Poison Ivy(193)

Allergic Dermatitis • Contact Dermatitis

The Facts

Poison ivy is a common wild plant that causes an extremely irritating allergic reaction when you touch it or brush against it. Exposure to it may result in what doctors call contact dermatitis – a blistering rash that spreads over the skin in the area touched by the plant. In severe cases, this rash can develop into extremely painful, swollen areas of skin filled with fluid.

The rash usually appears within 2 days of exposure, but may take longer to appear with the first exposure. The rash peaks after 5 days, and begins to fade after 7 to 10 days. While some people can become exposed and suffer little or no effect, being totally immune to poison ivy is unlikely. People who seem immune at one time and place may have an intense reaction the next time they encounter the plant. Poison ivy has 2 similarly nasty relatives: poison oak and poison sumac.

Causes

The leaves, stems, and roots of poison ivy contain a resin called urushiol. It's so toxic that tiny amounts on exposed skin can trigger an inflammatory allergic reaction. Doctors call this reaction contact dermatitis, which simply means an inflammation caused by contact with a foreign substance. Foreign substances can cause inflammation in 2 ways: irritation (irritant contact dermatitis) or allergic reaction (allergic contact dermatitis).

With an allergic reaction such as the one poison ivy causes, even repeated exposure to the plant may not cause a rash at first. This is because the body is registering its new sensitivity, a process that can take up to 10 days. But once someone is sensitized and fully allergic, their next contact with poison ivy could cause itching and a bad rash within 4 to 48 hours.

Urushiol resin can be transferred by fingers or animal fur, and it can remain for months on clothing, shoes, and tools. Thankfully, scratching the rash won't usually spread the urushiol poison to other parts of the body. Allergic contact dermatitis is most often confined to a specific area and usually has clearly defined boundaries. Scratching can prolong the discomfort and cause an infection

Symptoms and Complications

The effects of the contact dermatitis caused by poison ivy range from a mild, short-lived redness to severe swelling and blisters.

Often, the rash contains linear streaks of tiny, itching blisters (vesicles). The rash area may be very small or may cover a large area of the body. It rarely appears on the soles of the feet or palms of the hand. Usually, the rash first becomes noticeable as patches of red, itchy skin. Small blisters then form, filled with a clear fluid, and eventually break open. In severe reactions, the rash will develop into swollen, extremely painful areas of skin filled with fluid. Itching and a temporary thickening or scaliness of the affected skin may last for days or weeks

Exposure to poison ivy can cause severe allergic complications, such as a more general swelling, headache, fever, or infection. A doctor should be consulted if the rash stays red and itchy for more than 2 weeks, if the rash is over most of the body or near the eyes, or if fever is present. Also, the urushiol toxin in poison ivy is not killed by fire. As a result, being exposed to or inhaling the smoke from burning poison ivy can cause a severe allergic reaction, inside the body as well as on the skin.

Making the Diagnosis

Figuring out the cause of a case of contact dermatitis isn't always easy because the possibilities of contacts with allergens or irritants are endless. Also, many people don't remember what they've touched or where they might have been exposed. However, a poison ivy rash can usually be quickly identified if someone or their doctor is familiar with the plant's effects. One of the big hints is the distribution of the rash, which is usually in lines where the exposure to the plant occurs and then the rash is subsequently scratched.

Treatment and Prevention

Most cases of the rash can be self-treated using corticosteroids. Applying calamine* lotion or over-the-counter ointments and creams containing zinc oxide can also help with itching. Avoid using antihistamine and anesthetic (e.g., benzocaine) creams. These may be effective, but they may also cause an allergic reaction.

Applying cold compresses for 15 to 30 minutes at a time several times a day will help with the itching and blistering. A baking soda paste (3 teaspoons of baking soda and 1 teaspoon of water) can be applied to the rash, and colloidal oatmeal baths can also provide relief. An aluminum acetate solution can be applied as a damp compress for period of less than 20 minutes. 

Hydrocortisone cream or ointment can also be applied. For more severe cases, your doctor may prescribe a stronger steroid cream or ointment to be used on the skin, such as betamethasone or triamcinolone. Corticosteroids or antihistamines taken by mouth may also relieve the symptoms, but both medications can have unwanted side effects and should be used only on the advice of a health professional.

Anyone with complications from a severe case, or with a rash that is not improving with self-treatment, needs to see a doctor. If the case is so severe that a more general illness (fever, nausea, dehydration) develops, a doctor may recommend injections of a corticosteroid medication.

The best way to deal with poison ivy and its relatives is to learn to recognize the plants, and then stay out of reach. Wear protective clothing if you are going to be in or near areas with poison ivy. If you suspect you've been in contact with a poison ivy plant, wash the affected and surrounding areas immediately and thoroughly with soap and water. Change your clothes right away. Carefully clean the skin, clothes, shoes, and tools or anything that might have picked up the plant's toxic resin.

If you are going into poison ivy country, you can try one of the "barrier" lotions available from outdoor suppliers. These coat the skin in order to stop the urushiol poison from causing a reaction, as the toxin can remain on clothing for a while.

Finally, the old folk tale about eating poison ivy leaves to get immunity is just a myth. Never eat the leaves or berries of wild plants. Many of them can cause dangerous reactions in humans.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.
[references]

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