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Poison Ivy Treatment

“Contact dermatitis” means irritation of the skin after contact with a substance of some kind. Perhaps the most familiar kind of contact dermatitis is poison ivy, which is very common in children and teenagers. Other causes include certain metals such as nickel, various plant materials such as sap or pollen, and household chemicals such as laundry detergents. Most cases of contact dermatitis are caused by a “delayed” allergic reaction to the substance. No one gets a rash after only one exposure. Some people think that they or their children “don’t react” to poison ivy because they did not get a rash after one contact. They may be in for a nasty surprise later! Always avoid poison ivy and its relatives if you can.

Contact dermatitis, regardless of the cause, usually looks like red, raised bumps in straight lines along exposed parts of the body. Sometimes the bumps are so close together that all you can see are red lines. When the cause is poison ivy or one of the other plant sources, the rash usually stops right at the point where clothing begins. The rash may not develop for a day or two after the exposure. It starts as a faint redness and rapidly becomes darker red. It is sometimes scaly or oily in appearance, and is terribly itchy. Even after getting rid of the material that caused it, the rash tends to last a long time – up to 2-3 weeks.

Poison Ivy and Its Relatives

In most cases the biggest concern is severe itching and sometimes pain. People with poison ivy can become frantic with the itching. If the material gets into the eye there can be tremendous swelling of the lids and the thin layer of skin covering the eye (the cornea). If this swollen tissue becomes infected, it can leave scars or scratches on the eye that can damage vision. The rash does not cause scars on other parts of the body unless it becomes infected. Very rarely, contact with poison ivy can cause swelling of the throat and airways, which can be life-threatening. This is most likely to happen in people who are working in thick brush to clear it, especially if they inhale smoke from burning clippings.

The “poison” in poison ivy and its relatives (poison oak or sumac, and a few other plants) is an oily substance. If a child does not wash with soap and water immediately after contact with the plant, s/he may spread the oil to other parts of his or her body that were covered at the time of the exposure. In this way, children may spread the oil to the genitals or buttocks. After washing with soap and water, the oil can no longer spread on the child’s body. One can notspread poison ivy by scratching or touching the rash itself. The oil at the rash is already tightly stuck to proteins in the skin. Children can not spread poison ivy to each other unless they have close contact after touching the plant and before washing with soap and water. The irritating oil can stick to clothing, shoes, and other objects, though, so be sure to thoroughly wash everything that might have touched the plant.

Contact Dermatitis from Metals

Contact dermatitis caused by nickel is fairly common in people who wear jewelry. Many metals found in jewelry contain some nickel, even if they are advertised as “silver,” “steel,” or other metals. Because the dermatitis can develop hidden under a piece of jewelry (a watch or bracelet, for example), it can become quite severe before a person notices it. Occasionally a severe contact dermatitis of this kind can leave a permanent scar. People who have allergic reactions to metals should not get body piercings. These can set off very serious contact dermatitis with scarring and even permanent damage to the pierced part. Contact dermatitis often continues to get worse even after the irritating material is removed.

 

Poison Ivy treatment

The first step in treating any contact dermatitis is to remove the irritating material. The best way to do this is to remove the child from the material (if it is poison ivy) or the material from the child (if it is clothing or jewelry). If you see your child come into contact with poison ivy, poison oak, or poison sumac, wash him or her immediately in warm soapy water and rinse thoroughly. This is your best and only chance to remove the oily poison before it clings to skin protein and potentially causes the rash. Although some people recommend an old-fashioned brown laundry soap called “Fels Naphtha Soap,” there’s no scientific evidence available.

