Systemic corticosteroid dosing for pediatric poison ivy allergic contact dermatitis
Systemic corticosteroid therapy is indicated for extensive allergic contact dermatitis (greater than 20% body surface area) in children. [1] Prednisone is dosed at 0.5 to 1 mg/kg per day (with a maximum 60 mg/day) with tapering to prevent rebound dermatitis. [1,2]
Medication selection algorithm
Oral prednisone is recommended for extensive poison ivy dermatitis. [1,2] Oral prednisone should not be replaced with a short “steroid dose pack” because of inadequate dosing and duration. [1]
Initiation thresholds
Systemic corticosteroids are commonly recommended when allergic contact dermatitis involves more than 20% of body surface area. [1] Systemic corticosteroids typically provide symptomatic relief within 12 to 24 hours. [1]
Dosing regimen (prednisone)
Initial dosing should be 0.5 to 1 mg/kg per day. [1] For severe cases, an initial dose can be 1 mg/kg/day (0.5 mg/kg/day in pediatric patients) with a maximum dose of 60 mg/day. [2] A commonly recommended approach is 5 to 7 days of prednisone followed by dose reduction. [1] A taper over 2 to 3 weeks is recommended for severe rhus dermatitis to reduce the risk of rebound dermatitis after rapid discontinuation. [1,2]
Practical taper schedule examples
Prednisone 0.5 to 1 mg/kg/day for 5 to 7 days followed by reduction by 50% for the next 5 to 7 days is recommended when improvement occurs after the initial period. [1] Prednisone tapered weekly over 3 weeks after starting at 0.5 mg/kg/day in pediatric patients (max 60 mg/day) is recommended to prevent rebound dermatitis. [2]
Common pitfalls to avoid
Short systemic corticosteroid courses of insufficient duration are associated with rebound exacerbations shortly after discontinuation. [1,3] Steroid dose packs are not recommended due to insufficient dosing and duration. [1]
Targets and goals of therapy
The goal is rapid control of inflammation with prevention of rebound dermatitis through adequate duration and tapering. [1,2]