Prednisolone indications and dosage in dermatology
Introduction
Corticosteroids are essential in the treatment plan of many skin diseases. Prednisolone is one of glucocorticoids used widely in dermatology. Prednisolone, which is intermediate‐acting, is the biologically active metabolite of prednisone. Here, we will discuss most of prednisolone indications and dosage in dermatology. Despite its importance, we should be aware of side effects and precuations of prednisolone usage.
Indications of prednisolone in dermatology
Pyoderma faciale.
Acne fulminans.
Pemphigus vulgaris.
Acne associated with congenital adrenal hyperplasia in male patients.
Bullous pemphigoid (moderate to severe cases).
Pemphigoid gestationis.
Pyoderma gangrenosum.
Life or function-threatening hemangioma.
Necrobiosis lipoidica.
Widespread cutaneous lichen planus.
Oral lichen planus.
Lichen planopilaris.
Chronic cutaneous lupus erythematosus (active).
Nail lichen planus(more than 2 nails).
Grade 2 acute graft‐versus‐host disease.
Chronic graft‐versus‐host disease( moderate or severe disease).
Pemphigus vulgaris : prednisolone 2 mg/kg/day plus azathioprine 2 to 2.5 mg/kg/day.
Acne associated with congenital adrenal hyperplasia in male patients : 2.5–5 mg/day.
Bullous pemphigoid (moderate to severe cases): 0.5 – 1.0 mg/kg/day.
Pemphigoid gestationis : start at a dose of 0.5–1 mg/kg/day. The common flare associated with delivery usually requires a temporary increase in dosage.
Pyoderma gangrenosum : 0.5–1 g/kg.
Life- or function-threatening hemangioma : prednisolone (2 to 3 mg/kg per day) given over a mean of 1.8 months.
Widespread cutaneous lichen planus : 0.5–1 mg/kg per day until improvement (usually 4–6 weeks).
Oral lichen planus : soluble prednisolone tablet 5 mg dissolved in 15 ml water for a mouthwash swish and rinse three times daily>>oral candidiasis is the most frequent complication.
Prednisolone is a glucocorticoid receptor agonist.
On binding, the corticoreceptor-ligand complex translocates itself into the cell nucleus, where it binds to many glucocorticoid response elements (GRE) in the promoter region of the target genes.
The DNA bound receptor then interacts with basic transcription factors, causing an increase or decrease in expression of specific target genes.
Effects
Anti-inflammatory effect : NFκB inhibition and AP-1 inhibition.
Weakness in myasthenia gravis: anticholinesterase agentsand Mifepristone is contraindicated in pt on long term corticosteroids.
Pregnancy &Lactation
The safety of glucocorticoids during the first trimester of pregnancy has been debated. Slight increase in cleft lip with or without cleft palate was suggested.
Prednisolone should be used during pregnancy only if potential benefit justifies potential risk to fetus.
Prednisolone appears in human milk in minimal amounts.
For high doses, nursing should be delayed for about 4 hours after prednisone administration.
Precautions
Consider giving prednisolone at a starting dose of up to 1 mg/kg body weight daily, ideally given as a single dose in the morning.
Morning dose less likely to result in HPA axis suppression than when given at other times of day.
Long-term use associated with fluid retention and hypertension.
Development of Kaposi’s sarcoma associated with prolonged corticosteroid use.
If It is used for 10 days or longer, intraocular pressure should be routinely monitored.
Steroids should be used with caution in the presence of glaucoma. Intraocular pressure should be checked frequently.
Steroids after cataract surgery may delay healing and increase incidence of bleb formation.
Use of ocular steroids may prolong course and may exacerbate severity of many viral infections of the eye (including herpes simplex).
Patients receiving corticosteroids should avoid chickenpox or measles-infected persons if unvaccinated.
Latent tuberculosis may be reactivated (patients with positive tuberculin test should be monitored).
Suppression of hypothalamic-pituitary-adrenal axis may occur particularly in patients receiving high doses for prolonged periods or in young children; discontinuation of therapy should be done through slow taper.
A maintenance dose should not exceed 10–15 mg/day in the first trimester, as a slightly increased risk for cleft lip or cleft palate cannot be excluded.
In treating pregnancy dermatoses, corticosteroids are usually used only as a short‐term therapy (<4 weeks).
In rare cases with high‐dose therapy over many weeks, fetal growth should be monitored by ultrasound.
Drug Info
Prednisolone requires no metabolic conversion to be active, has a quicker onset of action, and has a cortisol-binding globulin affinity greater than that of prednisone.
Administration of live virus vaccines usually is not contraindicated in patients receiving corticosteroid therapy as short-term (<2 weeks) treatment, in low-to-moderate dosages, as long-term alternate-day treatment with short-acting preparations, or in maintenance of physiologic dosages (replacement therapy).
Prednisolone has intermediate mineralocorticoid activity activity.
Prednisolone is the systemic corticosteroid of choice in pregnancy.
Dermatology , Edited by Jean L. Bolognia , Julie V. Schaffer , Lorenzo Cerroni Fourth edition: Elsevier, 2018, ISBN 978–0‐7020–6275–9.
Griffiths, C., Barker, J., Bleiker, T. O., Chalmers, R., & Creamer, D. (Eds.). (2016). Rook’s textbook of dermatology. John Wiley & Sons.
Lebwohl, M. G., Heymann, W. R., Berth-Jones, J., & Coulson, I. (2013). Treatment of skin disease E-Book: comprehensive therapeutic strategies. Elsevier Health Sciences.
View Comments
Even creams contain steroids shouldn't be given to pregnant women especially in 1st trimester