Poison Oak, Ivy, Sumac dermatitis
Background
- ivy found east coast- 3 leaf structure
- oak- along Pacific Coast can be tree bush or vine- jet black stain on leaf, 3 leaf structure
- sumac- in swamps- 2 opposing leaflets single terminal leaf
-Mango and Cashews can cross react
- toxicodendron- antigen is urushiole
- T- cell mediated delayed hypersensitivity
- resin carried by smoke of burning leaves
- resin found in leaves and stems- not surface
- must break or crush to release resin
- resin binds in 30sec. After binds cannot wash off
- lesions start in 48hrs
- linear array of vesicles
- vesicle fluid not antigenic
Treatment
PREXPOSURE PROPHYLAXIS-
-Ivy Shield, Stokogard, Organoclay, IvyBlock
POSTEXPOSURE PROPHYLAXIS-
-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 TX
- if small can use topical Temovate 0.05%
- topical anesthetic- menthol or pramoxine
- single IM dose of Triamcinolone or 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
- systemic antihistamines
- cooling soothing baths
- Pentoxifylline- blocks formation of TNF alpha- suppresses allergic patch testing
Put sunscreen first, then prexposure ivy cream, then mosquito repellant
Source
6/06 MISTRY