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April, 10th 2017

 Sadly, poison ivy has already made an appearance at my home and my husband is nursing his first poison ivy rash of the season.  He is not alone!  I have been receiving calls at the pharmacy for advice, had people picking up calamine lotion and hydrocortisone from over the counter and even filled a couple of steroid dose packs.  With the sunshine and mild weather, we are all drawn outside and I myself am itching (pun intended) at the chance to get my flower beds and garden going.  But of course, the more we are out of doors higher chance we have running into poison ivy, poison sumac and poison oak.  As Oklahomans, I feel like a good number of us have been shown what this plant looks like and have tried to avoid it at all cost.  I grew up in the country and was always internally chanting “leaves of three let them be” to myself as we played in the woods around our house.  But of course, it seems like you are always in the middle of it before you realize that what you thought was just harmless brush is really something…itchy.  Here are some classic pictures of the offenders:

There are a few things that are interesting to know about these plants and the rashes that result from contact with them.  The oil from the plants, called urushiol, causes the allergic reaction and this oil is on every part of the plant – leaves, stems, roots, and flowers!  This oil sticks to just about anything including your gardening tools, sports equipment, and your sweet pet’s fur.  Dogs and other animals do not get the rash, only people are blessed with this luxury.  Also, burning poisonous plants can release urushiol into the air and those particles can then land on the skin or be inhaled!  MYTH about Poison Ivy:  The rash is not contagious.  You can NOT give a poison ivy rash to someone else if they touch the rash or blisters.  You have to touch the oil in order to get a rash and the skin absorbs it too quickly for you it to pass it onto someone else. 

Not to brag or anything, but I have never had poison ivy (and will promptly get it now that I have said that out loud).  Turns out 15% of the population do not become sensitive to urushiol and never develop a rash.  The other 85% develop a rash when they come in contact with the oil.  There is good news for the 85% however.  Adults who had rashes as children are often less sensitive as adults and may even lose their sensitivity and never get another rash.  On the flip side those that never had rashes from urushiol exposure as a kid may find that they become sensitive to it as an adult.  Either way, I am going to avoid these plants as best I can.  You can do this by wearing long sleeves, long pants, boots and gloves when working in areas that could have poisonous plants…make it as fashionable as you would like.  There are also barrier creams and lotions that could be applied before going outside to keep urushiol oil from absorbing into your skin. 

What to do if you are exposed to a poisonous plant:

1.  Immediately rinse skin with lukewarm soapy water, poison plant wash, or degreasing soap with lots of water.   Repeat!  If the wash solutions dry on the skin, you risk spreading urushiol around on. 

2. Wash clothing and anything that may have oil on its surface (including Fido).  (Here’s a crazy fun fact: Urushiol can remain active on objects for up to 5 years!!!)

Usually the itchy, blistering rash does not start until 12-72 hours after exposure to the oil and will resemble the picture below.  I know I said this once already but it is a well circulated myth and since at least my husband has a tendency to not believe me at times, it is worth repeating at least for his sake…the blister fluids are not contagious.  There, I feel much better.  

So finally I get to the point!  The rash from these poisonous plants will usually resolve itself within a few weeks but in the meantime here are a few things you can do to treat it.

• Apply wet, cool compresses

Heat (as well as scratching) can cause a release of histamine which will make the itch intensify.   So it makes since that cool compresses can help keep histamine from being released and sooth the itch.  Just grab a clean washcloth and wet it down with cool water, wring it out so it doesn’t cause a mess and apply to the itchy skin.

• Use Calamine lotion or hydrocortisone cream/lotion.

Both of these over the counter products can help with itching but remember to check the labels to see how often you should apply them.  Hydrocortisone can be used 3-4 times a day while calamine can be applied as needed. 

• Take short, lukewarm baths in colloidal oatmeal.

Personally I’m not a big fan of a lukewarm bath but if you consider the whole histamine release with heat notion, then lukewarm sounds like a pretty good idea.  Colloidal oatmeal can be found in your local (Razook’s Drug) pharmacy over the counter.  Also, I have seen some suggestion about adding a cup of baking soda to a bath of water to ease itching.  It’s worth a shot. 

• Take an oral antihistamine.

Key word here is oral.  Topical antihistamines (which can be found in creams, lotions and gels) can cause the rash and the itch to get worse.  The reason for this is worth a whole other post so if you want the nitty gritty you can call and ask me.  Also, please note that many antihistamines can cause drowsiness so if you are planning on using your front-end-loader consider asking your pharmacist which antihistamine will keep you, and others, safe. 

• Don’t scratch or mess with the blisters!

I know this is easier said than done.  Scratching can cause an infection and we don’t want to have to treat a skin infection on top of everything.  If the blisters open don’t remove the overlying skin because this skin can protect the irritated skin below and help prevent an infection. 

There are times when self-treatment is just not going to cut it.  Most of the time common sense is going to have you sitting at your doctor’s office but I know, and you know, that sometimes we can feel a bit foolish about going to the doctor if we don’t need to.  So here is a list to make us all feel better about making an appointment. 

When to go to the doctor:

• The rash covers most of your body

• You develop swelling, especially if an eyelid swells shut

• If you have a rash on your face or genitals

• Much of your skin itches or if nothing seems to ease the itch

• If you have a rash over 10 days

Always, always call 911 or go to the ER if you have swelling or difficulty breathing or if you have had a severe allergic reaction in the past!!! 

So there you have it.  I hope you all get to enjoy the spring weather and sunshine!

Courtney Redding, PharmD

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