What is the treatment for poison ivy?

Treatment for Poison Ivy

The first-line treatment for poison ivy includes topical corticosteroids such as hydrocortisone for mild cases, while oral corticosteroids (prednisone 0.5-1 mg/kg for 7 days with tapering over 4-6 weeks) are recommended for severe or widespread rash. 1

Immediate Management

1. Remove contaminated clothing and wash all potentially contaminated items to prevent further exposure 1
2. Wash exposed skin 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
3. Brush off any dry plant material before washing to minimize contaminant spread 1

Treatment Based on Severity

Mild to Moderate Cases

• Topical treatments:

  • Low-potency OTC hydrocortisone (2.5%) applied 2-3 times daily for 1-2 weeks 1, 2
  • For more severe localized cases, moderate to high-potency topical corticosteroids may be used 1

• Symptomatic relief:

  • Apply cool compresses to affected areas 1
  • Consider oatmeal baths for widespread exposure 1
  • Oral antihistamines (cetirizine, loratadine, or fexofenadine) may help with sleep disturbances but have limited efficacy for controlling itching 1

Severe Cases

• Oral corticosteroids (prednisone 0.5-1 mg/kg body weight) for 7 days with tapering over 4-6 weeks 1
• Consider additional medications during steroid treatment:
  • Proton pump inhibitor for GI prophylaxis
  • 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

Important Cautions

• Avoid these ineffective or potentially harmful treatments:
  • Calamine lotion (no evidence supporting effectiveness) 1
  • Topical capsaicin and crotamiton cream (lack of evidence) 1
  • Topical antihistamines, benzocaine, or other potential sensitizers (may cause additional allergic reactions) 1
  • Scratching (can lead to secondary infection) 1

When to Seek Medical Care

Seek medical attention if:

• Rash covers more than 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
• Persists beyond 3 weeks 1

Prevention Strategies

• Learn to identify poison ivy plants
• Wear protective clothing in areas where poison ivy may be present
• Consider commercial barrier creams if exposure is anticipated 1
• Cost-effective post-exposure prevention options include specialized products like Tecnu (70% protection), but even regular dish soap like Dial (56.4% protection) can be effective if used immediately after exposure 3

Clinical Considerations

• Poison ivy dermatitis is typically self-limiting, lasting 2-3 weeks without treatment 4, 5
• A rash persisting beyond 3 weeks may indicate continued exposure to urushiol oil, secondary complications, or misdiagnosis of another condition 1
• Approximately 50-75% of the US adult population is clinically sensitive to poison ivy, oak, and sumac 6