Urushiol-induced Contact Dermatitis - Treatments

Treatments

Potential treatments are in two phases: stopping the urushiol contact causing a reaction with the skin (this must be done within minutes), and later in reducing the pain or pruritus (itching) of any blistering that has formed.

Primary treatment involves washing exposed skin thoroughly with soap and water as soon as possible after exposure is discovered. Soap or detergent is necessary, as urushiol is an oil. Commercial removing preparations, which are available in areas where poison ivy grows, usually contain surfactants, such as the nonionic detergent Triton X-100 to solubilize urushiol; some preparations also contain abrasives.

Showers or compresses using very hot water (but not scalding) can offer relief of itching for up to several hours, with the caveats that this "also taxes the skin's integrity, opening pores and generally making it more vulnerable", and is only for secondary treatment (not while cleaning urushiol from the skin, which should be done with cold water). Those who have had a prior systemic reaction may be able to prevent subsequent exposure from turning systemic by avoiding heat and excitation of the circulatory system, and by applying moderate cold to any infected skin with biting pain.

Antihistamines and hydrocortisone creams or antihistamines by mouth in severe cases can be used to alleviate the symptoms of a developed rash. Nonprescription oral diphenhydramine (US tradename Benadryl) is the most commonly suggested antihistamine. Topical formulations containing diphenhydramine are available, but may further irritate the affected skin areas. No vaccine has been developed to counter urushiol symptoms, so the most effective "cures" are generally held to be those products that physically remove the urushiol.

In cases of extreme symptoms, steroids such as prednisone or triamcinolone are sometimes administered to attenuate the immune response. Prednisone is the most commonly prescribed systemic treatment, but can cause serious adrenal suppression changes, so it must be taken carefully, tapering off slowly. If bacterial secondary infection of affected areas occurs, antibiotics may also be necessary.

Many home remedies and even commercial products (e.g., Zanfel and Tecnu) claim to prevent urushiol rashes after the exposure. A study of such a product, Tecnu, and ordinary soap, Goop and Dial soap, found 70%, 62%, and 56% protection relative to the possible maximum response, at costs per ounce of $1.25, $0.07, and $0.07. The study compared four 2.5 cm exposed squares on the inner aspect of the forearm, three of which were treated and one untreated. Some clarifications:

• Scrubbing with plain soap and cold water will remove the urushiol from skin if it is done within a few minutes of exposure, before it bonds.
• Ordinary laundering with laundry detergent will remove urushiol from most clothing, but not from leather or suede. One home remedy includes laundering clothes with Fels-Naptha
• The fluid from the resulting blisters does not spread poison ivy to others.
• Blisters should be left unbroken during healing.
• Poison ivy is not harmless when the leaves have fallen off, as the toxic resin is very persistent. Every part of the plant contains urushiol, and can cause a rash with exposure at any time of the year.
• Ice, cold water, cooling lotions, or cold air do not help cure poison ivy rashes, but cooling can reduce inflammation and soothe the itch.
• Burow's solution, calamine lotion and Jewelweed are ineffective or of questionable effectiveness against itching.