DOI: 10.1097/JDN.0b013e3182429a4f

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Issn Print: 1945-760x

Publication Date: 2012/01/01


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Treating Poison Ivy, Oak, and Sumac: Still No Magic Bullet—But a Range of Options, Old and New

Daniel J. Boelman

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Author Information: is a customer service manager for Zanfel Laboratories, which manufacturers Zanfel Poison Ivy Wash, a product mentioned in this article. Contact author:

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Excerpt

Gary Bullis is a 49-year-old electric utility worker who presents to the ED complaining of a rash and severe itching for the last six days. (This case is a composite based on my experience.) He says the rash began to appear about 24 hours after a day of work cutting tree branches away from power lines. According to Mr. Bullis, poison ivy vines were intermingled with many of the branches. Hoping to remove any “poison ivy sap,” he showered when he returned home from work. His forearms and the backs of his hands are now covered with a red rash and have 1+ to 2+ edema. He has a 2 in. × 3 in. area of erythema on his neck and reports that his genitals are also affected. There are multiple 1-cm fluid-filled vesicles on all of his affected areas. He reports having applied 1% hydrocortisone cream to these areas three times a day since the rash appeared, but without much relief.
Mr. Bullis’s history suggests that he was exposed to urushiol, the resin found in the Toxicodendron genus of plants (Figure 1), which includes two species of poison ivy, two species of poison oak, and one species of poison sumac. Urushiol is present in all parts of the plant, including the leaves, roots, berries, and stems.1–3
In the United States, most urushiol exposures are to poison ivy, oak, and sumac (see Figure 24–8). Eastern poison ivy (Toxicodendron radicans) is a small shrub or climbing vine that grows east of the Rocky Mountains. Western poison ivy (Toxicodendron rydbergii) is a nonclimbing shrub that grows in the northern United States and in southern Canada. Poison oak (Toxicodendron diversilobum) grows west of the Rocky Mountains and in the southeastern United States (Toxicodendron toxicarium). Poison oak grows as a high or low shrub in the West, and as a low shrub in the Southeast. Poison sumac (Toxicodendron vernix) grows as a small tree in the eastern United States and southern Canada, and tends to grow in swampy areas. Alaska and Hawaii are the only states where plants of the genus Toxicodendron are not normally found.
Sensitivity to urushiol can develop after a first exposure. But it usually takes a second exposure to produce an allergic skin reaction. Urushiol is one of the strongest and most common plant sensitizers in the United States. After exposure, it takes just minutes for urushiol to penetrate the outer layer of skin and bond with cell membranes. Sixty minutes after exposure urushiol is completely bound to the skin and can no longer be washed off with regular soap and water.
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