WhiteCoat

Poison Ivy – Son Of An Itch!

Dr. Bates put up a post on her Suture For A Living blog about poison ivy. I was planning on doing the same thing, but she beat me to the punch. Her post did more than scratch the surface, but since we’re just starting to see poison ivy creep into the ED lately (ooh I’m on a roll), I wanted to add a few things.

Blistering or a rash that is in a line suggests some sort of contact dermatitis – usually from a plant or something stationary. Imagine walking past a plant and the edge of the leaf dragging against your skin. If you look at the picture on Dr. Bates’ site, the man’s arm has blistering in a line that is typical of poison ivy exposure. Another example is here.

While touching someone else’s rash generally won’t give you a rash (poison ivy isn’t “contagious”) sometimes you can get secondary contamination from things that have come into contact with the poison ivy plants. If you were walking in patches of poison ivy, it is possible to transfer the plant resin to your hands when you take off your shoes. If you pet your dog after your dog walked through poison ivy, you can transfer the resin from the dog’s fur to your hands. Then if you itch your face with your contaminated hand, you may develop a rash on your face.

The chemical that causes the reaction, urushiol, isn’t easy to wash off. If you get to it in the first hour or so after exposure, soap and water may remove it. After that, it penetrates into your skin and binds to the proteins in your skin so that ordinary soap and water will have little effect in removing it.

Once you get the rash from poison ivy and start itching, treatment involves getting the chemical off your skin and relieving the symptoms.
Tecnu Extreme and Zanfel are commercial products that wash away the chemical urushiol from the skin. If you use them early enough, you can significantly lessen your symptoms, although they reportedly have some effect for several days after exposure. Store brand products may work just as well and are considerably less expensive. Interesting point from another site is that Tecnu was initially developed to remove radioactive fallout dust from the skin and is a distillate of gasoline. This site also states that other organic solvents such as rubbing alcohol may work as well as Tecnu for removing urushiol – when rinsed with copious amounts of water.
Ivy Block blocks the urushiol from coming into contact with the skin and actually absorbs some of the urushiol. Lather up before you go out into the bushes and you may save yourself from even getting the rash. Just remember to rinse the Ivy Block off and reapply if you’re out for more than 4 hours.
One trick I learned for any kind of a bad itch is to use an ice cube to do the itching. The ice won’t scratch (and therefore irritate) your skin and the cold will help to get rid of the itch. When you’re done, you just throw out what’s left of the cube. Repeat as often as you want.
Domeboro solution (or Burow’s Solution) will help take away the itch. Mixing the packet with a small amount of warm water to dissolve it and then adding cold water to reach the proper dilution will create a cool compress that will help relieve the itching even more.
Use of steroids to treat poison ivy rash of poison ivy is debated. Some people swear by them, some people swear at them. I’m in the latter category. I generally don’t prescribe steroids due to the incidence of “rebound” symptoms if they are discontinued early. In this case, “early” is considered less than 2 weeks. That’s right – the books recommend that someone be on steroids for two weeks if the steroids are used to treat poison ivy. Sometimes you need steroids if the symptoms are severe or involve the eyes. On the other hand, I have seen multiple cases of rebound symptoms when a patient’s primary care physician gives a patient a Medrol DosePak for mild symptoms, the patient runs out over the weekend, and then the patient comes to the ED worse than when they started.

If you still have questions, this is a fairly comprehensive article on poison ivy for non-medical types and here is an article from eMedicine for the more medically-inclined.

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Remember: Leaflets three -> let it be. Berries white -> poisonous sight.

Picture credits here

10 Responses to “Poison Ivy – Son Of An Itch!”

  1. Katherine says:

    Hmmm… guess I must be immune because I touch those things all the time bare-handed and don’t break out. Otoh, my mom touches them and BREAKS out.

    But, in compensation, any time a rose thorn touches me, I get a massive rash… and she doesn’t, so I guess we’re even.

    Too bad–I really love roses. :-)

  2. Katherine says:

    PS what’s up with the avatar you assigned me? Am I not cool enough to rate something better? ;-) JK. I’m woman enough to take looking like a mosquito on ‘roids.

    The avatars are randomly assigned by WordPress based on the name you put into the comment. WordPress used to just have generic icons, but recently changed to these random ones.
    You can always sign up for a WordPress account and upload your own avatar. Then your avatar will show up on all the comments you make.

  3. jeffsher63 says:

    One of the local “folk remedies” for Poison Ivy is to pour bleach on it to “dry it up”. Bad idea; this can cause chemical burns.

    Also, there are some of the older people here that want “that poison ivy vaccine”. Years ago, there used to be a “vaccine” for poison ivy. It didn’t seem to work; it isn’t on the market anymore (as far as I know).

  4. rlbates says:

    Thanks for expanding on the topic. I can get the rash just from petting my dog after his has rolled in the stuff.

