From the Guidelines
Oral steroids should not be the first line of treatment for pediatric poison ivy, and instead, topical corticosteroids and supportive care should be prioritized. When considering treatment for pediatric poison ivy, it's essential to weigh the benefits and risks of oral steroids. According to the 2024 American Heart Association and American Red Cross guidelines for first aid 1, washing with soap and water can remove up to 100% of poison ivy oils if done immediately after contact, highlighting the importance of prompt and proper washing.
For symptomatic treatment of local symptoms, topical corticosteroids are often recommended, but those that have been demonstrated to improve local symptoms are not available over the counter 1. In cases where symptoms are severe, widespread, or involve sensitive areas, oral steroids like prednisone may be considered, typically given as a 5-7 day tapering course. The dosage for children is usually 1-2 mg/kg/day (maximum 60-80 mg daily), divided into 1-2 doses. However, it's crucial to note that the use of oral steroids should be reserved for severe cases, and supportive care, including cool compresses, calamine lotion, and antihistamines for itch relief, should be continued throughout the treatment.
Key considerations for pediatric poison ivy treatment include:
- Prompt washing with soap and water to remove poison ivy oils
- Use of topical corticosteroids for symptomatic treatment of local symptoms
- Reservation of oral steroids for severe, widespread, or sensitive area involvement
- Supportive care, including cool compresses, calamine lotion, and antihistamines for itch relief
- Monitoring for signs of infection, such as increasing redness, warmth, pus, or fever, and seeking medical attention promptly if necessary.
From the FDA Drug Label
Pediatric Use The efficacy and safety of corticosteroids in the pediatric population are based on the well-established course of effect of corticosteroids, which is similar in pediatric and adult populations The adverse effects of corticosteroids in pediatric patients are similar to those in adults Pediatric patients who are treated with corticosteroids by any route, including systemically administered corticosteroids, may experience a decrease in their growth velocity.
The use of oral steroids, such as prednisone, in pediatric patients for the treatment of poison ivy is not directly addressed in the provided drug label. However, it does mention that corticosteroids can be used in pediatric patients for certain conditions, and that the adverse effects are similar to those in adults.
- The growth effects of prolonged treatment with corticosteroids should be weighed against clinical benefits obtained and the availability of treatment alternatives.
- Pediatric patients should be titrated to the lowest effective dose to minimize potential growth effects. 2
From the Research
Pediatric Poison Ivy Treatment with Oral Steroids
- The treatment of poison ivy dermatitis depends on the severity of the reaction, and oral steroids may be prescribed in severe cases 3, 4, 5, 6.
- A study published in 2014 found that a longer course of oral prednisone (15 days) may be more effective in treating severe poison ivy dermatitis than a shorter course (5 days), with patients receiving the longer course being less likely to utilize other medications 4.
- Another study published in 2022 found that shorter duration oral corticosteroids (less than 14 days) were associated with an increased risk of return visits to healthcare clinicians, and recommended treating poison ivy dermatitis with oral steroids for at least 14 days 5.
- The use of systemic corticosteroids, including oral steroids, is generally recommended for severe cases of poison ivy dermatitis, especially when there are no limiting contraindications 5, 6.
- It is essential to assess the severity of the dermatitis and prescribe an appropriate supportive therapy, including oral steroids when necessary, to manage poison ivy cases effectively 3, 6.