Poison Oak, Ivy, Sumac dermatitis

From WikEM
(Redirected from Poison Oak, Ivy, Sumac)
Jump to: navigation, search

Background

Poison Ivy
Plant Distribution 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

Clinical Features

Urushiol induced rash
Urushiol induced contact dermatitis
  • Previous exposure leads to sensitization and earlier symptoms
    • 1-2 days for previous sensitizations and 10-14 days for first contact

Differential Diagnosis

Vesiculobullous rashes

Febrile

Afebrile

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
    • Topical menthol and phenol (calamine lotion) compounds
    • Topical astringents under occlusion dressing to dry weeping lesions[1]
      • Aluminum acetate (Burow's solution)
      • Aluminum sulfate calcium acetate (Domeboro)
    • Soap mixture of ethoxylate and sodium lauroyl sarcosinate surfactants (Zanfel)[2]
  • Oral antihistamines
    • Occasionally used, primarily for sedating effect (itching in poison ivy dermatitis is not caused by histamine release)[3]
  • High-potency topical corticosteroids: e.g. clobetasol propionate 0.05% cream
    • No evidence that alters course of disease once vesicles established[4]
  • 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)[5]

Not Indicated

  • Topical antihistamines
  • Anesthetics containing benzocaine
  • Antibiotics containing neomycin or bacitracin

Disposition

  • Almost always outpatient

See Also

Video

References

  1. Poison ivy dermatitis. Baer RL Cutis. 1990;46(1):34
  2. 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
  3. 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.
  4. 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.
  5. Brodell RT, Williams L. Taking the itch out of poison ivy. Are you prescribing the right medication? Postgrad Med. 1999;106(1):69.