Poison Ivy Tips

Amarillo Texas Tech Physician Kashif Ali, M.D., General Pediatrician, provides outdoor awareness tips

Since we are entering summer months and some of the families are planning to have fun on out door activities, it may be a good time to review one of most common summer maladies that we encounter in Pediatrics practices. That is contact dermatitis commonly referred as Poison Ivy, primarily arising from outdoor activities involving contact with the plants.

What is the cause? Who is vulnerable?

Allergic contact dermatitis is caused by toxicodendron formally called (rhus). This species includes poison ivy, poison oak, and poison sumac. It causes more rashes and contact dermatitis than any other family of plants in whole plant kingdom. Most significant medical morbidity is caused by Toxicodendron radicans (poison ivy), T. diversilobum (poison oak), and T. vernix (poison sumac or dogwood). The allergen in the plants is Oleoresin known as Urushiol found in plant sap.

Urushiol

Urushiol - the allergen- is found in all the parts of plant including stems, roots, leaves and even the fruit of these plants and retains its full antigenic potential even when dried. Trivial contact with any undamaged part of the plant does not usually cause any allergic reaction. The urushiol in poison ivy, poison oak, and poison sumac differs only slightly in the structure and they cross react. The adage -Leaves of Three- is a misnomer because poison oak has 3-5 leaves and poison sumac has 7-13 leaflets. So it is difficult to differentiate when some one is in the wilderness.

It's a disorder affecting approximately 10 to 50 million North Americans every year causing more than 7.1 million office visits and 43,000 hospitalizations in the USA.
It's a significant occupational hazard to the forest industry and fire fighters as well; causing 10% of the Forest Service's lost time injuries. Approximately one-third of forestry workers in California, Oregon, and Washington are disabled by poison oak dermatitis each fire season. The cost of treatment for this is 1% of California's yearly worker compensation budget.
The peak age group for sensitization is between 8 and 14 years of age. Infants are not as easily sensitized as adults. Genetic studies suggested that 80% of children born to two urushiol sensitive parents also become sensitive.
Majority of the US adult population is clinically sensitive to poison ivy, poison oak, and poison sumac.

What is the mechanism? How does it manifest?

Typical allergic contact dermatitis is a T-cell-mediated delayed hypersensitivity reaction to urushiol. A sensitized person typically develops an intensely pruritic erythematous rash within two days of exposure. The delay between exposure and eruption is most often 24 - 48 hours and can be as long as 5 - 15 days. Typically at the point of contact to the skin the lesion start as a linear array of streaks or areas of erythema followed by elevated papules than vesicles and bullae. The mildest reaction is limited to erythema and usually lacks vesicle formation.

What is the treatment?

Treatment basically is to avoid, block, and clean.

There are several products on the market that can be used. Some of the products are used before the oil comes in contact and some of the products help once the oil is fixed on the skin.

One of the products, Tecnu, is an organic solvent from petroleum distillate that helps to remove Urushiol after it comes in contact with the skin cost $1/oz.
Ivy Block is a product that prevents urushiol from being fixed to the skin. Use is 15 minutes before going out doors and every 4 hours after afterwards cost $12/oz.
Zanfel is a soap mixture of fatty acids ethoxylate and the surfactant lauroyl sarconsinate that is useful in preventing the induration and vesiculation at 48, 96, and 144 hours cost $37/oz.
Ivy Stat is the combination of Tecnu and hydrocortisone cost $25/oz.
Ivy-Dry is a product that contains Zinc acetate and alcohol. This product causes more drying than original itch.
Folk remedies also play a part in treatment. Oatmeal, baking soda, or a cornstarch bath can also help to alleviate the itch native Indians have used extract of plant jewelweed to alleviate the symptoms.
Barrier creams that work at avoiding poison ivy dermatitis are, hydrogel, Ivy Shield, Shield Skin, Uniderm and Dermo-Film.
Out of all the products, Ivy Block is approved by the FDA. There is also a vaccine underway, but the results are not available.

More Wellness Info:

immunization schedule

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