Poison ivy, oak, sumac dermatitis in Adult
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Synopsis
These species show regional variations in the nature of the plant including growth pattern, leaf characteristics, and flowering.
After exposure, the rash begins to appear within 1-2 days in previously sensitized individuals; in the newly sensitized, it may be delayed 2-3 weeks. As the resin is very stable, occult contact may occur from contaminated clothing, gear, or vegetation, even after months have elapsed.
Codes
ICD10CM:L23.7 – Allergic contact dermatitis due to plants, except food
SNOMEDCT:
200823002 – Allergic dermatitis due to poison ivy
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Differential Diagnosis & Pitfalls
- Phytophotodermatitis – Similar presentation but due to plant material and ultraviolet (UV) exposure. Hogweed, citrus fruits, celery, wild parsnip, wild carrots, and oil of bergamot are among the more common causes.
- Dermatitis due to other Anacardiaceae genera – mango, cashew, pistachio
- Allergic contact dermatitis to some other antigen
- Arthropod bite or sting reaction – Exaggerated vesiculobullous reactions may be associated with chronic lymphocytic leukemia, other hematological malignancies, and HIV.
- Bullous impetigo – more scattered, fragile bullae; golden crusts
- Cellulitis or erysipelas
- Herpes zoster – Inquire regarding prodrome of pain or burning. Viral polymerase chain reaction (PCR) can be used to confirm.
- Zosteriform herpes simplex – Inquire regarding sensory prodrome and possible previous episode. Viral PCR can be used to confirm.
- Porphyria cutanea tarda and hepatoerythropoietic porphyria – bullae on sun-exposed skin
- Solar urticaria
- Bullous tinea pedis – usually feet and possibly ankles; may additionally involve one hand
- Autoimmune blistering diseases
- Atopic dermatitis
- Nummular dermatitis
- Stasis dermatitis
- Drug-induced phototoxic reactions – Severe types may blister; diuretics, antiarrhythmics, and tetracyclines are common causes.
- Melanocytic lesions, including melanoma
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Last Reviewed:03/29/2023
Last Updated:04/06/2023
Last Updated:04/06/2023
Patient Information for Poison ivy, oak, sumac dermatitis in Adult
Overview
Poison ivy, poison oak, and poison sumac rashes (dermatitides) are all reactions to the oil (called urushiol) found on the leaves, stems, and roots of poison ivy, poison oak, and poison sumac plants.- People typically have itchy bumps (papules) and blisters (vesicles).
- Itching can be intense, and secondary bacterial infection can result from scratching.
- Scratching does not spread lesions; the rash first appears on the areas of skin exposed to the most oil and then, as the immune response increases, areas exposed to less oil begin to show a rash.
- Skin lesions usually begin to appear after 48 hours of initial exposure.
- Symptoms are usually related to severe itching.
Who’s At Risk
Poison ivy, poison oak, and poison sumac may affect people of all ages.Signs & Symptoms
- Poison ivy, poison oak, and poison sumac can occur anywhere on the body where the exposure to the plants has occurred.
- Red and brown-red raised areas and blisters may appear in a linear pattern. Crusted lesions may be seen.
- A "black dot variant" has been described. (The oil from the plant leaves a black dot on the skin.)
- Extreme facial swelling (edema) may be seen if there is significant exposure to the face.
Self-Care Guidelines
- It is important to use soap and water to wash all potentially exposed areas since the oil of the poison ivy, poison oak, and poison sumac plants sticks to the skin.
- Once the oil has been washed off, there is no risk of spreading poison ivy, poison oak, or poison sumac to other parts of the body.
- Be sure to wash any clothes potentially exposed to the oil as well.
- Soothing oatmeal baths (such as Aveeno Skin Relief Bath Treatment) and calamine lotion may be helpful in relieving symptoms.
- Wear protective clothing (eg, pants and long-sleeved shirts) to avoid future reactions.
When to Seek Medical Care
Seek medical help for a rash that does not respond to self-care measures or seems to be getting worse.Treatments
Your physician may prescribe:- In severe cases involving large body areas, a 14-20 day course of oral steroids (prednisone).
- In cases with more limited skin involvement, medium- to high-potency topical steroids may be used to treat the trunk and extremities, while low-potency topical steroids may be prescribed to treat the face and skin fold areas.
- Oral antihistamines may be prescribed for itching.
- Topical or oral antibiotics may be needed if an infection is suspected.
References
Bolognia, Jean L., ed. Dermatology, pp.227-229. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1167-1168. New York: McGraw-Hill, 2003.
Poison ivy, oak, sumac dermatitis in Adult
See also in: External and Internal Eye