What is the treatment for poison ivy?

Treatment of Poison Ivy

For poison ivy dermatitis, immediate washing with soap and water followed by topical high-potency corticosteroids for mild to moderate cases and oral prednisone (0.5-1 mg/kg daily for 15-21 days with taper) for severe cases is the recommended treatment approach. 1

Immediate Actions After Exposure

1. Prevention of rash development:
   • Wash exposed skin with soap and water immediately after contact
   • 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 contaminated clothing to prevent further exposure
   • Brush off any dry plant material before washing to minimize spread 1

Treatment Based on Severity

Mild to Moderate Cases

1. Topical corticosteroids:

   • High-potency corticosteroids (clobetasol propionate 0.05% or mometasone furoate)
   • Apply twice daily to affected areas
   • Continue for 1-2 weeks, reassess after 2 weeks 1
   • Over-the-counter hydrocortisone can temporarily relieve itching for minor cases 2

2. Symptomatic relief:

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

Severe Cases

1. Oral corticosteroids:
   • Indicated for severe or widespread rash
   • Prednisone 0.5-1 mg/kg body weight daily
   • Total treatment duration of 15-21 days
   • Include taper over 2-3 weeks to prevent rebound dermatitis 1
   • Monitor for steroid side effects (mood changes, insomnia, elevated blood glucose)
   • Consider proton pump inhibitor for GI prophylaxis during treatment 1

What to Avoid

• Scratching the affected areas
• Topical antihistamines, benzocaine, or other potential sensitizers that may cause additional allergic reactions
• These can increase risk of secondary infection 1

Expected Course and When to Seek Medical Care

• Poison ivy dermatitis typically resolves within 1-3 weeks without continued exposure 3, 4
• Seek medical care 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

Important Considerations

• A rash persisting beyond 3 weeks may indicate:
  • Continued exposure to urushiol oil
  • Secondary complications
  • Misdiagnosis of another condition (e.g., urticarial vasculitis or dermatitis from anticancer agents) 1
• Local treatment is usually sufficient for mild to moderate cases, but systemic corticosteroids are beneficial in more severe cases 3, 4
• Despite extensive research, there is no entirely effective preventive method besides complete avoidance 5