  5. SeaSpray says:

    Poison I-i-vy…p-oi-i-son i-i-vy… EVERY time a patient came into the ED (for ALL 20 seasons)…THAT song went through my head and did as soon as I read the title for this post too. And EVERY time we got a poison ivy patient I also had to resist singing the song but I’d hear it in my head and be chuckling silently or smirk when I turned away because I REALLY wanted to sing the song. Sometimes I told the patients I was thinking of the song if I thought they’d know what it was.

    I never got it at the shore but sure have since moving up here. I have had my eyes swell twice. And I’ve caught it every where including after having used nature’s facilities for tinkling. (It was dark!) NOT fun!

    My husband caught got it on his schwing schwang in the dead of winter. How? He was chopping wood for his grandmother and the poison ivy vines were all over the wood. He assumed that since there were no leaves, it was cold and wintertime that it was dead. Nope…evidently something must’ve been in the vines he chopped.

    The 2st time I had it (all over my legs) someone said to make a paste of baking soda and water. My aunt wanted to know what the white trail of powder was all through the house. Didn’t help anyway.

    For a long time …if my husband had it but I didn’t I would make sure we slept separately because I thought you could catch it from coming in contact with their rash. It wasn’t until I worked at the hospital that I learned it was systemic and from direct contact with the resin.

    Then someone told me if you take boiling water and put it on a cloth and as hot as you can stand it apply it to the rash…OH..my..g-o-s-h…it feels like an orgasm of the skin. That is the best description…seriously. It gives the most intense and pleasant itch relief, like a million perfectly attuned fingers to the area…amazing and then it STOPS itching for awhile. I’m not sure but it seems to prolong the rash though, but I always try to dry it out with alcohol or the lotions too.

    I told my doctor I did that and he said that is like hitting yourself on the head with a hammer. I’m not sure why though and I never asked him.

    But when I can’t stand the itch now, I use water on a paper towel heated in the microwave.

    I will try the ice next time. Thanks for this post. I will copy it to save for future reference if needed.

  6. SeaSpray says:

    Sorry – song’s in my head and couldn’t resist. Delete if you wish. :)
    [Poison Ivy lyrics found on http://www.completealbumlyrics.com

    Poison Ivy by the Coasters

    She comes on like a rose but everybody knows
    She’ll get you in Dutch
    Now you can look but you better not touch

    Poison iv-y-y-y-y, poison iv-y-y-y-y
    Late at night while you’re sleepin’ poison ivy comes a’creepin’
    Arou-ou-ou-ou-ou-ound

    She’s pretty as a daisy but look out man she’s crazy
    She’ll really do you in
    Now if you let her under your skin

    Poison iv-y-y-y-y, poison iv-y-y-y-y
    Late at night while you’re sleepin’ poison ivy comes a’creepin’
    Arou-ou-ou-ou-ou-ound

    Measles make you bumpy
    And mumps’ll make you lumpy
    And chicken pox’ll make you jump and twitch
    A common cold’ll fool ya
    And whooping cough’ll cool ya
    But poison ivy, Lord’ll make you itch!!

    You’re gonna need an ocean of calamine lotion
    You’ll be scratchin’ like a hound
    The minute you start to mess around

    Poison iv-y-y-y-y, poison iv-y-y-y-y
    Late at night while you’re sleepin’ poison ivy comes a’creepin’
    Arou-ou-ou-ou-ou-ound

    Measles make you bumpy
    And mumps’ll make you lumpy
    And chicken pox’ll make you jump and twitch
    A common cold’ll fool ya
    And whooping cough’ll cool ya
    But poison ivy, Lord’ll make you itch!!

    You’re gonna need an ocean of calamine lotion
    You’ll be scratchin’ like a hound
    The minute you start to mess around

    Poison iv-y-y-y-y, poison iv-y-y-y-y
    Late at night while you’re sleepin’ poison ivy comes a’creepin’
    Arou-ou-ou-ou-ou-ound

    La da la da la da
    La da la da la da
    La da la da la da
    La da la da la da

  7. Becky says:

    Thanks for the tips! It may save me from a shot in the butt and many bad days:)

  8. mottsapplesauce says:

    Boy does this bring back memories… summer berry picking in large wooded areas. I learned very young about these plants, oak & sumac too.

  9. chatch says:

    I have definitely wandered through a patch of poison ivy on more than one occasion, and have yet to develop the rash. So presumably I’m not going to. I hope.
    I really enjoy your blog, and I would love to do a link exchange with my blog-chatch.wordpress.com. Please let me know if you are interested.
    Thanks

  10. Joe says:

    I know this is a year old, but I thought you might like to know — I think you’re confusing Tecnu Extreme with (plain old regular) Tecnu. The “Extreme” version is advertised as “Homeopathic”; active ingredients are “Grindelia Robusta 3x” and alcohol. Regular tecnu is made from a petroleum distillate.

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