What is the recommended treatment for children with severe poison ivy?

Treatment of Severe Poison Ivy in Children

For severe poison ivy dermatitis in children, a combination of prescription-strength topical corticosteroids and systemic corticosteroids is recommended to reduce symptom duration and severity. 1

Immediate Management

• Decontamination: Wash affected areas with soap and water as soon as possible after exposure
  • Effectiveness decreases rapidly with time: 100% effective immediately, 50% at 10 minutes, 25% at 15 minutes 1
  • Even washing 2 hours after exposure can reduce symptoms by 55-70%

Treatment Algorithm Based on Severity

Mild to Moderate Cases

1. Topical Corticosteroids:

   • First-line: Prescription-strength topical corticosteroids 1
     • For body: Class I topical corticosteroids (clobetasol propionate, halobetasol propionate)
     • For face: Class V/VI corticosteroids (desonide, hydrocortisone 2.5%)
   • OTC options: Hydrocortisone (for children ≥2 years) applied to affected area no more than 3-4 times daily 2
     • Note: OTC hydrocortisone has limited effectiveness for poison ivy 1

2. Symptomatic Relief:

   • Cool compresses to affected areas
   • Oatmeal baths for widespread rash

3. Antihistamines (primarily for sleep disruption from itching):

   • Cetirizine/loratadine 10 mg daily (age-appropriate dosing)
   • Hydroxyzine 10-25 mg at bedtime (for severe itching disrupting sleep) 1

Severe Cases

Severe cases are characterized by extensive rash, facial/genital involvement, or significant discomfort:

1. Systemic Corticosteroids:

   • Oral prednisone/prednisolone for 14-21 days 3
   • Longer courses (14+ days) are associated with fewer return visits and less need for additional medications compared to shorter courses 4, 3
   • Typical regimen: Initial dose based on weight followed by a gradual taper

2. Continue Topical Therapy:

   • High-potency topical corticosteroids to affected areas
   • Combination of systemic and topical corticosteroids reduces itching duration 1

Special Considerations for Children

• Avoid long-term use of high-potency topical steroids, especially on the face, genitals, and skin folds
• Monitor for side effects of systemic corticosteroids, including mood changes, increased appetite, and sleep disturbances
• For children under 2 years, consult a physician before using any topical hydrocortisone 2

Monitoring and Follow-up

• Improvement should begin within 1-3 days of treatment
• Complete healing typically occurs within 1-3 weeks 5
• Watch for signs of secondary bacterial infection (increased redness, warmth, swelling, pus, fever)
• If infection is suspected, appropriate antibiotics should be administered for at least 14 days 1

Prevention Education

• Teach children to recognize and avoid poison ivy plants ("leaves of three, let them be")
• Recommend protective clothing when in wooded areas
• Wash all clothing, pets, and tools that may have contacted the plant

When to Refer to Emergency Care

• Extensive rash covering large body areas
• Severe facial or genital involvement
• Difficulty breathing or swallowing
• Signs of systemic involvement

The evidence strongly supports longer courses (14+ days) of systemic corticosteroids for severe poison ivy dermatitis to reduce healthcare utilization and prevent symptom recurrence 4, 3.