Doctors can prescribe prednisone for a rash.

…and prednisone can cause all sorts of rashes as a side effect.

Watch now!

Prednisone for Rash & Allergic Reactions

Transcription autogenerated from the video above so some errors are possible

Can you take prednisone for a rash?

Does prednisone can be prescribed for a rash? Yes. Prednisone can also cause a rash. That’s how prednisone is. It’s often prescribed for something and it can cause that same symptom as a side effect. Let’s first cover prednisone being prescribed for a rash and then at the end I’ll talk about the allergic reaction to prednisone possibility as far as what would happen if prednisone is causing a rash as a side effect. 

Prednisone for Rashes

1. Eczema or Atopic Dermatitis

What are typical rashes that prednisone could be prescribed for? One of them includes eczema or atopic dermatitis. That’s where you kind of have a genetic family history of people in your family having rashes.

In my family, we have eczema on our hands and some family members of mine have it all over and it can get pretty terrible, especially in stressful times of life. So should people with eczema or atopic dermatitis get prednisone? Well for their rash, generally, no. According to the American Academy of Dermatologists, prednisone is generally not recommended when it comes to a rash unless it is incredibly really bad; life-threatening.

It’s generally not recommended. There’s so many other treatment options at this point. They said;

“Although it is used frequently and shown to temporarily suppress disease, it should generally be avoided because of short and long-term adverse effects and an unfavorable risk-to-benefit profile. Short courses, [like if you only took it a little while] of oral steroids, can actually lead to flares of eczema.”

So we don’t want to put ourselves into a flare, we don’t want to have worse side effects than the disease itself, which is what can happen with prednisone. And they said topical steroids are recommended. This is the kind of topical steroid I use, mometasone, for hand rashes or other eczema rashes. But taking the pill of prednisone itself should be avoided if possible and “it should be exclusively reserved for acute, [that means short term] severe exacerbations and is a short term bridge therapy to other systemic steroids sparing therapy.”

Other treatments for Eczema or Atopic Dermatitis Rashes

Other possible treatments could be an injectable or another oral pill that you would take. Some alternatives to prednisone for an atopic dermatitis rash include cyclosporine, methotrexate (MTX), mycophenolate mofetil (MMF), and azathioprine (AZA).

They don’t necessarily kick in immediately like prednisone usually does. And so that’s when they say you might use prednisone, while waiting for those others to kick in. 

2. Prednisone for Psoriasis Rash

Other types of rashes you might be prescribed prednisone for include psoriasis. Psoriasis is where there’s plaques often on your elbows, your knees could be in lots of other places and prednisone could be used often. Again, we go for the topical version of steroids first and there are so many other treatment options for psoriasis these days that usually the pill is not recommended.

3. Prednisone for Allergic Reaction Rash

What about an allergic rash? Like you touch something and now you’re allergic to it. Should you use prednisone? And sometimes if it’s really, really bad, really severe then it might make sense. But in situations like poison ivy when you’re using that toxic oil from the poison Ivy or poison oak or poison sumac plant got on your skin called urushiol, it is generally not recommended to give prednisone for poison ivy. The exception is unless it’s severe, meaning it’s on your face, like your eyes are not able to open or it’s in your genital area or it’s covering more than a fourth of your body and your doctor says there’s nothing else we can do. And then if you were to do it for poison ivy, but it needs to be for quite a long time.

Watch this video about “9+ Poison Ivy Treatment Myths”

4. Prednisone for Hives Rashes or Uticaria

If you’ve got itchy bumps that are kind of covering your skin and you’re wondering, should I take prednisone for that? Yes or no? Well they did a study of people who went to the emergency room for hives and they said that prednisone, which is a steroid, offered no additional relief to emergency patients suffering from hives than a placebo did according to a randomized placebo controlled double blind parallel group study.

Learn More: I have a whole video all about chronic urticaria with an expert.

Watch this video all about chronic urticaria with an expert;

So prednisone is not necessarily going to help you for your hives and instead they recommend a second-generation antihistamine. In this case they were using levocetirizine, whose brand name is Xyzal, or another option is Zyrtec, which is cetirizine or other second generation antihistamines.

Second Generation Antihistamines for Chronic Urticaria (Hives) Rashes

• weight: 400;”>Cetirizine (Zyrtec)
• Desloratadine  (Clarinex)
• Fexofenadine (Allegra)
• Loratadine (Claritin)
• Levocetirizine (Xyzal)

Those are a lot better options for hives than prednisone.

If you’re going to sleep at night, another option would be Benadryl, which is diphenhydramine. That’s a first generation antihistamine and it makes you drowsy and so you don’t want to really have to take that except at night. If you were to have urticaria long term, called chronic urticaria (chronic idiopathic urticaria, also known as chronic spontaneous urticaria), you’d want to be taking really high doses of these medications (2-4 times the normal dose) and for a long time you wouldn’t really want to go to prednisone unless you absolutely have to as a last resort.

