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Poison Ivy Pointers.

The most common cause of allergic skin reactions is exposure to poison ivy and its "first cousins" poison oak and poison sumac. There are many misconceptions about these plants, all species of the plant genus Rhus, and the problems they can cause. Unless noted otherwise, whatever is said about poison ivy also applies to poison oak and poison sumac.

What Do These Plants Look Like

That's a deceptively simple question. Poison ivy, poison oak, and the less common poison sumac have different appearances in different parts of the country. It's best to check with your local health department or a local college's botany department for pictures and descriptions of each of these plants.

Where is Poison Ivy Found

None of these weeds are found in Hawaii or Alaska, but they are in every other state. They don't grow very well above 4,000 feet altitude. Poison ivy is found east of the Rockies, poison oak west of the Rockies. The rarer poison sumac is found in the Northeast, swampy areas such as central Florida, and occasionally in the Midwest.

How Is Poison Ivy Spread

All three of these plants contain a colorless to slightly yellow oil called urushiol. It's in the canals in the plant's leaves. When the fragile leaves are damaged, the oil leaks out and onto what touches the leaf. The oil may remain on clothing, boots, dog fur, or whatever rubs against the damaged leave. Even the ashes from a fire of burning poison ivy may have urushiol on them and, if they contact a child's skin, can cause a rash.

Some people who don't go into the woods or fields still get poison ivy. How? One way is their pets roam in fields or woods, brush against poison ivy, pick up the oil of their fur, come in the house, and transmit the oil to their owners.

How Does A Child Become Sensitized To Poison Ivy

First there has to be an exposure to poison ivy, poison oak, or poison sumac. It usually takes 1 to 2 days for the rash to first appear. Accompanying the rash is redness, itching and blisters. The blisters will usually heal in 10-14 days. In about 10% of people the first signs of a reaction appear within 4 to 8 hours.

Remember that if your child is sensitive to any one of the three plants, then he is sensitive to all them. That's because all three have the same type of oil in their leaves, and that's what causes the reaction. About half the adult population is sensitive to the oils in these plants.

About 10-15% of people are totally immune to poison ivy. Many people are subclinically sensitive--they don't react for many years or when exposed to small amounts of urushiol. But then for reasons that aren't clear, they become truly sensitive and develop a rash.

What Should I Do If My Child Has Been Exposed to Poison Ivy

Washing the exposed skin with water often removes all the urushiol. However, decontamination is better. One of the best ways to do this is to pour large amounts of rubbing (isopropyl) alcohol on the exosed area followed by a good washing with water. One advantage of rubbing alcohol is that it can actually extract some of the oil that has partially penetrated into the skin. Don't use premoistened towelettes or alcohol pads - they just spread the oils to other areas of the body.

The downside to using rubbing alcohol is that it removes the natural protective oils of the skin. If your child is exposed again to poison ivy after a decontamination with rubbing alcohol, his natural skin barriers are weakened and more of the urushiols will penetrate into his skin.

All clothing, canvas shoes, linens, etc. that have been exposed to poison ivy should be washed. It's a myth that the fluid in the blisters can spread the poison ivy.

How Can I Protect My Child

There are two preparations that dermatologists generally agree work: StokoGard outdoor cream and Ivy Block. StokoGard provides 4-8 hours of protection. Initially your child will smell like a dead fish, but this odor disappears. Once the outdoor activity is finished, the substance must be washed off.

Ivy Block is made from an organoclay from Arizona. It works by binding with the urushiol so it can't penetrate the skin. It doesn't need to be washed off.

What About Treatment

The treatment depends on the severity of the reaction. A few children develop a severe reaction that requires treatment in a hospital emergency department with potent steroids.

For less severe reactions but still serious reactions, oral steroids are often needed. This potent drug will help lessen the swelling and itching. The drug should be taken for two to three weeks with the dose being slowly decreased. It should not be stop suddenly.

If your child only has a localized skin reaction with some itching, blister, and swelling, then a steroid cream may be all that's necessary.

Most of the over-the-counter steroids are not strong enough to help much with the symptoms. It generally takes 7-10 days for the rash to go away no matter what treatment is used.

Calamine lotion will help with the itching and crust formation. Cool water also helps as does oatmeal soaks, bicarbonate of soda and acetic acid/vinegar in water. Antihistamines help only if the itching is severe or it your child is having trouble sleeping.

Remember no matter what you do, it will take time for the rash to go away and nothing speeds that up.

What About Desensitization

This used to be done, but about l0 years ago the FDA found that this didn't work. Although it's possible to get some of the preparations used for desensitization, it's illegal.

Consultant, 7/98, pp. 1689-1701.
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Copyright 1998 Gale, Cengage Learning. All rights reserved.

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Publication:Pediatrics for Parents
Date:Dec 1, 1998
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