From the Guidelines
For poison ivy treatment, a medium to high-potency topical steroid such as triamcinolone 0.1% or fluocinonide 0.05% is recommended, applied 2-3 times daily to affected areas for 1-2 weeks. According to the 2024 American Heart Association and American Red Cross guidelines for first aid 1, topical corticosteroids are often recommended for symptomatic treatment of local symptoms. However, over-the-counter corticosteroids such as 0.2% hydrocortisone lotion, 1.0% hydrocortisone ointment, 2.5% hydrocortisone ointment, and 2.5% hydrocortisone cream were not reported to improve symptoms in a randomized, blinded trial involving 92 cases of Toxicodendron dermatitis 1. Some key points to consider when using topical steroids for poison ivy treatment include:
- Washing with soap and water can remove up to 100% of poison ivy oils if done immediately after contact, and this can help reduce the severity of the rash 1
- Topical steroids should be used for a sufficient duration, typically 1-2 weeks, to avoid rebound rashes
- Supportive care, including cool compresses, calamine lotion, and oral antihistamines, can help relieve itch and discomfort
- Medical attention should be sought if the rash covers large body areas, affects the face or genitals, or if there are signs of infection.
From the Research
Recommended Steroid Dose for Poison Ivy Treatment
- The recommended treatment for localized acute allergic contact dermatitis, such as poison ivy, includes mid- or high-potency topical steroids, such as triamcinolone 0.1% or clobetasol 0.05% 2.
- For cases involving an extensive area of skin (greater than 20 percent), systemic steroid therapy is often required and offers relief within 12 to 24 hours 2.
- In patients with severe rhus dermatitis, oral prednisone should be tapered over two to three weeks because rapid discontinuation of steroids can cause rebound dermatitis 2.
- A study comparing a 5-day regimen of 40 mg oral prednisone daily to a 15-day regimen with a prednisone taper found that the longer course regimen was associated with less utilization of other medications 3.
- Another study found that shorter duration oral corticosteroids (less than 14 days) were associated with an increased risk of return visits to healthcare clinicians 4.
- The American Academy of Family Physicians recommends that oral corticosteroids be used for at least 14 days to treat poison ivy dermatitis, with some cases requiring longer treatment durations 4.
Systemic Steroid Therapy
- Systemic steroid therapy is often required for cases of poison ivy involving an extensive area of skin (greater than 20 percent) 2.
- Oral prednisone is commonly used for systemic steroid therapy, with a typical dose of 40 mg daily for 5 days, followed by a taper over 2-3 weeks 2, 3.
- A longer course of systemic steroid therapy (14-21 days) may be associated with better outcomes and reduced utilization of other medications 4, 3.
Topical Steroid Therapy
- Topical corticosteroids, such as triamcinolone 0.1% or clobetasol 0.05%, are effective for treating localized acute allergic contact dermatitis, such as poison ivy 2.
- Topical steroids are typically used for localized non-facial eruptions, while systemic corticosteroids are used for more severe or widespread eruptions 5.