What is the treatment for contact dermatitis caused by poison ivy?

Treatment for Contact Dermatitis from Poison Ivy

High-potency topical corticosteroids are the first-line treatment for poison ivy dermatitis and should be applied as soon as possible after exposure for maximum effectiveness. 1

Immediate Management

1. Decontamination

   • Wash affected area immediately with soap and water
   • Effectiveness decreases rapidly with time (100% at immediate contact, 50% at 10 minutes, 25% at 15 minutes) 1
   • Remove and wash all clothing that may have contacted the plant

2. Topical Treatment

   • Apply high-potency topical corticosteroid (e.g., clobetasol propionate 0.05%) twice daily 1
   • Avoid low-potency OTC hydrocortisone (0.2-2.5%) as it shows limited efficacy 1
   • For eyelid involvement, use tacrolimus 0.1% ointment once daily instead of corticosteroids to avoid skin atrophy 1

3. Symptomatic Relief

   • Apply cool compresses several times daily 1
   • Take oatmeal baths for widespread involvement 1
   • Consider topical polidocanol cream for itch relief 1

Systemic Treatment

• For severe or widespread cases, systemic corticosteroids may be necessary 2
• Antihistamines have limited evidence for effectiveness against poison ivy itch but may help with sleep disturbance 1

Treatment Based on Severity

Mild to Moderate Cases

• High-potency topical corticosteroids twice daily 1
• Cool compresses and symptomatic management
• Duration: typically 1-3 weeks unless there is continued exposure 2

Severe Cases

• Systemic corticosteroids 2
• Consider urgent referral (within 1 week) for:
  • Severe eyelid involvement
  • Visual changes or corneal involvement
  • Children under 7 years of age 1

Special Considerations

1. Facial/Eyelid Involvement

   • Avoid topical corticosteroids on eyelids due to risk of skin atrophy 1
   • Use preservative-free ocular lubricants 2-4 times daily 1
   • Consider topical calcineurin inhibitors (tacrolimus 0.1%) for eyelid application 1

2. Prevention

   • Wear protective clothing when in areas with poison ivy
   • Consider barrier creams before potential exposure 3
   • Learn to identify and avoid poison ivy plants

Common Pitfalls to Avoid

• Relying solely on over-the-counter hydrocortisone, which has limited efficacy 1
• Delaying treatment - effectiveness of decontamination decreases rapidly with time 1
• Using topical corticosteroids on eyelids, which can cause skin atrophy and telangiectasia 1
• Assuming antihistamines will effectively control the itch (they primarily help with sleep) 1

Contact dermatitis from poison ivy is typically self-limiting and resolves within 1-3 weeks with appropriate treatment, unless there is continued exposure to the allergen 2.