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Prednisone and itchy rash
Got Hives? Hold the Steroids
Itching is frequently associated with hives and can interfere with daily activities and sleep. International guidelines published in stated that a short course of oral corticosteroids may be helpful to reduce disease duration for acute hives. Prednisone is commonly prescribed in the emergency department to treat them, along with antihistamines. Even if short-term treatment with corticosteroids does not cause clinically significant toxicity, recurrent or long-term treatment may have deleterious effects.
Prednisone is an oral corticosteroid drug that can cause many serious side effects. Although rare, there are risks associated with short-term use, such as avascular necrosis, fatal varicella zoster in immunocompromised patients, severe mood changes, and psychotic reactions;[ 8 ] however, corticosteroid courses of less than 1 week duration that are prescribed in the absence of specific patient contraindications are unlikely to cause harm except possibly for psychotic or prepsychotic episodes.
Inappropriate prescribing and lack of follow-up can lead to patient safety issues. There is a paucity of research in the current literature on prescribing prednisone to treat nondescriptive dermatology conditions.
An investigation of diagnostic and prescribing practices for dermatology conditions in the ER might prove beneficial, because in Northern BC, many communities do not have a full-time dermatologist and instead rely extensively on ER physicians to treat dermatology patients.
Enhancing this knowledge may also help guide future dermatology training initiatives for medical students, residents, and current ER physicians. The primary purpose of this study was to determine the prevalence of nonspecific dermatology diagnoses such as rash and maculopapular rash given to patients who presented to the ER at a small hospital in Northern BC and the prevalence with which prednisone was prescribed to treat those patients.
We hypothesize that ER physicians may give nondescriptive diagnoses such as rash and maculopapular rash to patients with dermatologic conditions rather than specific true diagnoses. We also hypothesize that a number of those patients who are not given a clear diagnosis are empirically treated with prednisone, which in some cases may not be appropriate.
In addition, we suspect that many of those patients may not be referred to a specialist for follow-up. A retrospective medical chart review was conducted to measure the prevalence of nonspecific dermatology diagnoses such as rash that were treated with prednisone, as reported in ER clinical encounter records from University Hospital of Northern British Columbia UHNBC. Information collected included patient age, gender, diagnosis, treatment, and referral.
Excel software was used to analyze the data and perform descriptive statistics. Between 1 January and 31 December , patients were seen in the ER for rash and nonspecific skin eruption. The most common treatments prescribed for rash or nonspecific skin eruption—sedating antihistamines, such as diphenhydramine Benadryl or hydralazine Atarax , and supportive therapies [ Figure 1 ]—accounted for almost half of all treatments prescribed.
Approximately one-third of patients who were treated with prednisone were not given a follow-up referral to a health care provider. The percentage of rash cases in the ER that were treated with prednisone more than doubled from to , then declined somewhat from to [ Figure 2 ]. Systemic corticosteroids were prescribed for This may be related to the lack of a full-time dermatologist in this Northern BC community and a perceived lack of support for physicians to make specific diagnoses.
Few patients who were prescribed prednisone, however, were documented as waiting for further assessment. It is possible that the ER physicians were not fully aware that this service was available, or access may have been limited due to lengthy wait times. Prednisone provides relief for inflamed areas of the body. It is used to treat a number of different conditions, such as inflammation swelling , severe allergies, adrenal problems, arthritis, asthma, blood or bone marrow problems, endocrine problems, eye or vision problems, stomach or bowel problems, lupus, skin conditions, kidney problems, ulcerative colitis, and flare-ups of multiple sclerosis.
Prednisone is a corticosteroid cortisone-like medicine or steroid. It works on the immune system to help relieve swelling, redness, itching, and allergic reactions.
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do.
This is a decision you and your doctor will make. For this medicine, the following should be considered:. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines.
Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully. Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of prednisone in children.
However, pediatric patients are more likely to have slower growth and bone problems if prednisone is used for a long time. Recommended doses should not be exceeded, and the patient should be carefully monitored during therapy.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of prednisone in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for elderly patients receiving prednisone.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur.
In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Philadelphia: WB Saunders Company; Bernhard Jeffery D.
Itch: Mechanisms and Management of Pruritus. Litt, JZ, Topical treatment of itching without corticosteroids. Comparative study of effectiveness of oral acyclovir with oral erythromycin in the treatment of Pityriasis rosea. Nicotinamide and tetracycline therapy of bullous pemphigoid. Pemphigoid diseases: Pathogenesis, diagnosis, and treatment.
Eileen Murray June 22, at pm Permalink. This communication reflects the opinion of the author and does not necessarily mirror the perspective and policy of UBC CPD. Comments are moderated according to our guidelines. Visit ubccpd. Previous Next. Click here to print this article. Read Later. Adeera Levin Dr. Alexander Chapman Dr. Alice Chang Dr. Alisa Lipson Dr. Alissa Wright Dr. Amanda Hill Dr. Amin Javer Dr. Amin Kanani Dr. Andrew Farquhar Dr. Andrew Howard Dr. Anna Tinker Dr.
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❾-50%}Whether or not to use systemic corticosteroids to treat a skin disease - This Changed My Practice.
Few patients who were prescribed prednisone, however, were documented as waiting for further assessment. It is possible that the ER physicians were not fully aware that this service was available, or access may have been limited due to lengthy wait times. To address the need for dermatology services, the community has a part-time family physician dermatology clinic, but it also appears to be underutilized.
Although most patients were referred to their family physician, this may be a result of reflexive documentation, and it is unclear to what degree this was communicated to the patient or family physician.
Based on the lack of specific diagnoses for rash cases and the risks associated with inappropriate prednisone use, it was important for the patients to follow up with their primary caregiver or specialist for further investigation and monitoring and to ensure patient safety and continuity of care.
