Oral steroids

Prednisolone is the most common oral steroid (not to be confused with topical steroids or anabolic steroids) used in the UK. It is used to treat a wide range of health problems and to prevent organ rejection after a transplant. It should only be used for eczema in short courses because of its adverse effects.

How does prednisolone work?

Oral steroids work by attaching themselves to special receptors in cells, resulting in reduced production of inflammatory mediators and inhibiting the movement of white cells to sites of inflammation. In eczema, these effects lead to a marked and rapid reduction in the redness, weeping and irritation associated with the condition.

How is prednisolone taken?

Prednisolone is very helpful for controlling severe flares of eczema. A short course may also be useful for florid (very red) cases of acute allergic contact dermatitis (e.g. hair dye reactions), or for cases of severe vesicular (blistering) hand eczema.

For adults, doses of 20–30 mg are commonly used initially, although occasionally higher doses are used. The tablets are usually taken as a single dose in the morning.

Rebound flares of eczema can occur on stopping treatment, and side effects prevent prednisolone’s long-term use.

Prednisolone may be prescribed off-licence for children as a gradually decreasing course.

Who should NOT take prednisolone?

The vast majority of people can take short courses of oral prednisolone. However, caution is required in those with a history of peptic ulcers, osteoporosis, psychoses, diabetes and hypertension, as prednisolone can make these conditions worse.

FAQ'S

Oral steroids such as prednisolone suppress the immune system. This means that the risk of bacterial, fungal and viral infection is greater, and live vaccines can cause problems. People on prednisolone should therefore seek their doctor’s advice if they feel unwell, if they are exposed to measles, or the chicken pox or shingles viruses, and before being vaccinated.

Prednisolone can have numerous side effects if it is taken for a long period of time. For this reason it tends only to be used to manage a crisis flare of eczema and is not recommended for long-term treatment of eczema. If prednisolone is prescribed, doctors will aim to keep the dose as low as possible.

Weight gain is the most common initial side effect. Osteoporosis is an important problem in adults. Extra care is needed for people who are already known to have diabetes or hypertension (high blood pressure) as these conditions may be made worse with prednisolone. Longer-term use of this medication for children is generally avoided because of its effects on general growth and bone formation. Other potential side effects include: cataracts, muscle weakness, fluid retention, peptic ulcers, easy bruising, and altered mood (euphoria or depression, psychosis).

Prednisolone tablets are normally given as a short course. If they are taken for longer, they should not be stopped suddenly. This is because systemic steroids switch off the natural production of steroid hormones by the adrenal glands. If treatment is to be discontinued, the dose should be gradually reduced to 5 mg per day and at that point a test is performed (synacthin test) to determine whether the body’s own steroid production is still functioning. If not, replacement oral steroids will be required, sometimes for the rest of the person’s life. Your doctor will give you clear instructions on how to be weaned off this medication.

Some medications may interact with prednisolone. Medications to avoid while taking prednisolone include blood thinners, such as warfarin (Coumadin), certain antifungal drugs, such as fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral), the nausea medication aprepitant (Emend), and aspirin. This is not a complete list and it is important that you always inform your doctor and pharmacist that you are taking prednisolone.

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Living with eczema (for adults) booklet

Supportive, practical information for adults managing eczema, based on the latest research and regularly reviewed by doctors and nurses.