Our Pharmacist Manager, Scott Henson, shares an in-depth look at the best ways to treat poison ivy:
TREATMENT OF POISON IVY DERMATITIS
Summertime is now in full swing in Western North Carolina and a welcome time it is after an unusual spring season enduring COVID-19 lockdown. Like many other folks, I decided to take on additional outdoor projects in some of my spare time and soon became reacquainted with one of summer’s irritating afflictions: poison ivy.
Roughly 75% to 80% of people have some degree of sensitivity to poison ivy and many have encountered the dreaded, itchy rash brought on by exposure to the oils from the plant or its’ unfriendly cousins, poison oak and poison sumac. In the US alone, 25 to 40 million people annually require medical treatment for poison ivy dermatitis [1]. The culprit causing all the itchy trouble is a compound called urushiol which is a colorless, light oil found in the stem, leaves, flowers, sap, and roots of the offending plants.
The classic symptoms of dermatitis caused by skin exposure to urushiol typically include:
Skin redness, swelling, intense itching, and the formation of small blisters called vesicles. As the rash progresses it typically develops into linear streaked configurations of vesicles where oils have come in to contact with exposed skin. It is quite common for the vesicles to “weep” a clear fluid, which incidentally is not antigenic so it does not cause the rash to spread. It is also interesting to note that poison ivy rash itself is not contagious, however, clothing, gardening tools, and pet fur can all retain oils after exposure and perpetuate continued contact with urushiol.
Rashes typically begin to develop 12 to 72 hours after contact and generally lasts from several days up to a couple of weeks. More severe reactions can last up to 3 weeks [3].
Because the reaction to poison ivy is based upon skin exposure to urushiol, the best prevention is wearing sufficient protective clothing when working or playing in suspected areas of plant growth. Gloves are especially important during yard work and gardening where exposure is more likely. Washing skin thoroughly with warm soapy water (many landscapers recommend a mild dish detergent) after suspected contact with plant materials is also highly recommended. Studies have shown washing even 2 hours after exposure is beneficial in reducing the severity of reactions [2]. I recommend a couple of products that appear anecdotally to help when applied soon after exposure. These are Zanfel and Tecnu Cleanser and it’s a great idea to include one or the other in a first aid kit when hiking or working in remote areas where washing is not readily available. They are more expensive than soapy water but appear to have a loyal following of users. It is also important to remember to wash exposed clothing and also clean gardening tools with soapy water if there is suspected contact with poison ivy.
Most mild to moderate cases of poison ivy dermatitis respond well to over-the-counter treatments designed to provide symptom relief.
Topically, time tested methods to help provide relief and alleviate itching include:
- – Oatmeal (Aveeno) or baking soda baths
- – Cool compresses with cold water on a wrung-out washcloth for 15 to 30 minutes
- – Over-the-counter topical steroids to help reduce itching. The most effective of these products contain hydrocortisone 1% cream.
- – Calamine lotion
For oozing rash in smaller patches I recommend Ivy-Dry super spray. This product contains benzyl alcohol, camphor, and menthol. It’s designed to help dry the weeping exudate from blisters as well as helping relieve itching.
For oozing rash covering larger areas I recommend aluminum acetate solution also known as Burow’s solution which is an astringent that helps dry weeping areas. This is commonly available in a product called Domeboro. Once mixed properly the solution can be used as a cold compress, wet dressing, or soak.
Lastly, Benadryl or its generic, diphenhydramine may be helpful for mild to moderate reactions. Surprisingly, dermatitis from poison ivy is not histamine-mediated so anti-histamine products don’t help directly with itching. However, antihistamines like diphenhydramine cause drowsiness and this may help you sleep better with that persistent itch.
Severe dermatitis from reaction to urushiol will most likely necessitate a visit with a doctor for more potent topical steroid products, courses of treatment with oral steroids, and sometimes antibiotics if infection has developed.
Seek help from a physician if you experience any of the following:
- – Previous severe reaction to poison ivy
- – Rash covering large portions of body surface area
- – Rashes lasting more than a couple of weeks
- – Soft yellow scabs or pus formation in rash areas that indicate possible infection
- – Rash that affects eyes, mouth, or genital areas
- – Temperature over 100 F
- – Difficulty breathing, especially with possible inhalation of smoke from burning materials that may contain urushiol containing plant material
I hope you and your family have a fun summer free from the irritation of poison ivy. However, if you do encounter that familiar itchy rash and need some friendly advice, please stop by and ask to speak with one of the pharmacists at Sona Pharmacy. We are always happy to take the time to help!
References:
- Epstein WL. Occupational poison ivy and oak dermatitis. Dermatol Clin 1994: 12:511.
- Stibich AS, Yagan M, Sharma V, et al. Cost-effective post-exposure prevention of poison ivy dermatitis. Int J Dermatol 2000; 39;515.
- McGovern TW. Dermatoses due to plants. In: Dermatology, Bolognia JL, Jorizzo JL, Rapini RP, et al (Eds), Mosby, New York 2003. p. 274.
