Prednisone dosage for poison oak
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Scant evidence exists for the best duration of steroid therapy for contact dermatitis due to plants rhus. Review articles recommend 10 to 21 days of treatment with topical or oral corticosteroids for moderate to severe contact dermatitis due to plants strength of recommendation [SOR]: Cbased on review articles.
The primary reason given for the duration of 2 to 3 weeks is to prevent rebound dermatitis. Evidence for the best treatment of rhus dermatitis is negligible. Most recommendations stem from review articles and expert opinion. Rhus dermatitis is one example of a disorder for which we must fall back on our logic and personal experience.
Since the painful itchy blisters and erythema from the oleoresin may take up to 1 week to appear, and because the rash may persist for more than 2 weeks, it makes sense to prescribe oral steroids in severe cases for longer than the usual 5- to 7-day burst. Habif, a popular dermatology text, suggests gradually tapering steroids from 60 to 10 mg over a day course.
No published studies compare varying durations of treatment with steroids for contact dermatitis due to plants, including rhus. Many review articles refer to rebound dermatitis when using courses of oral steroids such as Medrol dosepaks for fewer than 14 days. One case report noted failure of a tapering dose over 5 days of oral methylprednisolone for treatment of poison ivy contact dermatitis.
The systemic treatments listed include oral or intramuscular corticosteroids, but no discussion of duration is mentioned. UpToDate discusses avoidance of the offending substance for 2 to 4 weeks, use of topical corticosteroids of medium to strong potency for a limited time without defining the durationand use of systemic corticosteroids in severe cases, prescribing a course of prednisone at 40 mg daily for 4 to 6 days followed by 20 mg for 4 to 6 days.
Because the rash may persist for more than 2 weeks, it makes sense to prescribe oral steroids for longer than 5 or 7 days. Skip to main content.
Clinical Inquiries. What is the best duration of steroid therapy for contact dermatitis rhus? J Fam Pract. Meadows, MLS. PDF Download. Evidence-based answers from the Family Physicians Inquiries Network.
❾-50%}- Whether or not to use systemic corticosteroids to treat a skin disease - This Changed My Practice
Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Corticosteroids for Poison Ivy, Oak, or Sumac. Topic Overview High-dose prescription corticosteroid medicines can reduce the symptoms of a poison ivy, oak, or sumac rash allergic contact dermatitis and sometimes reduce the severity and shorten the length of a rash.
Corticosteroid pills usually prednisone can dramatically reduce the symptoms caused by a strong reaction to poison ivy, oak, or sumac. Oral corticosteroids generally work better than other forms of these medicines for poison ivy, oak, or sumac. And they are usually taken until the symptoms are gone. How much medicine you take and for how long often depends on how soon you seek help after the rash appears. Many review articles refer to rebound dermatitis when using courses of oral steroids such as Medrol dosepaks for fewer than 14 days.
One case report noted failure of a tapering dose over 5 days of oral methylprednisolone for treatment of poison ivy contact dermatitis.
The systemic treatments listed include oral or intramuscular corticosteroids, but no discussion of duration is mentioned. UpToDate discusses avoidance of the offending substance for 2 to 4 weeks, use of topical corticosteroids of medium to strong potency for a limited time without defining the duration , and use of systemic corticosteroids in severe cases, prescribing a course of prednisone at 40 mg daily for 4 to 6 days followed by 20 mg for 4 to 6 days.
Because the rash may persist for more than 2 weeks, it makes sense to prescribe oral steroids for longer than 5 or 7 days. Shorter courses of steroids may be followed by severe rebound exacerbations shortly after drug therapy is discontinued. Oral antihistamines may help reduce pruritus and provide sedation, when needed. The authors conclude that prevention requires educating patients to recognize the offending plants and to wear protective clothing when engaging in outdoor activities.
