Hi. We just visited dermatologist and he prescribed my daughter those medicines: Prednisalon tablets - 2t. a day for 10 days and then 1t. a day for another 10 days. Advanton cream once a day for one week in the morning, Elidel cream first week only evenings then for two weeks both mornings and evenings. Just would like to get another opinion about this prescription, could there be any side effects or are those doses safe for 3,5 year old girl?
Person's Gender: Female
Person's Age: 3 year and half
That all described in previous questions/messages.
Hello,I assume that your daughter is suffering from severe eczema. While the dosage of Advanton and Elidel is normal for children between the ages of 2-5 years, Prednisalon tablets are usually prescribed only if the patient does not respond to the creams. The dose is 0.05 to 2 mg/kg/day divided 1 to 4 times/day. Since Prednisalon tablets are available as 5mg tablets, what dose your daughter needs will depend on her body weight.I hope this helps. Please feel free to ask a followup question if necessary. If not, please click the green 'Accept' button on this page. Leaving a bonus and positive feedback will be highly appreciated.
Her weight is approx. 14 kg and doctor prescribed 2 tablets (to be taken all at once) a day for 10 days then reduce to one a day for 10 more days. Do you think it will make a difference to give her at once two tablets or is better to divide throughout a day? And Prednisalon doctor mostly prescribed to stop spreading her vitiligo patches, and, of course, there are online so much negative references of using oral steroids specially for kids, it does make me somehow very cautious. I want very much to help my daughter, but without hurting her health much as well... Are oral steroids that bad as it is described in most of the internet sites? Please advise.
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Are the prednisolone tablets 5 mg a piece? Is the spelling prednisolone or a brand name prednisalon as you write? I am assuming that they are prenisolone as the main ingredient. So I read your other questions briefly and would like to commend you on your description of what is likely eczema in your daughter as well as your observations on what triggers or exacerbates it for her. I have a few suggestions. First to answer the steroid question I would need the dosage of the tablets. Did they tell you to crush them? We usually use a liquid in a child of this age. Second the Elidel is what I have used in the past with actually surprising success for vitiligo (under derm recommendation). I have never had anyone prescribe oral steroids for this condition. I have had them prescribed for severe eczema though but not for such a long course. There are side effects to steroids of course but most of the time for the benefit you are using them for the side effects are worth the risk. How bad is her vitiligo? Have you tried the Elidel exclusively yet? When is your next appt with the derm? How bad is her eczema? The cream you are using is methylprednisone and we usually use forms of hydrocortisone but should work when used in conjunction with a good skin care regimen to control her eczema (this I can explain in brief in another post)...but I would agree with you to feel a bit cautious about the oral steroids.
So I just looked up oral steroid pulses for vitiligo...they are used in lower doses than for other causes...I found one study for 0.3mg/kg/day with success in over 80% of halting progression and 70% regression of spots. However as I mentioned above generally topical therapy is tried first including the elidel or other topical steroids due to decreased toxicity. Have you guys tried other steriod creams?
So probably the below will be redundant for you as you have been to see specialists for the care of her eczema...but I always like to talk about eczema starting at the beginning. Eczema or the itch that rashes...is dry/sensitive skin. Her skin reacts to stimuli (heat/sweat/allergens/perfumes) that normal people do not react to...there is an immune response in her skin and she is itchy...she scratches and the rash comes out. You must work diligently on the dryness factor and the avoidance of possible triggers. Use a thick emmolient or hydration cream 3x/day or more such as Eucerin, petroleum jelly (vaseline), anything colorless/odorless etc...For all of her skin care, soaps, detergents for clothes the above applies. By avoiding dyes and fragrances in the products you can eliminate the most common irritants. Hopefully no one smokes at home as this is another common irritant that can be avoided. When the spots come out in her elbow folds or other places you need to use the steroid cream 2x/day to "stop the itch" many times you can use the stronger creams just for a few days then control again either with vaseline or a less strong steroid like hydrocortisone 1% to the area. Elidel can also be used on the eczema spots but I would save it for the vitiligo due to $$ and that there is a black box warning about possible skin cancer relation that really has not changed much how we use it as pediatricians as it hasn't really panned out too much.
Tablets Prednisolone 5mg. If you have access to all my previous questions to DR.Das you will be able to visualize the skin problems my daughter has. It is really so long to repeat. But concerning steroid cream and Elidel we only apply on her eczema, not vitiligo. Her vitiligo (which is mostly in her genital area, where she used to have diaper rash when she was a baby) started to develop more patches, specially after course of antibiotics she just had recently due to flu, that's mostly why dermatologist prescribed Prednisolon to stop spreading the vitiligo.
Hmm.. I have already viewed your other responses and really your description of her eczema is excellent! To be totally honest you may consider using the elidel cream to the area only for a while before using the oral therapy as this is what is generally done by the dermatologists I have worked with. If she really doesn't have fast spreading or extensive disease it doesn't seem to be very severe as of yet. Again I am not a pediatric dermatologist but a general pediatrician. As I mentioned above I have seen good success with both elidel and steroid creams to the vitiligo spots in the past and have never needed to use oral steroids for my patients. Vitiligo can start at any time and as your derm has confirmed the diagnosis by woods lamp and you have noted spreading this is likely what it is. The only caveat to the steroid creams is that we don't like to use them in the genital area for too long as their local side effects are thinning of skin (minor!) but the genitalia already have pretty thin skin. However for other conditions steroids are used in the gential area for many weeks at a time thus I would just take this into consideration when using the creams to this area. The dose of 10mg of prednisolone a day for a 14 kg child is equal to 0.7mg of steroid a day per kg of body weight and is well below the dose we use for other reasons such as asthma etc...thus should be safe and he is tapering the dose which is recommended when using for this period as well. Thus to answer your steroid question you may dose it in whichever way you feel is easiest...prenisolone can be one or 2 doses a day...if she tastes it and won't take it split the dose up, if she takes it fine do one dose daily as you are less likely to forget the second later on in the day!
US Pediatrician licensed in California living abroad