What is the treatment for extensive dermatitis caused by poke weed?

Treatment of Extensive Pokeweed Dermatitis

For extensive pokeweed dermatitis, immediately wash the affected area with soap and water, then initiate treatment with high-potency topical corticosteroids applied twice daily combined with liberal emollients; if the dermatitis covers more than 20% body surface area or is severe, systemic corticosteroids (oral prednisone 0.5-1 mg/kg/day tapered over 2-3 weeks) should be started promptly.

Immediate Decontamination

• Wash the exposed skin with soap and water as soon as possible after contact to remove plant oils and irritants, ideally within minutes of exposure for maximum effectiveness 1
• Washing effectiveness decreases rapidly with time: 100% removal if immediate, 50% at 10 minutes, 25% at 15 minutes, and only 10% at 30 minutes 1
• Commercial decontamination products, hand cleaners, or dishwashing soap are equally effective alternatives to regular soap and water 1

Topical Corticosteroid Therapy

For Localized or Moderate Dermatitis (< 20% Body Surface Area)

• Apply high-potency topical corticosteroids (such as clobetasol propionate 0.05% or triamcinolone 0.1%) twice daily to all affected areas 2, 3
• Continue treatment for 1-4 weeks depending on response 2
• Over-the-counter low-potency hydrocortisone (0.2%-2.5%) is not effective for significant plant dermatitis and should be avoided 1
• A randomized trial of 92 patients with Toxicodendron dermatitis (similar mechanism to pokeweed) found that hydrocortisone at concentrations up to 2.5% provided no symptom improvement 1

Application Technique

• Apply to clean, slightly damp skin for optimal absorption 2
• Use twice daily during acute phase 2, 4
• Apply corticosteroid first, then wait 15-30 minutes before applying emollients 2

Systemic Corticosteroid Therapy for Extensive Disease

Indications for Systemic Treatment

• Dermatitis involving greater than 20% body surface area requires systemic corticosteroids 3
• Severe symptoms with significant vesicles, bullae, or intense pruritus warrant systemic therapy 3
• Involvement of face, genitals, or areas causing significant functional impairment 3

Dosing Protocol

• Oral prednisone 0.5-1 mg/kg/day (typically 40-60 mg daily for adults) 1, 3
• Taper over 2-3 weeks minimum—this extended taper is critical 3, 5
• Rapid discontinuation or short courses (less than 2 weeks) cause rebound dermatitis and treatment failure 3
• Relief typically occurs within 12-24 hours of starting systemic steroids 3

Essential Adjunctive Measures

Emollients (Non-Negotiable Component)

• Apply alcohol-free moisturizers containing 5-10% urea at least twice daily to all affected and surrounding skin 1, 2, 4
• Emollients are not optional—they restore skin barrier function and are integral to treatment success 2, 6
• Oil-in-water creams or ointments are preferred over alcohol-containing lotions 2
• Continue liberal emollient use throughout treatment and recovery 2, 4

Symptomatic Relief

• Cool compresses may provide symptomatic relief of itching and discomfort 1
• Oatmeal baths can be considered for widespread pruritus 1
• Oral antihistamines have uncertain efficacy for plant dermatitis itching but may help with nighttime sleep 1

Critical Pitfalls to Avoid

Common Treatment Errors

• Do not use over-the-counter hydrocortisone—it lacks sufficient potency for plant dermatitis 1
• Do not prescribe short steroid courses (less than 2 weeks) for extensive dermatitis—this causes rebound flares 3, 5
• Do not use topical antibiotics (neomycin, bacitracin) as they are common allergens themselves and can worsen dermatitis 6, 4
• Do not neglect emollients—failure to use them significantly compromises outcomes 2, 6
• Avoid hot water, harsh soaps, and scrubbing of affected areas 1, 6

When Antibiotics Are Indicated

• Antibiotics are not indicated for uncomplicated plant dermatitis as it is not an infectious condition 6
• Only prescribe antibiotics if secondary bacterial infection develops (indicated by purulent discharge, yellow crusting, or failure to respond to appropriate anti-inflammatory therapy) 1

Treatment Algorithm by Severity

Mild (< 10% BSA, minimal symptoms)

• High-potency topical corticosteroids twice daily 2, 4
• Liberal emollients at least twice daily 2, 4
• Cool compresses as needed 1

Moderate (10-20% BSA or significant symptoms)

• High-potency topical corticosteroids twice daily 2, 3
• Liberal emollients throughout the day 2
• Consider short-term systemic corticosteroids if symptoms are severe 3

Extensive/Severe (> 20% BSA, vesicles/bullae, or severe pruritus)

• Oral prednisone 0.5-1 mg/kg/day tapered over 2-3 weeks 3, 5
• High-potency topical corticosteroids to affected areas 2, 3
• Liberal emollients multiple times daily 2
• Cool compresses and oatmeal baths for symptom relief 1

Expected Course and Follow-Up

• Plant dermatitis typically resolves within 1-3 weeks with appropriate treatment 5
• Symptoms should begin improving within 12-24 hours of starting systemic corticosteroids 3
• If no improvement occurs after 1 week of appropriate therapy, consider alternative diagnoses or secondary infection 1
• Hyperpigmentation may persist for weeks to months after resolution of acute inflammation 5