly

For poison ivy, a common tapering schedule for prednisone is:

• Day 1-2: 40-60 mg per day
• Day 3-4: 30-40 mg per day
• Day 5-6: 20-30 mg per day
• Day 7: 10-20 mg per day
• Day 8 and beyond: taper by 5 mg every 2-3 days until discontinuation 2 Key points:
• The dosage should be individualized based on the patient's response
• The taper should be gradual to avoid withdrawal symptoms
• The patient should be monitored for any signs of relapse or adverse effects during the tapering process

From the Research

Prednisone Taper for Poison Ivy

• A prednisone taper for poison ivy can be created based on the study by 3, which compared a 5-day regimen of 40 mg oral prednisone daily to the same 5-day regimen followed by a prednisone taper of 30 mg daily for 2 days, 20 mg daily for 2 days, 10 mg daily for 2 days, and 5 mg daily for 4 days over a total of 15 days.
• The study found that patients receiving the long course regimen were significantly less likely to utilize other medications, suggesting that a longer course prescription may save patients' time and exposure to excess medication in the treatment of severe poison ivy.
• Another study by 4 recommends tapering oral prednisone over two to three weeks in patients with severe rhus dermatitis to avoid rebound dermatitis.
• The following prednisone taper can be considered:
  • 40 mg daily for 5 days
  • 30 mg daily for 2 days
  • 20 mg daily for 2 days
  • 10 mg daily for 2 days
  • 5 mg daily for 4 days
• However, the study by 5 suggests that treatment of two to three weeks with oral steroids may be necessary to reduce healthcare utilization associated with undertreatment, especially in patients who present to the emergency department with more severe disease.
• It is essential to note that the treatment of poison ivy dermatitis depends on the severity of the reaction, and patients with systemic involvement may require physician consultation, as stated in the study by 6.