Desensitization efforts are of uncertain value. The success of topical barrier preparations is variable, but some, such as organoclay preparation, can limit response in exposed susceptible persons when applied to the skin at least 15 minutes before anticipated exposure. Application should be repeated every four hours if exposure is prolonged. This content is owned by the AAFP. Glen Burgoyne Dr. Gordon Francis Dr. Graeme Wilkins Dr. Greg Rosenfeld Dr.
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By Dr. Eileen Murray on October 3, Eileen Murray MD FRCPC biography and disclosures Disclosures: Served as a consultant for the pharmaceutical industry and participated in clinical research evaluating new therapies for psoriasis and atopic dermatitis.
When I started out in dermatology, corticosteroids were the only systemic drug available to treat patients with severe allergic contact dermatitis ACDatopic dermatitis ADdrug reactions and those with bullous diseases.
Corticosteroids are potent and excellent immunosuppressive agents. The main problem with systemic use is the high risk of drug interactions, as well as multiple serious acute and long-term side effects. It was the belief at the time that patients treated oral corticosteroids for short periods, two weeks or less for instance were not adversely affected by treatment. Severe ACD caused by poison ivy was the disease I treated most frequently with systemic corticosteroids.
Patients were given a two-week course of oral Prednisone, 50mg daily for seven days and 25mg daily for another seven total dose of mg. Two weeks of treatment was necessary to prevent recrudescence and completely clear the eruption. The following article made me change the way I treated ACD and stimulated me to try to avoid using systemic corticosteroids when at all possible. McKee et al 1 reported a group of male patients who had developed osteonecrosis six to thirty-three months after a single short-course of oral corticosteroids within three years of presentation.
The mean steroid dose in equivalent milligrams of prednisone was range — mg. The mean duration of drug therapy was Osteonecrosis is a known complication of systemic corticosteroid use and was initially believed to occur only in patients who received high doses equivalent to more than mg of prednisone for extended periods 3 months or longer. Each patient with ACD is instructed to apply a wet dressing 3,4 see Patient handout three times daily for 15 to 20minutes followed by the application of clobetasol propionate cream — the most potent topical corticosteroid.
The patient continues the wet dressings daily until they are no longer itchy. Soon after changing my practice, I had a series of patients with severe, generalized ACD appearing two days post surgery. Systemic treatment would have interfered with post operative healing. All of them were treated with the topical regime and had quick relief of itching. Their ACD cleared just as quickly as those patients I had previously treated with systemic corticosteroids. Psoriasis and chronic urticaria: do not treat either of these diseases with systemic corticosteroids!
Do not treat undiagnosed skin disease or itching with systemic corticosteroids:. A young man in the middle of the night presented to the emergency with a generalized rash and severe itching; so severe he was begging for relief. Three weeks previously he had been seen in a walk-in clinic and prescribed a one-week course of oral prednisone.
A week later, no better, he saw his family physician and was given an antifungal cream. Within the week, he was seen at another walk-in clinic and given a topical corticosteroid. The rash continued to get worse culminating in his visit to emergency where he was being treated with IV Solu-Medrol and antihistamines.
He had the most severe case of pityriasis rosea PR I have ever seen. I discontinued his corticosteroids, prescribed a day course of erythromycin and a compounded cooling lotion containing 0. By then his itch had subsided. His rash cleared within five days. In this case, the initial treatment with oral corticosteroids had increased the severity of the disease so much that none of the physicians he saw subsequently were able to make a clinical diagnosis.
The etiology of PR is still not known. It may be a reaction to unknown triggers. Most cases are mild and resolve spontaneously without treatment. Recent studies have suggested an infectious etiology might be responsible.
Both oral erythromycin and acyclovir have been reported to clear patients with severe disease 5. An older male patient, within hours of inadvertently ingesting one cloxacillin capsule, presented with fever, facial swelling, diffuse erythema and numerous pin-sized non-follicular pustules.
He was otherwise well. I suggested that he be admitted and observed overnight. That evening, I found an article describing a series of patients with the same presentation — an unusual and rare drug reaction designated as acute generalized exanthematous pustulosis. The good news, it resolves spontaneously within a few days.
