What is the recommended treatment for poison ivy?

Poison Ivy Treatment

The recommended first-line treatment for poison ivy is immediate washing with soap and water within 10-15 minutes of exposure, followed by topical corticosteroids for mild cases and oral corticosteroids (prednisone 0.5-1 mg/kg for 7 days with tapering over 4-6 weeks) for severe or widespread rashes. 1

Immediate Management After Exposure

1. Immediate decontamination:

   • Wash exposed areas with soap and water as soon as possible 1
   • Effectiveness of washing decreases rapidly with time:
     • Immediate washing: 100% effective
     • After 10 minutes: 50% effective
     • After 15 minutes: 25% effective
     • After 30 minutes: only 10% effective 1
   • Remove and wash all contaminated clothing to prevent further exposure 1
   • Brush off any dry plant material before washing to minimize spread of urushiol oil 1

2. Cleansing products:

   • Several products show similar effectiveness for removing urushiol oil:
     • Specialized products like Tecnu (70% protection)
     • Automotive degreaser like Goop (61.8% protection)
     • Regular dish soap like Dial (56.4% protection) 2
   • Cost-effectiveness varies significantly, with dish soap and automotive degreasers being much more economical than specialized products 2

Treatment Based on Severity

Mild to Moderate Cases

• Topical corticosteroids:

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

• Symptomatic relief:

  • Cool compresses to affected areas 1
  • Oatmeal baths for widespread exposure 1
  • Oral antihistamines (cetirizine, loratadine, fexofenadine) may help with sleep disturbances but have limited efficacy for itch control 1

Severe Cases

• Oral corticosteroids:
  • Indicated for severe or widespread rash (>30% body surface area) 1
  • 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

When to Seek Medical Care

Seek immediate medical attention if:

• Rash covers more than 30% of body surface area 1
• Face, eyes, or genitals are involved 1
• Signs of secondary infection are present 1
• Difficulty breathing or swallowing occurs 1
• Rash doesn't improve after 7-10 days of treatment 1
• Symptoms persist beyond 3 weeks 1, 3

Important Precautions

• Avoid:

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

• Do not use:

  • Syrup of ipecac or activated charcoal unless specifically advised by poison control 1

Prevention Strategies

• Learn to identify poison ivy plants 1, 4
• Wear protective clothing in areas where poison ivy may be present 1, 5
• Consider commercial barrier creams if exposure is anticipated 1, 5
• Wash all potentially contaminated items promptly 1

Clinical Pearls

• Poison ivy dermatitis is a type IV hypersensitivity reaction to urushiol oil 4
• The characteristic streak-or-line appearance helps in diagnosis 3
• Without continued exposure, symptoms typically resolve within 1-3 weeks 3
• A rash persisting beyond 3 weeks may indicate continued exposure to urushiol oil, secondary complications, or misdiagnosis of another condition 1
• Consider urticarial vasculitis or dermatitis from anticancer agents in differential diagnosis for persistent rashes 1