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Poison Oak, Ivy, Sumac dermatitis
From WikEM
Contents
Background
- Type of contact dermatitis
- Caused by Urashiols found in the sap of the plant.
| Plant | Distribution | Charateristics |
| Ivy | East of the Rockies |
|
| Oak | West of the Rockies |
|
| Sumac | Southeast swamps |
|
Clinical Features
- Previous exposure leads to sensitization and earlier symptoms
- 1-2 days for previous sensitizations and 10-14 days for first contact
Differential Diagnosis
Vesiculobullous rashes
Febrile
- Diffuse distribution
- Varicella
- Smallpox
- Disseminated gonococcal disease
- DIC
- Purpural fulminans
- Localized distribution
Afebrile
- Diffuse distribution
- Bullous pemphigoid
- Drug-Induced bullous disorders
- Pemphigus vulgaris
- Phytophotodermatitis
- Erythema multiforme major
- Localized distribution
- Contact dermatitis
- Herpes zoster
- Dyshidrotic eczema
- Burn
- Dermatitis herpetiformis
- Erythema multiforme minor
- Poison Oak, Ivy, Sumac dermatitis
- Bullosis diabeticorum
Evaluation
- Clinical diagnosis
Management
Prophylaxis
Prexposure
- Ivy Shield, Stokogard, Organoclay, or IvyBlock
Postexposure
- Technu Poison Cleanser- may solubilize bound resin several hours post exposure
- Dr Wests Ivy Detox Cleanser chelates urushiol- decreases itching even if have rash
Symptomatic Treatment
- Soothing measure options:
- Oatmeal baths
- Cool, wet compresses
- Topical menthol and phenol (calamine lotion) compounds
- Topical astringents under occlusion dressing to dry weeping lesions[1]
- Aluminum acetate (Burow's solution)
- Aluminum sulfate calcium acetate (Domeboro)
- Soap mixture of ethoxylate and sodium lauroyl sarcosinate surfactants (Zanfel)[2]
- Oral antihistamines
- Occasionally used, primarily for sedating effect (itching in poison ivy dermatitis is not caused by histamine release)[3]
- High-potency topical corticosteroids: e.g. clobetasol propionate 0.05% cream
- No evidence that alters course of disease once vesicles established[4]
- Systemic corticosteroids
- prednisone taper over 15-20 days: 60mg x 4d then 50mg x 4d then 40 30 20....Use oral steroid for 3wks until skin turns over
- Standard burst dosing may be too short (with rebound dermatitis common)[5]
Not Indicated
- Topical antihistamines
- Anesthetics containing benzocaine
- Antibiotics containing neomycin or bacitracin
Disposition
- Almost always outpatient
See Also
Video
References
- ↑ Poison ivy dermatitis. Baer RL Cutis. 1990;46(1):34
- ↑ Davila A, Lucas J, Jacoby J, et al. A new topical agent, Zanfel, ameliorates urushiol-induced Toxicodendron allergic contact dermatitis. Ann Emerg Med. 2003;42:S98
- ↑ Munday J, Bloomfield R, Goldman M, Robey H, Kitowska GJ, Gwiezdziski Z, Wankiewicz A, Marks R, Protas-Drozd F, Mikaszewska M. Chlorpheniramine is no more effective than placebo in relieving the symptoms of childhood atopic dermatitis with a nocturnal itching and scratching component. Dermatology. 2002;205(1):40.
- ↑ Vernon HJ, Olsen EA. A controlled trial of clobetasol propionate ointment 0.05% in the treatment of experimentally induced Rhus dermatitis. J Am Acad Dermatol. 1990;23(5 Pt 1):829.
- ↑ Brodell RT, Williams L. Taking the itch out of poison ivy. Are you prescribing the right medication? Postgrad Med. 1999;106(1):69.
