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Dr Emily Altman’s answer to “What’s the best way to treat poison ivy?”

Every year many people develop a rash from poison ivy.  Now that fall is near and yard preparation for winter begins, it’s important to talk about poison ivy.  Poison ivy rash, also called Rhus dermatitis, is an allergic contact dermatitis caused by the component of the plant’s oil, called urushiol.

Urushiol is also present in other Toxicodendron species – poison oak and poison sumac, as well as in mango rind, Rengas tree, Burmese lacquer tree, India marking nut tree, the shell of the cashew nut and Gingko biloba. Contact with these substances can cause a rash identical to the rash of poison ivy.  Once in a while a patient comes into the office with a typical poison ivy rash around the mouth and nowhere else.  And they always smile when I ask whether they were eating mango with the rind on.

How to recognize poison ivy, poison sumac and poison oak (from the American Academy of Dermatology)

The sayings, “Leaves of three, beware of me” or “Leaves of three, let it be” help you spot poison ivy and oak. But the saying really should be “leaflets of three, beware of me.” That’s because each leaf on poison ivy and oak has 3 smaller leaflets. The middle leaflet has a longer stalk than the 2 leaflets on either side.

What poison ivy looks like (from the American Academy of Dermatology)

  • Each leaf has 3 small leaflets.
  • It grows as a shrub (low woody plant) in the far Northern and Western United States, Canada, and around the Great Lakes.
  • It grows as a vine in the East, Midwest, and South of the United States.
  • In spring, it grows yellow-green flowers.
  • It may have green berries that turn off-white in early fall.
Poison Ivy Plant

Poison Ivy

Poison Ivy

Poison Ivy

What poison oak looks like

  • Each leaf has 3 small leaflets.
  • It most often grows as a shrub.
  • It can grow as a vine in the Western United States.
  • It may have yellow-white berries.
Poison oak

Poison Oak

Poison oak in western states

Poison oak in western states

What poison sumac looks like

  • Each leaf has a row of paired leaflets and another leaflet at the end.
  • It grows as a tall shrub or small tree.
  • In the Northeast and Midwest, it grows in standing water in peat bogs.
  • In the Southeast, it grows in swampy areas.
  • Often the leaves have spots that look like blotches of black paint. These spots are urushiol, which when exposed to air turn brownish black. Before urushiol hits the air, it is clear or a pale yellow.
  • It may have yellow-white berries.
Poison sumac

Poison sumac

Poison sumac drawing

Poison sumac drawing

Because it is caused by contact with the leaves or stems of the poison ivy plant (fresh or dry), the distribution of the rash is usually linear where the plant brushed along the skin. The rash itself is red and often contains vesicles. The fluid in the vesicles is just edema and cannot spread the rash further. The idea that the rash is contagious and can be spread by touching the involved areas comes from the fact that not the entire extent of the rash appears at one time. It can take up to 2-3 weeks for all of the rash to appear.  Usually the rash appears within 12-72 hours of contact with the plant and may last several weeks.

Linear papules and vesicles of poison ivy (Rhus) dermatitis

Linear papules and vesicles of poison ivy (Rhus) dermatitis

Poison ivy dermatitis

Poison ivy dermatitis

Poison ivy rash

Poison ivy rash

Blisters from a urushiol-induced dermatitis

Blisters from a urushiol-induced dermatitis

Urushiol induces an allergic reaction (type IV hypersensitivity reaction) which involves a response by T lymphocytes, a type of white blood cell. In fact, the first exposure to urushiol may not result in a rash at all.  What the first exposure does is prime the immune system to respond to the allergen on next encounter.  When the reaction does happen, the body produces memory T cells, which remember the allergen and induce a faster and more extensive rash the next time the allergen is encountered. This happens with every exposure to the plant oil.

Steps to take If there is contact with poison ivy:

  • The first thing to do is to wash the area with soap and cool water
  • Apply cold soaks to the area
  • If the rash appears, apply cold soaks, followed by a cortisone gel and calamine lotion two to three times a day for about a week. The idea is to dry the rash as soon as possible.
  • If the rash is severe, see your doctor as soon as possible.

If you develop a serious rash, you need to see the doctor right away.  Serious rashes include swelling around the eyes, mouth or genital areas or a widespread eruption.  These eruptions need to be treated with systemic medications.  You should see your doctor immediately if the blisters are oozing pus or you have a fever.

Hot water may make the itching better for an instant but because it allows for more circulation into the affected area, may make the rash actually worse.

If the exposure was extensive, a prescription strength cortisone gel or even oral prednisone may be necessary.  Prednisone treatment must continue for 12-14 days as premature termination of treatment may result in a flare of the rash.

Post-steroid flare of poison ivy rash (Rhus dermatitis)

Post-steroid flare of poison ivy rash (Rhus dermatitis)

It’s important to remember that the plant oil does stay on tools and gloves used in gardening, so handle those with care. Clothing, shoes and gardening tools used during exposure to poison ivy need to be washed to assure removal of the plant oil.  The oil can also be brought into the house by pets that go outside as it stays on the fur.

Do not burn poison ivy plants. The oil of the poison ivy plants can be aerosolized by burning the plant.  The aerosolized particles in the smoke can coat the skin and cause a severe, widespread reaction.  Inhaling smoke from burning poison ivy plants can cause severe irritation or injury to your eyes and breathing passages.

Prevention is the name of the game with poison ivy!

  • Learn what poison ivy, poison oak and poison sumac look like so that you can identify them in your yard or in the parks and forests.
  • Remove poison ivy from your environment or have a landscaper remove it if you have an allergy to it.
  • Wear long sleeves, long pants and gloves when handling poison ivy.
  • Wash clothing, shoes, garden tools or anything that may have been contaminated with urushiol afterwards.
  • Appy an over-the-counter barrier skin cream containing bentoquatam (Ivy Block) to protect your skin. Bentoquatam absorbs urushiol and prevents or lessens your skin’s reaction to the oil.

Disclaimer: Advanced Skin Wisdom provides the content on this website solely for informational and educational purposes. Information provided on this website should not be considered medical advice and is not a substitute for consultation with a qualified medical professional. Communications to or from the Advanced Skin Wisdom website and any person will not be considered to establish a patient/doctor relationship.

Comments

Comment from Houston DJ
Time October 4, 2011 at 1:56 pm

Oh my goodness. Some of those pics make me scared to do yard work.

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Disclaimer: The information on this Web site is solely for to educate patients. It is not intended to be medical advice and, therefore, should not be considered a substitute for consultation with a qualified medical professional. Communications to or from the Summit Medical Group Web site and any person will not be used to establish a relationship between a patient and doctor.