Additionally, it is worth noting the prevalence with which sedating first-generation antihistamines such as diphenhydramine were prescribed to patients in the ER who presented with nonspecific rash. It is possible that, like prednisone, sedating antihistamines were being prescribed empirically.
Second-generation antihistamines are preferred for the treatment of dermatologic conditions such as urticaria because of their superior tolerability, safety, and efficacy, as well as nonsedating properties. The main limitation of this study is that the chart review was retrospective and relied on documentation of diagnostic codes and treatment.
Coding is not mandatory, and only Prednisone was likely also prescribed for nonspecific rash cases that were listed under other diagnostic codes such as those for eczema, psoriasis, or urticaria. This study suggests a need for further education in using current guidelines for treating dermatological conditions when considering the prescribing of prednisone.
In addition, further education is needed on diagnosing common dermatologic presentations in the ER and on the importance of implementing follow-up for acute skin disorders after prednisone has been prescribed in the ER.
Increased dermatology access and supports within underserviced areas of BC is also needed for local patients. Further studies on dermatology cases that present in ERs in Canada and BC are also needed given that the variable treatment of nonspecific rash is commonly recognized as a possible systemic issue. Also, prescribing trends identified in this study could be compared with those in other communities that have a dermatologist to determine if the prescribing of prednisone to treat nonspecific rash is related to a lack of dermatology services or is an ER-wide trend.
Additionally, the ER physician rationale for using prednisone as an empiric treatment could be explored. Baibergenova A, Shear NH. Skin conditions that bring patients to emergency departments. Arch Dermatol ; The most common dermatology diagnoses in the emergency department. J Am Acad Dermatol ; Martin E. Concise medical dictionary. Oxford University Press; Accessed 4 December Assessment of maculopapular rash.
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Taylor Drury Dr. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. If you will be taking this medicine for a long time, it is very important that your doctor check you at regular visits for any unwanted effects that may be caused by this medicine.
Blood or urine tests may be needed to check for unwanted effects. Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away. If you are using this medicine for a long time, tell your doctor about any extra stress or anxiety in your life, including other health concerns and emotional stress. Your dose of this medicine might need to be changed for a short time while you have extra stress.
Using too much of this medicine or using it for a long time may increase your risk of having adrenal gland problems. Talk to your doctor right away if you have more than one of these symptoms while you are using this medicine: blurred vision, dizziness or fainting, a fast, irregular, or pounding heartbeat, increased thirst or urination, irritability, or unusual tiredness or weakness.
This medicine may cause you to get more infections than usual. Avoid people who are sick or have infections and wash your hands often. If you are exposed to chickenpox or measles, tell your doctor right away.
If you start to have a fever, chills, sore throat, or any other sign of an infection, call your doctor right away. Check with your doctor right away if blurred vision, difficulty in reading, eye pain, or any other change in vision occurs during or after treatment.
Your doctor may want you to have your eyes checked by an ophthalmologist eye doctor. While you are being treated with prednisone, do not have any immunizations vaccines without your doctor's approval.
Prednisone may lower your body's resistance and the vaccine may not work as well or you might get the infection the vaccine is meant to prevent. In addition, you should not be around other persons living in your household who receive live virus vaccines because there is a chance they could pass the virus on to you.
Some examples of live vaccines include measles, mumps, influenza nasal flu vaccine , poliovirus oral form , rotavirus, and rubella. Do not get close to them and do not stay in the same room with them for very long. If you have questions about this, talk to your doctor. This medicine may cause changes in mood or behavior for some patients. Tell your doctor right away if you have depression, mood swings, a false or unusual sense of well-being, trouble with sleeping, or personality changes while taking this medicine.
This medicine might cause thinning of the bones osteoporosis or slow growth in children if used for a long time. Tell your doctor if you have any bone pain or if you have an increased risk for osteoporosis. If your child is using this medicine, tell the doctor if you think your child is not growing properly. Make sure any doctor or dentist who treats you knows that you are using this medicine.
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.
localhost › articles › prednisone-oral-tablet. Prednisone is a corticosteroid (cortisone-like medicine or steroid). It works on the immune system to help relieve swelling, redness, itching. Despite standard use for the itching associated with urticaria (commonly known as hives), prednisone (a steroid) offered no additional. "I was on prednisone for 3 days when the rash appeared. It was red burning itching like be lit on fire I read that using lavender essential oils (can be mixed. Doctors often prescribe an oral corticosteroid, like prednisone, along with an antihistamine to treat mild itchy rashes. Anne Antrim Dr.With the addition of prednisone, the relief scores were actually worse. Thirty percent of patients in the prednisone group and 24 percent in the placebo group reported relapses. Acute urticaria, or hives, is a fairly common presentation in the emergency department. Itching is frequently associated with hives and can interfere with daily activities and sleep. International guidelines published in stated that a short course of oral corticosteroids may be helpful to reduce disease duration for acute hives.
Prednisone is commonly prescribed in the emergency department to treat them, along with antihistamines. Even if short-term treatment with corticosteroids does not cause clinically significant toxicity, recurrent or long-term treatment may have deleterious effects. Annals of Emergency Medicine is one of the peer-reviewed scientific journal for the American College of Emergency Physicians ACEP , the national medical society representing emergency medicine.
Annals of Emergency Medicine is the largest and most frequently cited circulation peer-reviewed journal in emergency medicine and publishes original research, clinical reports, opinion, and educational information related to the practice, teaching, and research of emergency medicine. For further information: Steve Arnoff sarnoff acep.
American College of Emergency Physicians. About Us. Got Hives? Hold the Steroids May 3, Related Articles. Five Questions with Dr. Claudette Rodriguez.
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