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Systemic Corticosteroid — Acute Dermatoses Pregnancy: Use with caution — short courses acceptable for severe acute dermatoses; prednisolone does not cross placenta as effectively as dexamethasone; preferred systemic steroid in pregnancy

Prednisolone (Systemic)

Brand names: Deltacortril (enteric-coated), Predsol, Dilacort

Adult dose

Dose: Severe eczema flare/allergic contact dermatitis: 30–40 mg once daily for 5–7 days. Pemphigus vulgaris/bullous pemphigoid: 0.5–1.5 mg/kg/day (high dose). Acute urticaria/angioedema: 30–40 mg once daily for 3–5 days
Route: Oral
Frequency: Once daily in the morning (with food)
Max: 1.5 mg/kg/day (autoimmune blistering disease); 40 mg/day (short courses)
Systemic corticosteroid for severe acute dermatoses requiring systemic anti-inflammatory therapy: severe atopic eczema flare, pemphigus, bullous pemphigoid, acute severe allergic contact dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis. Short courses require no taper; longer courses (>3 weeks) require gradual dose reduction.

Paediatric dose

Dose: 1–2 mg/kg/day (max 40 mg/day) mg/kg
Route: Oral
Frequency: Once daily in the morning
Max: 40 mg/day
BNFc: severe eczema — 1 mg/kg/day for 5 days; soluble/liquid preparation for children who cannot swallow tablets

Dose adjustments

Renal

No dose adjustment required

Hepatic

Use with caution — prednisolone is hepatically activated; may accumulate in severe impairment

Paediatric weight-based calculator

BNFc: severe eczema — 1 mg/kg/day for 5 days; soluble/liquid preparation for children who cannot swallow tablets

Clinical pearls

  • Rescuing a severe eczema flare: short course 30–40 mg for 5–7 days (no taper needed) — do NOT use repeatedly; frequent systemic steroid use should prompt transition to biologic
  • BAD guidance: systemic prednisolone for atopic eczema is a 'bridge' only — must be combined with optimisation of topical therapy and consideration of systemic immunosuppressant or biologic
  • Pemphigus vulgaris: high initial doses (1–1.5 mg/kg/day) with slow taper over months; add steroid-sparing agent (azathioprine, mycophenolate) to reduce cumulative steroid dose
  • Bone protection: calcium + vitamin D supplementation from day 1 of systemic steroid course >3 months; add bisphosphonate if continued beyond 3 months (NOGG guidelines)
  • Morning administration mimics cortisol diurnal rhythm — reduces HPA suppression and improves sleep vs evening dosing
  • Adrenal crisis risk: patients on prednisolone >5 mg/day for >3 weeks should carry a steroid card and know to double dose during illness (sick-day rules)

Contraindications

  • Systemic infection without antimicrobial cover (contraindicated for prolonged use)
  • Live vaccines (during immunosuppressive doses)

Side effects

  • Hyperglycaemia
  • Hypertension
  • GI ulceration (use with PPI if prolonged)
  • HPA axis suppression
  • Osteoporosis (prolonged use — add calcium/vitamin D + bisphosphonate)
  • Adrenal crisis on abrupt withdrawal
  • Mood disturbance
  • Cushing's syndrome (prolonged)

Interactions

  • NSAIDs — additive GI ulceration risk
  • Antidiabetics — hyperglycaemia
  • Live vaccines — contraindicated
  • Rifampicin, carbamazepine — reduce prednisolone levels
  • Warfarin — variable INR effect

Monitoring

  • Blood glucose (diabetics and pre-diabetics)
  • Blood pressure
  • Bone density (prolonged use — DEXA scan)
  • Weight
  • FBC
  • Ophthalmic review (prolonged use — cataracts, glaucoma)

Reference: BNFc; BNF 90; BNFc; BAD Atopic Eczema Systemic Guidelines 2020; BAD Pemphigus Guidelines; NOGG Bone Protection Guidelines 2017. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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