Table of Contents
Trauma Pictures
After reading this article, be sure to visit our Trauma
section for pictures of a Poison
Ivy Rash.
Poison Ivy
Poison Ivy or Poison Oak is the most common cause of allergic
skin reactions. Around 50% of the adult population is clinically
sensitive to these plants.
The oil or resin on the leaves, stem and root of this plant
is the culprit. The allergic principle is Uroshiol. It is
colorless, or may have a slight yellow tinge. In a fire, Uroshiol
is carried in smoke and can be carried downwind. The oil can
also be on the coats of animals and can be transmitted to
humans this way also.
The amount of Uroshiol in the plant is equally present year
round.
The weeds do not grow in Alaska or Hawaii, and cannot survive
above 4,000 feet. Generally, Poison Ivy grows east of the
Rockies and Poison Oak west of the Rockies, and Poison Sumac
is usually found in the southeastern United States. Once the
oil is on the skin, a person has around 1-4 hours to wash
it off. This rash usually starts within 2-6 hours after exposure,
depending on sensitivity.
Poison Ivy Pictures
 A
trailing or climbing vine, leaflets in clusters of three.
Leaflets can be shiny, dull, toothless or saw toothed as above.
Berries arrive later in the summer are white and in clusters.
Picture to the right depicts poison ivy with berries in early
spring. During late summer these berries will often be white.
 Poison
ivy look alike. A box elder which frequently is confused with
poison ivy. Notice the serrated edges of the leaf, and notice
the stems coming off each leaf to the main stem as apposed
to poison ivy below.
Poison Ivy Treatment
Outdoor Treatment
In the outdoors, cool water or soaks
can be beneficial. You could also use a cloth soaked in Benadryl
and then applied to the area to help stop the itching. The
best treatment is washing in a stream or lake after being
in the woods. Ivy block which is still available can be used
before going into the woods, and works fairly well. It is
a lotion which acts as a barrier to the resin. Treatment for
Poison Ivy in the office setting: Usually the first line would
be a course of systemic steroids which would be taken by mouth
over a 6-9 day period, as well as an antihistamine to help
stop the itching.
Healthcare Provider Medical Treatment
This author is still amazed at the amount
of healthcare providers who do not realize that poison ivy,
oak and sumac cannot be transmitted to other individuals via
the rash itself. POISON IVY, POISON OAK AND POISON SUMAC DERMATITIS
CANNOT BE TRANSMITTED TO OTHER INDIVIDUALS VIA DIRECT CONTACT.
The Uroshiol oil from the plant itself is absorbed directly
into the skin and the subsequent red blisters and dermatitis
you see, even though very ugly in appearance, cannot be transmitted
to others.
Treatment interventions
It should be noted that many times,
poison ivy will resolve on its own. However, this can be an
uncomfortable 7-10 day process. The majority of cases do need
to be treated. Treatment will make the patient more comfortable
and lead to fewer chances of skin infections.
In consultation with many dermatologists,
the recommended treatment for a moderate to severe cases is
Prednisone, taken orally. A 15-day course of Prednisone is
consistently reinforced, not a 6-day or 9-day taper. This
author has been using this for approximately one year, and
has had excellent success without any relapses when using
a 15-day course. 60 mg./day for 5 days, followed by 40 mg./day
for 5 days, followed by 20 mg./day for 5 days is totally effective.
These are usually 20 mg. tablets. Please be advised that Prednisone
should not be prescribed to obvious diabetics as it does increase
glucose levels. Antihistamines can be helpful in decreasing
the itching. In severe cases, Prednisone combined with a topical
steroid can be effective in decreasing itching. In severe
cases, Ultravate or Temovate are recommended. If opposed to
using po Prednisone, Kenalog, 40-60 mg. IM can be used. Lidex
gel, 0.05%, 2-3x/day is usually much more soothing than creams
or ointments. It is safe and can be very effective.
Poison oak was first discovered on Vancouver
Island by David Douglas (also known for the Douglas Fern).
Poison oak is very similar to poison ivy in appearance, except
the three-leaf distribution in poison oak has serrated and/or
lobed edges like an oak leaf. As with poison ivy, the leaves
do change color depending on the season, green in the summer
and reddish in the fall. Leaves are absent in winter; however,
you can still develop the symptomatic rash if contact is made
during the winter months.
Poison Oak
Poison oak is primarily found west of the Rockies. It has
been found in some extreme southern states like Florida and
Georgia. Some individuals in the Midwest claim they have seen
it in Illinois and Missouri; however, this has not been documented.
Individuals develop the telltale rash when coming in contact
with the oil or urushiol resin from the poison oak leaves,
a blistering type rash on a red base, where the blisters are
usually filled with fluid.. Some individuals claim immunity
to poison oak, ivy and sumac; however, individuals may react
at any point in their lives, making it difficult to ascertain
whether an individuals is truly “immune.” Some
individuals believe the resultant rash from poison oak is
worse than that of poison ivy. That has not been my experience
either in the woods or in the clinical setting.
Poison Oak Treatment
Poison oak treatment is the same as for poison ivy, written
above.
Poison Sumac
Poison sumac is predominantly found in southern or southeastern
states such as South Carolina, Florida, Georgia, and southeastern
areas of Canada such as Ontario and Quebec. It can be a tall
shrub or small tree. The leaves usually have six to twelve
leaflets and are arranged in pairs. They have small yellowish-green
flowers. There is a non-poisonous species and a poisonous
species. The non-poisonous species has a red fruit and the
poisonous has whitish-green fruit.
Poison Sumac Symptoms
The symptoms of poison sumac are identical to poison oak
and poison ivy, a blistering type rash on a red base, where
the blisters are usually filled with fluid. They can be streaky
and very pruritic (“itchy”).
Poison Sumac Treatment
Poison sumac treatment is the same as for poison ivy, written
above.
References
1. Paul S. Auerbach,
Wilderness Medicine
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