From the Guidelines
The most effective treatment for poison ivy in the ER is immediate washing with soap and water to remove up to 100% of poison ivy oils, followed by the use of cool compresses for relief of local symptoms, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
Treatment Approach
The primary goal of treating poison ivy is to reduce the inflammatory response to urushiol, the oil from the poison ivy plant that causes the allergic contact dermatitis.
- Washing with soap and water can remove up to 100% of poison ivy oils if done immediately after contact, with the effectiveness decreasing over time 1.
- Topical corticosteroids, such as 0.2% hydrocortisone lotion, 1.0% hydrocortisone ointment, 2.5% hydrocortisone ointment, and 2.5% hydrocortisone cream, have not been shown to improve symptoms in a randomized, blinded trial involving 92 cases of Toxicodendron dermatitis 1.
Recommendations
- Washing with soap and water as soon as possible after exposure to remove urushiol oil, with a commercially available decontamination product as an alternative 1.
- Cool compresses may be considered for relief of local symptoms from exposure to poison ivy, oak, or sumac 1.
- Oatmeal baths may be considered for relief of local symptoms from exposure to poison ivy, oak, or sumac, although the evidence is limited 1.
Additional Considerations
- Patients should be advised to thoroughly wash all clothing and items that may have contacted the plant to prevent further exposure.
- Avoid scratching to prevent secondary infection, and continue any prescribed medications even as symptoms begin to improve to prevent rebound reactions.
- For extensive blistering or signs of infection, the ER may clean the area and possibly prescribe antibiotics, although this is not directly addressed in the provided guidelines.
From the FDA Drug Label
Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema psoriasis poison ivy, oak, sumac insect bites detergents jewelry cosmetics soaps seborrheic dermatitis The treatment of poison ivy in the ER may include hydrocortisone (TOP) to temporarily relieve itching associated with minor skin irritations, inflammation, and rashes due to poison ivy 2.
- Key points:
- Hydrocortisone (TOP) is used for minor skin irritations and rashes.
- It is not explicitly stated that this is for ER treatment, but it can be used to relieve itching associated with poison ivy. Note that prednisone (PO) is not directly indicated for the treatment of poison ivy in the provided drug label 3.
From the Research
Treatment Approaches
- The treatment of poison ivy dermatitis depends on the severity of the reaction, and most cases can be managed by a nurse practitioner, but physician consultation is necessary in cases of systemic involvement 4.
- A study found that emergency clinicians often prescribe oral corticosteroids for shorter durations, which can lead to return visits, and recommends treatment for at least 14 days 5.
- Another study compared the efficacy of a 5-day regimen of oral prednisone to a 15-day regimen and found that the longer course regimen was associated with less utilization of other medications 6.
Effectiveness of Treatments
- A review of the current postexposure treatment and preventive methods for poison ivy, oak, and sumac dermatitis found that there is a need for a better therapy to definitively prevent allergic contact dermatitis to these plants 7.
- A study evaluated the effectiveness of available treatments for poison ivy and found that only one treatment approach significantly reduced pruritus, while three approaches were often associated with recurrences of rash or symptoms 8.