Poison Oak, Ivy, Sumac dermatitis

Background

- ivy found east coast- 3 leaf structure

- oak- along Pacific Coast can be tree bush or vine- jet black stain on leaf, 3 leaf structure

- sumac- in swamps- 2 opposing leaflets single terminal leaf

-Mango and Cashews can cross react

- toxicodendron- antigen is urushiole

- T- cell mediated delayed hypersensitivity

- resin carried by smoke of burning leaves

- resin found in leaves and stems- not surface

- must break or crush to release resin

- resin binds in 30sec. After binds cannot wash off

- lesions start in 48hrs

- linear array of vesicles

- vesicle fluid not antigenic

Treatment

Prexposure Prophylaxis

-Ivy Shield, Stokogard, Organoclay, IvyBlock

Postexposure Prophylaxis

-Technu Poison Cleanser- may solubilize bound resin several hours post exposure

-Dr Wests Ivy Detox Cleanser chelates urushiol- decreases itching even if have rash

Symtomatic Treatment

• if small can use topical Temovate 0.05%
• topical anesthetic- menthol or pramoxine
• 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

6/06 MISTRY