Wilderness Medicine, First Aid, and Outdoor Skills
Poison Ivy, Oak, and Sumac

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Appendix A: First Aid Case and Kits, Dressings, and Bandages
Appendix B: Rescue and Transportation Procedures
Appendix C: Common Problems/Conditions
Appendix D: Digital Pressure
Appendix E: Decontamination Procedures
Appendix F: Glossary

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

Poison IvyA 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.



1. Paul S. Auerbach, Wilderness Medicine

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