Poison Oak, Ivy, Sumac dermatitis

Background

Poison Ivy

• Type of contact dermatitis
• Caused by Urashiols found in the sap of the plant.

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

Clinical Features

Urushiol induced rash

Urushiol induced contact dermatitis

• 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 (chickenpox)
  • Smallpox
  • Monkeypox
  • Disseminated gonococcal disease
  • DIC
  • Purpural fulminans
• Localized distribution
  • Necrotizing fasciitis
  • Hand-foot-and-mouth disease

Afebrile

• Diffuse distribution
  • Bullous pemphigoid
  • Drug-Induced bullous disorders
  • Pemphigus vulgaris
  • Phytophotodermatitis
  • Erythema multiforme major
  • Bullous impetigo
• Localized distribution
  • Contact dermatitis
  • Herpes zoster (shingles)
  • Dyshidrotic eczema
  • Burn
  • Dermatitis herpetiformis
  • Erythema multiforme minor
  • Poison Oak, Ivy, Sumac dermatitis
  • Bullosis diabeticorum
  • Bullous impetigo
  • Folliculitis

Evaluation

• Clinical diagnosis

Management

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

Symptomatic 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

See Also

• Rashes
• Contact dermatitis

Video

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