What is the assessment and treatment for poison ivy exposure?

Assessment and Treatment of Poison Ivy Exposure

For poison ivy exposure, immediate washing with soap and water within 10-15 minutes is the most effective first-line intervention, followed by appropriate topical or systemic corticosteroids based on severity of the rash. 1

Initial Assessment

• Identify characteristic features of poison ivy rash:

  • Linear or streak-like appearance
  • Pruritic erythematous rash with vesicles and bullae
  • Symptoms typically appear 24-48 hours after exposure 2
  • Usually self-limiting, lasting 2-3 weeks 3, 4

• Assess severity based on:

  • Body surface area affected
  • Location (face, eyes, genitals)
  • Presence of secondary infection
  • Systemic symptoms

Immediate Management

1. Decontamination:

   • Immediately wash exposed skin with soap and water 1
   • 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 contaminated clothing 5

2. For dry plant material:

   • Brush off any dry material before washing with water 5
   • Avoid spreading contaminant to other areas 5

Treatment Based on Severity

Mild to Moderate Cases:

• Topical treatments:

  • Apply cool compresses for symptom relief 1
  • Use topical corticosteroids:
    • Low-potency OTC options like 2.5% hydrocortisone for mild cases 1, 6
    • Moderate to high-potency prescription corticosteroids for more significant rashes, applied 2-3 times daily for 1-2 weeks 1
  • Consider oatmeal baths for widespread exposure 1

• Symptomatic relief:

  • Oral antihistamines (cetirizine, loratadine, fexofenadine) may help with sleep disturbances but have limited efficacy for itching 1

Severe Cases:

• Systemic corticosteroids for severe or widespread rash:
  • Prednisone 0.5-1 mg/kg for 7 days followed by tapering over 4-6 weeks 1
  • Shorter courses (<14 days) are associated with increased risk of symptom recurrence 1
  • Consider PPI for GI prophylaxis during treatment 1
  • Add PCP prophylaxis if immunosuppression expected to last more than 3 weeks with >30 mg prednisone daily 1

Important Cautions

• Avoid:

  • Scratching affected areas
  • Topical antihistamines, benzocaine, or other potential sensitizers
  • These can cause secondary infection or additional allergic reactions 1

• Do not:

  • Administer anything by mouth for poisoning unless advised by poison control 5
  • Use syrup of ipecac 5
  • Use activated charcoal unless advised by poison control 5

When to Seek Medical Attention

Seek immediate medical care if:

• Rash covers >30% body surface area
• Face, eyes, or genitals are involved
• Signs of secondary infection appear
• Difficulty breathing or swallowing develops
• No improvement after 7-10 days of treatment 1
• Rash persists beyond 3 weeks (may indicate continued exposure, complications, or misdiagnosis) 1

Prevention Strategies

• Learn to identify poison ivy, oak, and sumac plants
• Wear protective clothing when in areas where these plants grow
• Wash all potentially contaminated items
• Consider commercial barrier creams if exposure is anticipated 1
• For industrial or severe chemical exposures, consult poison control centers for specific guidance 5