Prednisone Dose for Skin Rash

Prednisone dosage range for rash = 0.5 – 1 mg/kg/day

As far as the prednisone dose you might use for a rash the range is often between a half of a milligram to a full milligram per kilogram per day. And what in the world does that mean?

If a person is 130 pounds, then that is the same thing as approximately 60 kilograms. Therefore that person would take somewhere between 30 and 60 milligrams per day. That’s an average American 130 pounds, somewhere between 30 to 60 milligrams per day is the average dose for an adult who is taking prednisone for a rash.

For an adult weighing 130 pounds = 60 kg
Prednisone dose per day for rash = 30 to 60 mg per day

When does Prednisone Start Working for Rash?

What about timing? When would you notice that your prednisone is working for your rash? It could be an instant relief. For some people, after just a few hours after the prednisone kicks in, they notice, “Wow! it’s gone.” 

But for other rashes like poison ivy, it might be three to five days before you see the effect. 

Definitely talk to your doctor, your dermatologist, or your pharmacist about your situation, and about when you should expect prednisone to work for your rash. It could be anywhere from a few hours to a few days until you could have that relief provided by the prednisone for your rash. 

Side Effects of Prednisone for Rash

What side effects can you expect if you take prednisone for a rush? There are up to 150 side effects possible, which is shocking, especially for pharmacists like myself. When I was prescribed prednisone, I knew it was bad, but I didn’t know it was that bad.

In one study the side effects that people actually reported to the study scientists, this is what they said, “hypertension, (which is high blood pressure), glucose intolerance, which means high blood sugar), gastritis, (which means stomach upset), weight gain (happens all the time), decreased bone density, adrenal suppression, and emotional lability.”

• Hypertension
• Glucose intolerance
• Gastritis
• Weight gain
• Decreased bone density
• Adrenal suppression
• Emotional lability
• Decreased linear growth in children

Emotional lability means your emotions go up and down, way higher than you normally get, and way lower than you normally get, going from happy to sad, really fast, being super cranky, making your family want to go on a vacation without you.

If it’s a child, they can actually have what they call a decreased linear growth. That means it’s harder for them to grow up vertically. People who have to take prednisone long term as a child end up shorter. So we want to avoid it if at all possible. Like at the beginning, the American Academy of Dermatology says;

The benefits of prednisone just doesn’t work that well most of the time for most people because there are so many side effects.

It just doesn’t make sense to take prednisone for most rashes unless they’re incredibly bad and you’ve tried every other option.

Alternatives to Prednisone for Rash

So what are these other options that you could try instead? So often it’s a topical steroid, you can put it on your hands instead of in your mouth, right? It could be other pills. So here are some alternatives. They’re usually immunosuppressants.

Topical alternatives to prednisone for Rash (medications applied to the skin directly) from the American Academy of Dermatologists:

• A corticosteroid: Many eczema treatment plans include this type of medication, which can quickly relieve symptoms. These can come as a cream, ointment, spray, foam, shampoo and more.
• Pimecrolimus cream (Elidel) or tacrolimus ointment (Protopic): Also known as topical calcineurin inhibitors (TCIs), your dermatologist may prescribe one of these medications if corticosteroids stop working, fail to work, or are not a good option for you
• Crisaborole ointment (Eucrisa): Approved to treat patients 3 months of age or older, crisaborole can be used on many areas of the skin.
• Ruxolitinib cream (Opzelura): This newer medication is approved to treat patients 12 years of age or older.
• Coal tar: Used for more than 100 years to treat eczema, coal tar may be prescribed for some patients.

Biologic Medication Alternatives to Prednisone for Rash from the American Academy of Dermatologists:

• Dupilumab (Dupixent®): This medication is a biologic. It’s FDA approved to treat patients 6 months of age or older who have moderate or severe eczema that isn’t well controlled with medication applied to the skin. Dupixent is given as an injection.

• Abrocitinib (Cibinqo™) and upadacitinib (Rinvoq®): These medications are called JAK inhibitors. They work by reducing the inflammation that’s believed to cause eczema. Both abrocitinib and upadacitinib are tablets. If your dermatologist prescribes one of these JAK inhibitors, you will take one pill a day.
• Tralokinumab-ldrm (Adbry™): This biologic medication has been FDA approved to treat adults who need stronger medication than a topical (applied to the skin) medication can provide. This medication is injected into the skin, so patients learn how to give themselves an injection.

Other Oral alternatives to prednisone for rash:

• Cyclosporine

• Methotrexate (MTX)

• Mycophenolate mofetil (Cellcept, Myfortic)

• Azathioprine

Things like cyclosporine, methotrexate, mycophenolate mofetil, azathioprine. Those alternatives, if you Google them, may look and sound scarier than prednisone. But in general they are safer and more effective than prednisone. It’s just they have a few side effects that just look really bad but are incredibly rare. Whereas prednisone is just generally awful for most people and it has a few incredibly rare side effects that are terrible but is generally just a miserable experience to take prednisone.

