Poison Oak, Ivy, Sumac dermatitis: Difference between revisions
 
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==Background==
==Background==
[[File:PoisonIvyOakSumac.jpeg|thumbnail]]
[[File:Poison-ivy-oak-sumac.jpg|thumb|]]
[[File:Poison Ivy in Perrot State Park.jpg|thumb|Poison Ivy]]
*Type of [[Contact dermatitis|contact dermatitis]]
*Caused by Urashiols found in the sap of the plant. 
 
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Plant'''
| align="center" style="background:#f0f0f0;"|'''Distribution'''
| align="center" style="background:#f0f0f0;"|'''Charateristics'''
|-
| Ivy ||East of the Rockies||
*3 leaf structure
|-
| Oak||West of the Rockies||
*can be tree or bush
*vinejet black stain on leaf
*3 leaf structure
|-
| Sumac||Southeast swamps||
*2 opposing leaflets single terminal leaf
|}
 
{{Dermatitis types}}
 
==Clinical Features==
[[File:PoisonIvyOakSumac.jpeg|thumbnail|Urushiol induced rash]]
[[File:Urushiol induced contact dermatitis.jpg|thumb|Urushiol induced contact dermatitis]]
[[File:Severe allergic reaction to urushiol (poison oak) 4 days after exposure.jpg|thumb|Contact dermatitis from poison oak exposure (Day 4).]]
*Previous exposure leads to sensitization and earlier symptoms
**1-2 days for previous sensitizations and 10-14 days for first contact


*Caused by Urashiols found in the sap of the plant. 
==Differential Diagnosis==
{{Bullous rashes DDX}}
 
==Evaluation==
*Clinical diagnosis


*Ivy
==Management==
**East of the Rockies: 3 leaf structure
===Prophylaxis===
*Oak
====Prexposure====
**West of the Rockies: can be tree bush or vine- jet black stain on leaf, 3 leaf structure
*Ivy Shield, Stokogard, Organoclay, or IvyBlock
*Sumac
**Southeast: in swamps- 2 opposing leaflets single terminal leaf


Previous exposure leads to sensitization and earlier symptoms (1-2 days for previous sensitizations and 10-14 days for first contact)
====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


==Treatment==
===Symptomatic Treatment===
===Prexposure Prophylaxis===
*Soothing measure options:
-Ivy Shield, Stokogard, Organoclay, IvyBlock
**Oatmeal baths
**Cool, wet compresses
**Ice packs
**Topical menthol and phenol (calamine lotion) compounds
**Topical astringents under occlusion dressing to dry weeping lesions<ref>Poison ivy dermatitis. Baer RL Cutis. 1990;46(1):34</ref>
***Aluminum acetate (Burow's solution)
***Aluminum sulfate calcium acetate (Domeboro) 
**Soap mixture of ethoxylate and sodium lauroyl sarcosinate surfactants (Zanfel)<ref>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</ref>
*Oral [[antihistamines]]
**Occasionally used, primarily for sedating effect (itching in poison ivy dermatitis is not caused by histamine release)<ref>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.</ref>
*High-potency [[topical corticosteroids]]: e.g.  [[clobetasol propionate]] 0.05% cream
**No evidence that alters course of disease once vesicles established<ref>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.</ref>
*Systemic [[corticosteroids]] for severe disease
**[[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)<ref>Brodell RT, Williams L. Taking the itch out of poison ivy. Are you prescribing the right medication? Postgrad Med. 1999;106(1):69.</ref>


===Postexposure Prophylaxis===
===Not Indicated===
-Technu Poison Cleanser- may solubilize bound resin several hours post exposure
*Topical [[antihistamines]]
*Anesthetics containing [[benzocaine]]
*Antibiotics containing [[neomycin]] or [[bacitracin]]


-Dr Wests Ivy Detox Cleanser chelates urushiol- decreases itching even if have rash
==Disposition==
*Almost always outpatient


===Symtomatic Treatment===
==See Also==
*if small can use topical Temovate 0.05%
*[[Rashes]]
*topical anesthetic- menthol or pramoxine
*[[Contact dermatitis]]
* single IM dose of Triamcinolone or 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
*systemic antihistamines
*cooling soothing baths
*Pentoxifylline- blocks formation of TNF alpha- suppresses allergic patch testing
*Put sunscreen first, then prexposure ivy cream, then mosquito repellant


==Source==
==References==
<references/>


[[Category:Tox]]
[[Category:Toxicology]]

Latest revision as of 20:13, 17 April 2024

Background

Poison-ivy-oak-sumac.jpg
Poison Ivy
Plant Distribution Charateristics
Ivy East of the Rockies
  • 3 leaf structure
Oak West of the Rockies
  • can be tree or bush
  • vinejet black stain on leaf
  • 3 leaf structure
Sumac Southeast swamps
  • 2 opposing leaflets single terminal leaf

Dermatitis Types

Clinical Features

Urushiol induced rash
Urushiol induced contact dermatitis
Contact dermatitis from poison oak exposure (Day 4).
  • 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

Afebrile

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
    • Ice packs
    • 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 for severe disease
    • 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

Disposition

  • Almost always outpatient

See Also

References

  1. ↑ Poison ivy dermatitis. Baer RL Cutis. 1990;46(1):34
  2. ↑ 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
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ Brodell RT, Williams L. Taking the itch out of poison ivy. Are you prescribing the right medication? Postgrad Med. 1999;106(1):69.
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