Hydrocortisone vs Prednisone

The dose is set by the severity of the flare and by body weight, not a standard tablet count, with an end date written in from the start.

Starting dose: For a severe rash, commonly 0.5 to 1 mg per kilogram per day as a single morning dose. Milder problems need much less.

Going up: Rarely in dermatology. If a rash has not responded in a few days, the next step is a different treatment, not a higher dose.

Usual dose: The starting dose held a few days to a week, then stepped down.

Total course: For severe allergic contact dermatitis such as poison ivy, around two to three weeks with a taper — shorter courses are a common cause of rebound. Blistering disease can need months, but that is specialist care with a plan to come off, alongside a second drug that lets the steroid dose fall.

For a short course in a healthy person, no routine blood tests are needed. What gets watched is blood sugar in anyone with diabetes or borderline sugars, blood pressure, weight, sleep and signs of infection.

On a longer course — more than about three months, or repeated courses — monitoring becomes real: blood pressure and blood sugar, weight, a bone density scan with calcium and vitamin D, an eye check for cataracts and raised eye pressure, and a plan for protecting the stomach and bones. Usually shared care, not a dermatologist alone.

Prednisone is not a drug to stay on for skin disease. Almost every serious side effect is dose multiplied by time, so the monitoring plan and the exit plan are one conversation.

Once a day in the morning, with food or milk. Morning matters — it matches your own cortisol rhythm and is the best thing you can do about steroid insomnia. Food reduces stomach upset; take it with a full glass of water. Split doses are used in some conditions, only when a doctor asks.

Take it as soon as you remember on the same day. If you do not remember until the next day, take only that day's dose — never two together. On a longer course, if you have missed more than a day, call the prescriber rather than restarting yourself; stopping suddenly is what causes trouble.

After stoppingWatch for rebound: Usually within a few days to two weeks, which is why a longer-term treatment starts at the same time. After a longer course, weeks of tiredness while the adrenal glands restart is normal.

First 24 to 48 hoursStarting: Itch and swelling ease first; severe hives respond faster to this than to anything else, with antihistamines alongside. Early side effects arrive in the same window — poor sleep, big appetite, restlessness, flushed face, indigestion.

Days 2 to 7Working: The rash flattens and fades. Poison ivy and contact dermatitis settle here, and a severe eczema flare clears fast. Fluid retention and facial puffiness may appear, blood sugar rises in those prone to it, blood pressure can go up.

Days to 2 weeksBlistering disease: New blisters usually stop forming. Healing takes longer, and a steroid-sparing drug is started early so the dose can come down.

Weeks 2 to 3Stepping down: Run the course out rather than stopping early — stopping early brings the rash back. Side effects step down with the dose, and sleep and appetite settle within days of finishing.

Only with long coursesThe long-term risks: Bone thinning, cataracts, thigh muscle weakness, easy bruising, thin skin, hip pain from reduced blood supply to the bone. Reasons to keep courses short, not to refuse a short one.

Generic prednisone is among the cheapest prescription drugs, stocked everywhere. Cost is almost never the reason it is or is not used.

The delayed-release brand costs far more with no clear advantage in skin disease. The liquid costs more and is kept for children and anyone who cannot swallow.