You could take those, there are many new biologics coming out, some that are great for atopic dermatitis, some that are great for psoriasis. There’s just a lot of options. If you’re wondering what’s best for you, definitely make an appointment with your dermatologist.

How can you prevent the side effects of Prednisone for Rash from happening?

The American Academy of Dermatology says these are their recommendations for preventing side effects. They said;

If you’re on a long-term protocol of prednisone, you might need calcium and vitamin D replenishment.

I invented a supplement specifically for people on long-term or even short-term steroids to give back that calcium and vitamin D. You might need to get immunizations because you’re immunosuppressed.

You might become really frustrated because your disease might flare and then you should usually taper off. If you’re on prednisone longer than five days, generally you need to taper off. Definitely, if you’re longer than 10 to 14 days you need to taper off.

Want to Check While on Prednisone

And then what should you be checking while you’re on it? If you’re on long-term steroids, they say you should check your blood pressure, have eye exams, check your HPA axis. Plus have a bone density evaluation and growth velocity measurement in children.

If you don’t know what these things are, if you’re like, whoa, that’s a lot of technical medical stuff, I’ve got you covered.

I’ve got a free downloadable printable PDF checklist, you just sign up below, you can get your own prednisone checklist. It’s got all the things to check up to make sure that if you’re taking prednisone, you’re catching any side effects before they get terrible and you’re giving back what you need to give back. It’s got all of the best tips I could come up with about prednisone and the side effects and counteracting them.

Prednisone Causing Rash as a Side Effect

What if prednisone itself is causing a rash? We talked first about prednisone treating the rash, being prescribed for the rash. Now in this section, prednisone is prescribed for something else and it could be causing a rash as a side effect. In that case, does this happen? And how often and what do we do about it?

In one scientific study they were giving people very high doses of prednisone. Actually, they were giving a sister drug to prednisone, which is called Methylprednisolone or Medrol.

They were giving 48 milligrams of methylprednisolone which is equivalent to prednisone 60 milligrams. They were giving it for at least five days and usually much longer than that. And they measured how many people complained of which side effects. In this study, 14.7% of people complained of rash as a side effect to methylprednisolone or steroid treatment. What were these rashes like?

Symptoms of Prednisone Rash

What kind of a rash was it? So some people said it was like a hot flash. So I personally had that when I took Medrol, I had bright red cheeks flushing, I felt like I was a menopausal woman getting hot flashes.

Prednisone rash could also be just a few little bumps or pimples like things happening. Some people get acne and some people even get these little red dots, they’re called petechiae.

Other people get actinic purpura.

There’s a huge range of types of rashes you could get from prednisone. You could actually be allergic to prednisone, although this is incredibly rare because prednisone itself is usually what they treat allergies with.

Allergic Reaction to Prednisone?

It’s really hard to get an allergic reaction to a thing you treat allergies with. But if you are in an incredibly allergic situation in your life; for some reason you’ve got higher levels of IgG immunoglobulins and your immune system is completely out of whack, it is possible to be allergic to prednisone. If that’s the case, you would definitely want to tell your doctor, let them know and they can help you figure out the treatment plan.

When does Prednisone Rash Happen?

But when would a prednisone rash happen in general? Well, generally most people do not get a rash immediately upon treatment. You don’t usually get a rash the first moment you take prednisone.

Maybe you get hot flashes after the first or a couple doses. But according to this one study it said;

Most cases of skin rash had begun at week three.

They had only taken two weeks of the drug and then the rash doesn’t happen until week three. And they said this was assumed because it took about one to two weeks until the skin reaction appeared as the immune mechanism acted. Given the admin drug administration period, it was only 12 days, it indicated that these adverse effects, these rashes from prednisone can happen even one to two weeks after taking prednisone or methylprednisolone. So doctors should keep checking you and making sure you’re okay even three to four weeks after stopping.

Allergic Reaction to Prednisone

Even though it seems impossible to be allergic to the drug that is the treatment for allergic reactions, it’s possible. A few times doctors reported this in the scientific literature. One article stated:

“Corticosteroids are widely used for the treatment of allergic reactions but paradoxically themselves may induce acute, delayed, local or systemic allergic reactions and even anaphylaxis with Kounis syndrome.”

Another case report showed that an epidural steroid injection caused anaphylaxis.

If you are having such a terrible allergic reaction that it’s not just a rash at this point, you’re having trouble breathing, swelling of your face, your lips, your eyelids, any of your soft tissues, and it’s spreading, definitely go to the emergency room. If you’re really having a hard time breathing, call 911.

Allergic reactions are not something we mess with. Get the help you need. If you are taking prednisone and you’re wondering what you can do about short-term treatments and counteracting those side effects, be sure to download my prednisone checklist.