Daily Bolus of LR: Toxicodendron Dermatitis

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September 2, 2011 by dailybolusoflr

Toxicodendron Dermatitis

* The allergic contact dermatitis caused by the toxicodendrom is better known by the particular plants in this group: Poison Ivy, Poison Oak or Poison Sumac
* The culprit, known as urushiol, triggers a type IV delayed hypersensitivity reaction in approximately 70% of people who are exposed
* Typical onset of the rash is 1-2 days after exposure, but new rash can develop from allergen that has remained under finger nails or on clothes for up to a week
* It is also important to tell patients that even without re-exposure, new rash can develop for up to 2 weeks, but a re-exposure must always be suspected
* Patients should be told to wash their clothes/sheets etc in a washing machine. They should be reminded about shoes or other apparel they had on when they were exposed
* Fluid from the vesicles is NOT able to transmit the rash, as it does not contain antigen
* Mild cases typically show a linear eruption of an erythematous base with small vesicles that are pruritic and/or painful
* More severe cases can result in diffuse confluent erythema and severe pain and/or itching
* If you know you have been contaminated with one of these plants, immediate washing of the skin within 20 minutes can actually prevent the penetration of urushiol, as this takes about 20 minutes to occur
* Minor rashes can be treated with topical corticosteroids (potent ones. .not your OTC hydrocortisone), while more severe rashes or rashes involving the face may need systemic corticosteroids (prednisone 60mg tapered over 2-3 weeks) NOTE: pre-made medrol dose packs are too short and can lead to recrudescence of rash
* Other treatments involve oatmeal baths, burrows solution, cool compresses and systemic anti-histamines

Ref: Minor Emergencies Buttaravoli and Stair

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