View source for Poison Oak, Ivy, Sumac dermatitis

==Background==
[[File:Poison-ivy-oak-sumac.jpg|thumb|]]
[[File:Poison Ivy in Perrot State Park.jpg|thumb|Poison Ivy]]
*Type of [[Contact dermatitis|contact dermatitis]]
*Caused by Urashiols found in the sap of the plant.  

{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Plant'''
| align="center" style="background:#f0f0f0;"|'''Distribution'''
| align="center" style="background:#f0f0f0;"|'''Charateristics'''
|-
| Ivy ||East of the Rockies||
*3 leaf structure
|-
| Oak||West of the Rockies||
*can be tree or bush 
*vinejet black stain on leaf 
*3 leaf structure
|-
| Sumac||Southeast swamps||
*2 opposing leaflets single terminal leaf
|}

{{Dermatitis types}}

==Clinical Features==
[[File:PoisonIvyOakSumac.jpeg|thumbnail|Urushiol induced rash]]
[[File:Urushiol induced contact dermatitis.jpg|thumb|Urushiol induced contact dermatitis]]
[[File:Severe allergic reaction to urushiol (poison oak) 4 days after exposure.jpg|thumb|Contact dermatitis from poison oak exposure (Day 4).]]
*Previous exposure leads to sensitization and earlier symptoms 
**1-2 days for previous sensitizations and 10-14 days for first contact

==Differential Diagnosis==
{{Bullous rashes DDX}}

==Evaluation==
*Clinical diagnosis

==Management==
===Prophylaxis===
====Prexposure====
*Ivy Shield, Stokogard, Organoclay, or IvyBlock

====Postexposure====
*Technu Poison Cleanser- may solubilize bound resin several hours post exposure
*Dr Wests Ivy Detox Cleanser chelates urushiol- decreases itching even if have rash

===Symptomatic Treatment===
*Soothing measure options:
**Oatmeal baths 
**Cool, wet compresses
**Ice packs
**Topical menthol and phenol (calamine lotion) compounds
**Topical astringents under occlusion dressing to dry weeping lesions<ref>Poison ivy dermatitis. Baer RL Cutis. 1990;46(1):34</ref>
***Aluminum acetate (Burow's solution)
***Aluminum sulfate calcium acetate (Domeboro)  
**Soap mixture of ethoxylate and sodium lauroyl sarcosinate surfactants (Zanfel)<ref>Davila A, Lucas J, Jacoby J, et al. A new topical agent, Zanfel, ameliorates urushiol-induced Toxicodendron allergic contact dermatitis. Ann Emerg Med. 2003;42:S98</ref>
*Oral [[antihistamines]]
**Occasionally used, primarily for sedating effect (itching in poison ivy dermatitis is not caused by histamine release)<ref>Munday J, Bloomfield R, Goldman M, Robey H, Kitowska GJ, Gwiezdziski Z, Wankiewicz A, Marks R, Protas-Drozd F, Mikaszewska M. Chlorpheniramine is no more effective than placebo in relieving the symptoms of childhood atopic dermatitis with a nocturnal itching and scratching component. Dermatology. 2002;205(1):40.</ref>
*High-potency [[topical corticosteroids]]: e.g.  [[clobetasol propionate]] 0.05% cream
**No evidence that alters course of disease once vesicles established<ref>Vernon HJ, Olsen EA. A controlled trial of clobetasol propionate ointment 0.05% in the treatment of experimentally induced Rhus dermatitis. J Am Acad Dermatol. 1990;23(5 Pt 1):829.</ref>
*Systemic [[corticosteroids]] for severe disease
**[[prednisone]] taper over 15-20 days: 60mg x 4d then 50mg x 4d then 40 30 20....Use oral steroid for 3wks until skin turns over
**Standard burst dosing may be too short (with rebound dermatitis common)<ref>Brodell RT, Williams L. Taking the itch out of poison ivy. Are you prescribing the right medication? Postgrad Med. 1999;106(1):69.</ref>

===Not Indicated===
*Topical [[antihistamines]]
*Anesthetics containing [[benzocaine]]
*Antibiotics containing [[neomycin]] or [[bacitracin]]

==Disposition==
*Almost always outpatient

==See Also==
*[[Rashes]]
*[[Contact dermatitis]]

==References==
<references/>

[[Category:Toxicology]]