I stopped at the hospital early the next morning. I was too late; his physician had treated him with overnight with IV solu-medrol. Treating with topical corticosteroid is sometimes as effective for skin disease as the systemic drug:. There is evidence to show that treating severe bullous diseases with potent topical corticosteroids can be as effective as treating with systemic.
Topical treatment is very much safer as very little of the drug is absorbed even with open lesions. Also, as the skin heals even less corticosteroid is absorbed. Bullous pemphigoid most common in elderly patients is now often treated with topical corticosteroids alone or in combination with high doses of tetracycline and niacinamide 6,7. Patients who may require systemic corticosteroids include patients with severe or unresponsive disease or those intolerant to other treatment.
Diseases most frequently treated include drug reactions, AD, nummular dermatitis, ACD, bullous pemphigoid and lichen planus. From: Murray Eileen, Diagnosing Skin Diseases: A diagnostic tool and educational resource for pediatricians and primary care givers. Note: Wet dressings are cool and soothing, antipruritic, and antiseptic. They also enhance absorption of topical medications. They are the epitome of a treatment that always helps and never harms.
For skin diseases with weeping or crusting a wet dressing open to the air dries the lesions. If the skin is dry an occluded wet dressing increases moisture retention. Physicians began using wet dressings several hundred years ago. Solutions were compounded by surgeons treating wounded soldiers. Many lives were saved because the wet dressings greatly reduced the risk of infection.
Karl August Burow, -a German surgeon, an inventor of both plastic surgery and wound healing techniques. Whether or not to use systemic corticosteroids to treat a skin disease. View Results. Read More 2 Comments. The information presented here is interesting, but anecdotal. If I am to weigh the risk and benefit of offering oral steroids to my patients I need to get a sense of how likely such adverse events are. I agree with Dr. Murray that it is important to know that this complication happens in the 50mg per day dosing range, and I thank her for her contribution — but a decision to abandon a traditional and highly effective treatment requires a better sense of absolute risk.
The orthopaedic surgeon who put together the osteonecrosis case series discussed in this article sees a highly select population of those who suffer such complications.
What was the denominator? Having written perhaps prescriptions for oral steroids I have never seen this complication — although clearly that is too small a sample size to be meaningful. The next time your local Division of Family Practice gets together count heads, and years of practice, and ask how many cases of osteonecrosis secondary to oral steroids the group has seen.
I thank Dr. Scott Garrison for his thoughtful comments. Statistics are not my thing so am not able to provide a sense of absolute risk. I do think that the large cohort study by Dr. Feng-Chen Kao provides compelling evidence for the association of systemic corticosteroid use with both fracture-related arthroplasty and fracture-unrelated surgery. In a group of 21, users matched with non-users followed over 12 years, the hazard ratio HR was double for steroid users over non-users.
The HR increased with increased steroid dosage, particularly in those with fracture-unrelated arthropathy. The adjusted HR increased from 3. I think the most important point is that systemic corticosteroids are not a substitute for topical corticosteroids.
They are a potent, broad-spectrum immunosuppressive agent and need to be prescribed with the same cautions you would use with any other immunosuppressive agent. Topical corticosteroids are potent immunosuppressants but with normal use, rarely cause systemic symptoms. Our skin is an excellent barrier. I remember seeing a sixteen-year-old girl who had been prescribed clobetasol cream to treat her atopic dermatitis.
It cleared her disease. However, she continued to apply it to her skin every morning after her shower to prevent the eczema from coming back. She continued the daily treatment for a year. By that time, she had developed severe striae over her arms and legs. She was assessed by an endocrinologist and had no evidence of adrenal suppression.
Notify me of followup comments via e-mail. You can also subscribe without commenting. Whether or not to use systemic corticosteroids to treat a skin disease By Dr. Eileen Murray on October 3, Dr. What I did before When I started out in dermatology, corticosteroids were the only systemic drug available to treat patients with severe allergic contact dermatitis ACDatopic dermatitis ADdrug reactions and those with bullous diseases.
