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Jesse Hsieh, MD

Medical Editor, Michiana Family Magazine

Dr. Hsieh has been in practice at Granger Family Medicine for almost 20 years. He also serves as President of the South Bend Clinic, Memorial Hospital Board, Clinical Associate Professor at IU Med School-SB, and lead guitarist for Vyagrafalls, at Vyagrafalls.com

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Poison ivy reminds me of a bad zombie movie. It can get you even when it's dead.

It can disfigure you with bumps, swelling, bubbles and discoloration all over - in fact, no part of your body is immune to it, including your face and privates (yikes!).

People run away from you, and they are afraid they'll become like you if you touch them. Your itching is so bad that you're restless, constantly moving, scratching and horribly miserable. Robbed of your sleep, patience, and ability to think, you start to feel like one of those …zombies.

Every summer, we get hundreds of calls and visits about poison ivy. Not surprising, considering how common it is in our area. Even more widespread is the confusion on what it is, and how it can be treated.

The Facts

Contact Dermatitis is the medical term for an allergy reaction of the skin to any chemical it doesn't like, including the poison ivy plant. The plant can be dead; the resin from it is all that is needed. It can also be on your clothing or tools. The oils on your hands can often keep the skin on your hands from reacting to the resin; but even when there's no rash on your hands, everything you touch, such as your face, and privates will get the rash. (Right now there's a reader somewhere saying "ah-ha, so that's how I got it there- I know I didn't frolic naked through the woods".)

Whether it's poison oak, sumac, or ivy, it really doesn't matter; the skin reaction's is the same. After contact, the immune system overreacts (hypersensitivity), and "primes" itself over the next 2 days. Priming involves creating huge numbers of cells laden with inflammatory molecules such as histamines. When released, these contents cause blood vessels to dilate and leak, swell and itch.

Heat, sweating, scratching, and anything else that irritates the skin such as clothing that is tight, scratchy or binding will result in more release of these chemicals from the immune cells. Therefore, the rash is really not contagious. The original offender, poison ivy, may be nowhere near you, yet it can continue to spread if you irritate the skin enough.

What to Do:

Prevention.

Recognizing plants such as poison ivy, sumac, and oak are important. Don't be fooled by plants that have shed their leaves - their vines and residual resin can still cause a rash year-round. Since our area is so heavily populated with these plants, avoidance can be difficult. Any work outside involving woods and brush should include gloves and clothing that covers the skin. Wash the hands and clothes afterwards. Even burning brush with poison ivy in it can cause a rash if exposed to the particulate matter from the smoke.

If it's too late, and you already have the telltale streaks of bubbles on an itchy, red rash, minimize the damage. Don't scratch! You will create new rashes where you do. Stay cool. Very hot showers and hot-tubs are good only if you enjoy making the itchy rash explode all over your body. If the itching is making you crazy, use none-prescription anti-histamines like Benadryl oral medication. Apply plain 70% isopropyl rubbing alcohol to the skin. It'll burn, but stops the itching and acts as an astringent to dry up the rash, and probably at $1 a bottle works better than all the other products on the shelf.

When to Seek Medical Attention:

If widespread, on the face, or if there is a past history of severe sensitivity, seek medical attention. Or, when you feel and look like a zombie. Your doctor will most likely prescribe a steroid of some sort in various different forms. Steroids suppress the hypersensitive immune response of contact dermatitis.

Prescription strength topical steroid creams are mostly for smaller and manageable rashes just getting started. For worse cases, prednisone pills work best and cost just a few dollars. Prednisone can have a lot of side effects if used long-term, however. But for this, a few days at low doses is usually safe, although be careful with diabetes (raises blood sugar) or birth control pills (reduces effectiveness of the pill).

Shots are often given, with a higher cost ($15 or more) and discomfort. Yet they don't really confer any quicker resolution or greater potency to the treatment. They contain a long-acting slow release steroid. I generally only use shots if continued exposure is a concern, or if we really have a bad case that isn't resolving anytime soon.

If people do understand these basic principles of contact dermatitis, we can probably avoid a lot more phone calls and office visits. And poison ivy sufferers can avoid being put in the same social standing as zombies.

 

Michiana Family Magazine
Phone (574) 293-FAM1 (3261) • Fax (866) 745-6246
Media@Michianafamilymagazine.com • 530 E. Lexington Avenue Suite 100C Elkhart, IN 46516

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