Once contact dermatitis develops, we can only treat the symptoms and wait for the rash to go away. Keep the area of rash clean and dry. Wash it gently each day with warm soapy water. Please do not apply alcohol, bleach, or any other cleaning agent to the skin. You can give your child an antihistamine such as diphenhydramine (Benadryl® and others). It won’t help much with the itching in contact dermatitis, which has a different mechanism than most other itchy conditions. Its side effect of drowsiness, though, can be a real help in a frantic child. Your doctor may prescribe a different antihistamine. In more severe cases, particularly if the rash involves the eyes, mouth, or genitals, your doctor may prescribe steroid medication by mouth (prednisone or prednisolone, Ora-Pred®, Prelone® and others). The course of treatment with steroids may last up to 3 weeks. Steroids given for this much time can have serious side effects if you stop them suddenly. Doctors prescribe a “tapering” dose that starts out high and gradually decreases, to avoid those side effects. Please be sure to give the steroid medicine exactly as prescribed, and do not stop it early. If you lose or spill the medicine, call your doctor for a refill right away to prevent any interruption.

Some people recommend oatmeal baths (a cup of oatmeal in a tub of water – don’t forget the strainer in the drain!), to help soothe and dry the skin. A commercial version called Aveeno Bath® is available and is less messy. Lotions like calamine and caladryl are messy and may not help much, but they are safe when used as directed. If they seem to help your child it is fine to use them. Please do not use steroid -containing creams or ointments (cortisone, hydrocortisone, and others) over large areas. These can cause permanent skin color changes and can be absorbed and cause other side effects.

 

When should I be worried?

Contact dermatitis, especially from plants like poison ivy, can be terribly itchy and even painful. It does normally clear up with time, but it takes quite a while (up to 3 weeks). If the rash gets infected from scratching or rubbing, there can be permanent scars. Eye or throat involvement can be dangerous. These are some warning signs of a serious condition:

  • Noisy breathing or difficulty breathing
  • A feeling that the tongue, throat, or mouth are swollen
  • Wheezing or persistent coughing
  • Swelling of the eyes to the point that the child cannot see
  • Complaints of eye pain or blurry vision
  • Inability to swallow
  • Fever
  • Redness or swelling that spreads away from the original lines or bumps of the rash for more than 24 hours
  • Pus draining from the rash or from scratches around it
  • Extreme swelling of an arm or leg with pain, numbness, or tingling
  • A rapidly spreading rash over parts of the body that were not originally involved

If any of these occur, please be sure to call your doctor’s office right away. If your child is having trouble breathing or swallowing, please go to an emergency room immediately.

 

Other points of concern

In rare cases people may develop a full-body version of contact dermatitis called “systemic contact dermatitis,” which is related to another rare condition called “erythema multiforme” (air-a-theme-a mul-tee-form-ee), or EM. This condition is potentially dangerous – it can cause blistering and loss of skin, with infection, fluid loss, and shock. It is most common in people who have swallowed or inhaled the irritating material, such as poison ivy sap. The victim develops a rapidly spreading rash with large bumps, wheals, or hives, large blisters, or sores in the mouth or eyes.

Some homeopathic or herbal medicines contain “Rhus lacquer,” or “toxicodendron extract.” These are the active poisons in poison ivy and its relatives. There have been reports of serious illness or injury from these medications, which some people use to treat certain viral infections such as chicken pox and herpes. Please do not use any such medication for your child.

Contact dermatitis is not contagious after the child has washed. It is fine for your child to go to school, daycare, or camp with contact dermatitis as long as s/he feels comfortable enough to go.

 

Other Conditions that Might Be Present

Shingles can sometimes look like contact dermatitis, especially if it appears on an exposed part of the body. Shingles is usually painful in the area before there is any rash, and once the rash develops there are small blisters that are usually the tip-off. The condition called EM mentioned above can happen to children following a viral infection, a medication, or for no apparent reason at all. Early in its course, EM can also look a bit like poison ivy. Later, the rash becomes raised and can look like mosquito bites or other swollen bumps. Often the rash of EM turns dark bluish or purple at the center.

Any rash that is flat, red, and does not blanch with pressure is not poison ivy, and can be a sign of a dangerous condition. Please see your doctor at once if your child has this kind of rash.