What is the treatment for sequelae of contact dermatitis caused by poison ivy after washing with water and soap?

From the Guidelines

For treating poison ivy rash after washing with soap and water, cool compresses may be considered for relief of local symptoms, as the usefulness of over-the-counter topical steroids and antihistamines is uncertain 1. After washing with soap and water, the primary goal is to manage symptoms and prevent further irritation.

• Cool compresses can provide relief and are considered for local symptom management 1.
• Over-the-counter hydrocortisone cream or ointment may not significantly improve symptoms, as demonstrated in a randomized, blinded trial involving 92 cases of Toxicodendron dermatitis 1.
• Oral antihistamines like diphenhydramine (Benadryl) or non-sedating options like cetirizine (Zyrtec) may be used to control itching, although their effectiveness is uncertain 1.
• Oatmeal baths may also be considered for relief of local symptoms from exposure to poison ivy, oak, or sumac 1. It is essential to avoid scratching to prevent secondary infection and to seek medical attention if the rash is severe or involves the face or genital area, as oral steroids like prednisone may be necessary in these cases. The rash occurs because urushiol oil from the poison ivy plant triggers an allergic reaction in the skin, causing inflammation, and most cases resolve within 1-3 weeks with proper treatment. Given the uncertainty surrounding the effectiveness of over-the-counter treatments, it is crucial to prioritize evidence-based recommendations, such as cool compresses, and consult a healthcare provider for severe cases or further guidance 1.

From the FDA Drug Label

Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema psoriasis poison ivy, oak, sumac insect bites detergents jewelry cosmetics soaps seborrheic dermatitis temporarily relieves external anal and genital itching

• Treatment of poison ivy after washing with water and soap may include applying hydrocortisone (TOP) to relieve itching associated with the rash, as it is indicated for use in relieving itching associated with poison ivy 2.
• It is essential to follow proper wound care and hygiene practices, such as washing the affected area with soap and water, to help prevent infection and promote healing.

From the Research

Sequela Treatment of Poison Ivy

After washing the affected area with water and soap, the treatment of poison ivy sequela typically involves managing the allergic contact dermatitis that has developed.

• The primary treatment for poison ivy dermatitis is the use of oral corticosteroids, as seen in a study published in 3.
• However, the duration of corticosteroid treatment is crucial, with shorter durations associated with an increased risk of return visits to healthcare clinicians, as found in the same study 3.
• Topical corticosteroids may also be used, but their efficacy in acute irritant dermatitis is controversial, and their use may have unintended consequences, such as reducing skin barrier recovery, as discussed in 4.
• It is essential to note that some individuals may develop an allergy to topical corticosteroids themselves, which can be diagnosed through patch testing, as reviewed in 5.
• Other treatments, such as antihistamines and topical antibiotics, may also be used to manage symptoms, but their potential to cause contact dermatitis and cross-reactivities should be considered, as evaluated in 6.