What changed my practice The following article made me change the way I treated ACD and stimulated me to try to avoid using systemic corticosteroids when at all possible. What I do now 1. Allergic contact dermatitis: Each patient with ACD is instructed to apply a wet dressing 3,4 see Patient handout three times daily for 15 to 20minutes followed by the application of clobetasol propionate cream — the most potent topical corticosteroid.
Refractory dermatitis can be treated with oral corticosteroids such as prednisone, with an initial dosage of 1 mg per kg per day, slowly. Corticosteroid pills (usually prednisone) can dramatically reduce the symptoms caused by a strong reaction to poison ivy, oak, or sumac. Oral corticosteroids. Severe ACD caused by poison ivy was the disease I treated most frequently with systemic corticosteroids. Patients were given a two-week. Corticosteroid pills (usually prednisone) can dramatically reduce the symptoms caused by a strong reaction to poison ivy, oak, or sumac. Oral corticosteroids. Steroid pills or injections — If you develop severe symptoms or the rash covers a large area (especially on the face or genitals), you may need. Sylvia Stockler DrugCocktails. Two weeks of treatment was necessary to prevent recrudescence and completely clear the eruption. Routine neonatal oximetry screening for critical congenital heart defects in British Columbia: It's time! Kelly Luu Dr. Osteonecrosis is a known complication of systemic corticosteroid use and was initially believed to occur only in patients who received high doses equivalent to more than mg of prednisone for extended periods 3 months or longer.Allergic contact dermatitis is most commonly caused by poison ivy, western poison oak, eastern poison oak and poison sumac. Urushiol, commonly the chief allergen, is found in the oleoresinous sap located in the leaves, stems and roots of these plants. Between 50 and 70 percent of people are sensitive to contact with the oleoresin released from a bruised plant.
Indirect contact through clothing, pets and even smoke from a burning plant may cause a similar reaction. Lee and Arriola review common presenting signs and symptoms, and management and prevention strategies for allergic contact dermatitis caused by plants. The rash associated with contact dermatitis typically appears 24 to 48 hours after exposure in a previously sensitized person.
This rash is usually self-limiting and resolves one to two weeks after exposure. Redness and intense pruritus also develop, followed by papules, vesicles and sometimes bullae. Lesions can appear in streaks, suggesting plant contact. Fluid from the lesions is not sensitizing to others. Complications include secondary bacterial infections and, rarely, erythema multiforme and urticaria. Management should include thorough washing with soap and water, preferably within 10 minutes of exposure, as this may prevent dermatitis.
All contaminated clothes should be removed as soon as possible and cleaned. Frequent baths, using colloidal oatmeal, also relieve symptoms.
Treatment of mild to moderate rash includes application of cool compresses or diluted aluminum acetate solution, such as Burow's solution, or calamine lotion. Use of topical antihistamines and anesthetics should be avoided because of the possibility of increased sensitization. Early application of topical steroids is useful to limit erythema and pruritus.
However, occlusive dressings should be avoided on moist lesions. Refractory dermatitis can be treated with oral corticosteroids such as prednisone, with an initial dosage of 1 mg per kg per day, slowly tapering the dosage over two to three weeks.
Shorter courses of steroids may be followed by severe rebound exacerbations shortly after drug therapy is discontinued. Oral antihistamines may help reduce pruritus and provide sedation, when needed. The authors conclude that prevention requires educating patients to recognize the offending plants and to wear protective clothing when engaging in outdoor activities.
Desensitization efforts are of uncertain value. The success of topical barrier preparations is variable, but some, such as organoclay preparation, can limit response in exposed susceptible persons when applied to the skin at least 15 minutes before anticipated exposure. Application should be repeated every four hours if exposure is prolonged. This content is owned by the AAFP.
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