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Poison Ivy – 5 Tips For Effective Treatment

The itch is driving your crazy! You need help now!

Rashes from poison ivy, poison oak, and poison sumac all look about the same—raised, reddened, blistered bumps in areas of exposure. All are caused by hypersensitivity to plants containing urushiol. The rash and itching begin 24 to 48 hours after exposure, getting worse over the next few days. Assuming you had a shower before the rash appeared, poison ivy is not contagious. The only way to share it is if the plant oil is still on your skin and you touch another person. Bladder fluid is not contagious.

Although in some cases people are worried about their appearance, mostly the itching is what prompts them to seek medical care.

Here are 5 tips for quick help.

1. Use an OTC antihistamine. Over-the-counter antihistamines are just as good as prescription antihistamines. The main benefit of using these is a reduction in itching, although they may slightly reduce swelling. The main side effect is drowsiness with certain antihistamines, although this can be a benefit if the itching keeps you awake. The non-sedating antihistamines are Claritin (loratadine) and Zyrtec (cetirizine). The sedative antihistamines are Benadryl (diphenhydramine), chlorpheniramine, and doxylamine (found in sleeping aids and Nyquil). If these are effective in reducing your symptoms and the appearance of the rash is not a concern, an antihistamine may be all you need. The rash will go away on its own if you can wait for it – which usually takes 2 to 4 weeks.

2. Use an OTC topical preparation. Calamine lotion and oatmeal baths help relieve the itching but do not actually reduce the rash. 1% hydrocortisone cream is effective in reducing the itching and healing the rash in mild cases. For a more severe reaction, prescription medication may be needed. Hydrocortisone decreases the body’s reaction to the offending oil, making the rash appear less red and irritated. Any of these can be used in addition to an antihistamine.

3. Call your doctor for a prescription. Your doctor may be willing to prescribe you medication over the phone, or may require you to make an appointment to make sure your self-diagnosis is correct. Prescription options include stronger steroid creams, steroid shots, and steroid pills. For small areas of rash, the creams are most suitable. However, for larger areas or a rash on the face (especially if the eyes are swollen shut) steroid injections or oral medications are suitable. Usually the rash starts to improve within 24 to 48 hours after starting treatment. Don’t make the mistake of stopping the medication as soon as the rash gets better – it’s likely to come back if you stop too soon. A five-day treatment plan is the minimum, but often 10 to 14 days of medication is advisable.

4. Watch for secondary infection. Any open area of ​​skin can become infected. If the area of ​​redness increases, or especially if you see pus (not just clear blister fluid), see your doctor to learn if you need an antibiotic.

5. Do not use triple antibiotic ointment or Benadryl cream. When applied to the skin, both the neomycin in triple antibiotic ointment and the active ingredient in Benadryl cream (diphenhydramine) can cause a rash that looks just like poison ivy. Many patients have made the problem worse or confused the diagnosis by using these over-the-counter preparations. (Diphenhydramine (Benadryl) taken by mouth does not cause this problem.)

Ultimately, an ounce of prevention is worth a pound of cure. Avoid contact with the leaves, stems and roots of the plants, which all contain urushiol. If you pull out the plants, use disposable gloves and discard both the plants and gloves. Burning the plant can put the chemical into the air and cause a serious rash to anyone exposed to the smoke.

Copyright 2010 Cynthia J. Koelker, MD

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