These were the initial and only study questions identified and reviewed for face validity prior to study initiation by approximately 20 physician members of the Primary Care Health Improvement Project (PCHIP) PBRN and all studied measures are reported below. Our study addressed the question of whether a 5-day regimen of corticosteroid therapy at doses higher than a Medrol Dosepak ® is as effective as the same regimen followed by a tapering dose of corticosteroids for initial control and treatment of symptoms (as evidenced by whether the rash improved with study treatment and lengths of time to improvement and resolution of rash, as well as use of other medications for treatment after initiation of the study protocol) compliance and side effects with the study protocol and prevention of rebound rash from severe poison ivy dermatitis. Upon finding little literature support and no clear evidence of which method of treatment was more effective, we undertook this study. Practice patterns within the supporting practice-based research network (PBRN) varied widely from short course doses of steroids to long course doses inclusive of a taper leading us to question the evidence base behind both regimens. Expert recommendation for treatment in this area includes use of oral steroids for severe cases, variably described as either involving greater than 20% of body surface area, the presence of severe blistering or itching, or involvement of the face, hands, or genital area. Expert opinion and one case report on the commonly prescribed Medrol Dosepak ® (total of 84 mg of methylprednisolone tapered over 6 days) note this regimen to be insufficient and likely to cause rebound rash. It is commonly thought that too short a treatment course allows for rebound dermatitis after initial improvement. Several recommended regimens exist in the current literature. Oral corticosteroids are often used for treatment, but no randomized controlled trials have been found supporting a particular dosing regimen. Contact dermatitis, particularly from Toxidendron foliage (poison ivy, oak, and sumac), is a common complaint in primary care offices.
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