What is the treatment for poison ivy?

Treatment for Poison Ivy

For poison ivy rash, treatment should include immediate washing with soap and water after exposure, followed by topical corticosteroids for mild to moderate cases and oral corticosteroids (prednisone 0.5-1 mg/kg for 7 days with 4-6 week taper) for severe or widespread cases. 1

Immediate Management

1. Wash the exposed area immediately with soap and water

   • Effectiveness decreases rapidly with time:
     • Immediate washing: 100% effective
     • After 10 minutes: 50% effective
     • After 15 minutes: 25% effective
     • After 30 minutes: 10% effective 1
   • Remove and wash all potentially contaminated clothing

2. Apply cool compresses to affected areas for symptomatic relief 1

3. Consider oatmeal baths for widespread exposure 1

Treatment Based on Severity

Mild to Moderate Cases

• Topical corticosteroids:

  • Low-potency OTC options like 2.5% hydrocortisone for mild cases 1, 2
  • Moderate to high-potency prescription corticosteroids for more significant cases
  • Apply 2-3 times daily for 1-2 weeks 1

• Oral antihistamines (cetirizine, loratadine, fexofenadine):

  • Limited efficacy for itching but may help with sleep disturbances 1

Severe or Widespread Cases

• Oral corticosteroids:
  • Prednisone 0.5-1 mg/kg daily for 7 days
  • Taper over 4-6 weeks to prevent rebound dermatitis 1
  • Consider PPI for GI prophylaxis during treatment
  • Add PCP prophylaxis if immunosuppression expected to last more than 3 weeks with >30 mg prednisone daily 1

Important Considerations

• Duration: Poison ivy dermatitis is typically self-limiting and resolves within 2-3 weeks 3, 4

• Monitor for complications:

  • Secondary bacterial infection
  • Steroid side effects (mood changes, insomnia, increased appetite, elevated blood glucose) 1

• Avoid:

  • Scratching the affected areas
  • Topical antihistamines, benzocaine, or other potential sensitizers that may cause additional allergic reactions 1

When to Seek Medical Attention

Seek immediate medical care if:

• Rash covers >30% of body surface area
• Involves face, eyes, or genitals
• Shows signs of secondary infection
• Causes difficulty breathing or swallowing
• Doesn't improve after 7-10 days of treatment 1

Prevention Strategies

• Learn to identify poison ivy, oak, and sumac plants
• Wear protective clothing when in areas where these plants may grow
• Wash all potentially contaminated items (clothing, tools, pets)
• Consider commercial barrier creams if exposure is anticipated 1

If a poison ivy rash persists beyond 3 weeks, consider continued exposure to urushiol oil, secondary complications, or alternative diagnoses such as urticarial vasculitis or other forms of contact dermatitis 1.