What is the treatment for poison ivy?

Poison Ivy Treatment

For poison ivy exposure, immediate washing with soap and water is the most effective treatment, followed by topical corticosteroids for mild cases and oral corticosteroids for severe cases. 1

Immediate Management

1. Decontamination (Critical First Step)

   • Immediately wash exposed areas 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 1
   • Brush off any dry plant material before washing to minimize spread 1

2. Symptomatic Relief for Mild to Moderate Cases

   • Topical treatments:

     • Moderate to high-potency topical corticosteroids 2-3 times daily for 1-2 weeks 1
     • Low-potency OTC options like 2.5% hydrocortisone may have limited efficacy 1
     • Cool compresses for local symptom relief 1
     • Oatmeal baths for widespread exposure 1

   • Oral medications:

     • Oral antihistamines (cetirizine, loratadine, fexofenadine) may help with sleep disturbances but have limited effect on itching 1, 2

Treatment for Severe Cases

Oral corticosteroids are indicated for severe or widespread rash:

• Recommended regimen: prednisone 0.5-1 mg/kg body weight for 7 days with tapering over 4-6 weeks 1
• Consider proton pump inhibitor for GI prophylaxis during treatment 1
• Add PCP prophylaxis if immunosuppression expected to last more than 3 weeks with >30 mg prednisone daily 1
• Monitor for steroid side effects including mood changes, insomnia, increased appetite, and elevated blood glucose 1

What to Avoid

• Do not scratch affected areas as this can lead to secondary infection 1
• Avoid topical antihistamines, benzocaine, or other potential sensitizers that may cause additional allergic reactions 1
• Do not administer anything by mouth for poisoning unless advised by poison control 3

When to Seek Medical Attention

Seek medical care if:

• Rash covers >30% of body surface area 1
• Involves face, eyes, or genitals 1
• Shows signs of secondary infection 1
• Causes difficulty breathing or swallowing 1
• Doesn't improve after 7-10 days of treatment 1
• Persists beyond 3 weeks (may indicate continued exposure, secondary complications, or misdiagnosis) 1

Prevention Strategies

• Learn to identify poison ivy plants 1
• Wear protective clothing when in areas where poison ivy may be present 1, 4
• Consider commercial barrier creams if exposure is anticipated 1, 4
• Wash all potentially contaminated items 1

Important Considerations

• Poison ivy dermatitis is self-limiting, typically resolving in 1-3 weeks without treatment 5, 6
• Cost-effective post-exposure prevention options include specialized products like Tecnu (70% effective), but household products like Goop (61.8% effective) and dish soap (56.4% effective) also provide significant protection at much lower cost 7
• The allergic reaction develops within hours or days after exposure, which can facilitate unknowing spread of the urushiol oil inside the home 8