What is the recommended treatment for contact dermatitis, such as poison ivy?

Treatment of Contact Dermatitis from Poison Ivy

The recommended first-line treatment for contact dermatitis from poison ivy is immediate washing of the exposed area with soap and water or a commercially available decontamination product, followed by symptomatic relief measures including cool compresses and oatmeal baths. 1

Immediate Management

• Wash the exposed area with soap and water or a commercial decontamination product as soon as possible after exposure - this can remove up to 100% of poison ivy oils (urushiol) if done immediately, but effectiveness decreases to 50% at 10 minutes and 10% at 30 minutes 1
• Even washing 2 hours after exposure can reduce symptoms by 55-70% 1
• Various cleaning products (commercial decontamination products, hand cleaners, dishwashing soap) show similar effectiveness 1, 2

Symptomatic Relief

• Apply cool compresses to the affected area to relieve local symptoms 1
• Oatmeal baths may provide relief for itching and inflammation 1
• For adults and children over 2 years, over-the-counter hydrocortisone can be applied to affected areas up to 3-4 times daily 3

Effectiveness of Common Treatments

• Over-the-counter topical steroids: Evidence for effectiveness is uncertain - low-potency corticosteroids (0.2-2.5% hydrocortisone) have not shown significant symptom improvement in studies 1
• Over-the-counter antihistamines: Evidence for effectiveness in reducing itching is uncertain, though they may help with sleep at night 1
• High-potency prescription topical corticosteroids combined with systemic corticosteroids have been shown to reduce the duration of itching 1, 4

When to Seek Medical Care

• For severe or widespread cases (covering >20% of body surface), systemic steroid therapy may be required 4
• Oral prednisone should be tapered over 2-3 weeks to prevent rebound dermatitis in severe cases 4
• Seek medical attention if there is:
  • Extensive involvement 4
  • Facial or genital involvement 4
  • Signs of secondary infection 4
  • Symptoms not improving with home treatment 4

Important Considerations

• Contact dermatitis from poison ivy is self-limiting, typically lasting 2-3 weeks 1, 5
• The extent and severity of symptoms are proportional to the area and duration of exposure 1
• Approximately 50-75% of individuals react to urushiol, the allergic compound in poison ivy 1
• Avoid scratching to prevent secondary infection and potential scarring 4
• Wash all clothing, tools, and anything else that may have contacted the plant to prevent re-exposure 6

Prevention

• Learn to identify poison ivy, oak, and sumac plants 6
• Wear protective clothing when in areas where these plants may be present 6
• Consider barrier creams before potential exposure 6
• Wash pets that may have been exposed, as they can carry the oil on their fur 6