Treatment for Poison Oak Exposure
Immediately wash the exposed skin with soap and water within the first few minutes of contact—this is the single most effective intervention and can remove up to 100% of the urushiol oil if done right away. 1
Immediate Decontamination (Time-Critical)
The effectiveness of washing drops dramatically with time, making speed essential:
- Wash within 1 minute: Up to 100% removal of urushiol oil 1
- Wash at 10 minutes: Only 50% effective 1
- Wash at 15 minutes: Only 25% effective 1
- Wash at 30 minutes: Only 10% effective 1
Remove all contaminated clothing, jewelry, and materials from the exposed area immediately to prevent continued oil transfer 1. Brush off any dry plant material before washing with water 1.
If immediate soap and water are unavailable, commercial decontamination products, hand cleaners, or dishwashing soap can still reduce symptoms by 55-70% even when used up to 2 hours after exposure 1.
Symptomatic Treatment Algorithm
For Mild to Moderate Cases:
- Apply cool compresses to affected areas for immediate relief of itching and inflammation 1
- Consider oatmeal baths for widespread involvement 1
- Over-the-counter hydrocortisone cream (0.5-1%) can be used for minor symptoms, though evidence for low-potency corticosteroids is limited 1, 2
For Moderate to Severe Cases:
High-potency topical corticosteroids are more effective than over-the-counter preparations and should be prescribed for significant dermatitis 1.
Systemic corticosteroids (oral prednisone) should be prescribed for severe cases—the combination of systemic and high-potency topical corticosteroids reduces the duration of itching more effectively than either alone 1.
Adjunctive Measures
- Oral antihistamines have uncertain effectiveness for local itching but may help with nighttime sleep 1
- Antihistamines should not be relied upon as primary treatment 1
Critical Pitfalls to Avoid
- Do not delay washing—every minute counts, and waiting even 10-15 minutes dramatically reduces decontamination effectiveness 1
- Do not rely solely on over-the-counter hydrocortisone for severe reactions—this is insufficient and will prolong suffering 1
- Do not contaminate yourself when removing the patient's clothing or jewelry 1
- Do not administer anything by mouth (including activated charcoal or ipecac) unless specifically directed by poison control, as these are not indicated for topical plant exposures 3
When to Activate Emergency Services
Activate EMS immediately if the patient exhibits any life-threatening signs after poison oak exposure, including difficulty breathing, seizures, severe swelling affecting airways, or altered mental status 3. Contact the Poison Help hotline (800-222-1222) for guidance on severe or unusual presentations 3.