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Phytodermatitis: Poison Oak/Ivy/Sumac Dermatitis

Matthieu DeClerck, MD and Mike Weinstock, MD
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Review Phytodermatitis (an type of Allergic Dermatitis) caused by 3 plants of the Toxicodendron Species (formerly called Rhus). The 3 plant being reviewed will be Poison Ivy (T radicans), Poison Oak (T diversilobum), and Poison Sumac (T vernix). We will review diagnosis, treatment, complications from, recognition of, and prevention.

 

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J.A. W. -

Thanks for the great podcast on poison ivy/oak! I'm a NP in my first year of practice in urgent care. My clinic uses IM steroids for treatment of poison ivy/oak/sumac and rarely see bounce backs. Can you please comment on the use of IM steroids rather than oral and the appropriate choice of steroid and dose to use if a provider chooses IM. As a new provider I have struggled with the use of IM steroids as their use is not always supported by evidence/guidelines, but providers use them frequently and most patients would prefer a shot rather than 2-3 weeks of pills. Thank you!

Mizuho M., DO -

Hi J.A.W! Here is the reply by Dr.Declerk:

"While there is not much published data on the optimal regimen and dose of IM corticosteroid for the treatment of severe cases of Toxicodendron Dermatitis (Poison oak/ivy/sumac dermatitis), clinical experience does support the use of long acting corticosteroids (Triamcinolone) for pts who can not tolerate or comply with an oral taper.

Recommended dose is Triamcinolone 0.5 to 1 mg/kg IM once. The steroid effect at these doses is approximately 1-2 months (longer duration as the dose increases) and thus would prevent the rebound dermatitis effect. The down side is that once an IM dose is given it can not be stopped or reversed or adjusted once administered. That being said IM Triamcinolone is a viable and often used treatment.

Hope this is helpful."

Matthieu Declerk MD

J.A. W. -

Thank you!

Mike W., MD -

Good question. I would treat it similar to a PCN injection for strep throat - use a shared decision making model. I personally would prefer oral, but I totally get it if the pt prefers a one time shot. Sounds like you are doing everything right!!

J.A. W. -

Thank you!

Kevin M., PA-C -

Nice timing on this talk. Tis' the season of poison ivy rashes, tick bites and sunburn presenting to my urgent care.
When I think about bad cases of poison ivy, 2 patient's from last year come to mind specifically because of the location of the rash. Both of these patient's had it on their face and what was concerning was that it was periorbital. I treated them with a tapering steroid and both did well.
With the proximity to the eye is there a chance of this spreading to the eye and causing something like vision loss? Should I send a pt like this to an eye specialist on a urgent matter?

Mike W., MD -

Thx Kevin. I have not heard of this being a problem and have never referred anyone to ophthalmology. I will see what Matt has to say

Mike W., MD -

Without direct contact the hypersensitivity reaction would not likely spread to the ophthalmic tissue/cornea and usually is limited to the dermis that came into contact with the plant. That being said, if there is direct contact with the cornea/conjunctiva you can have a reaction, a careful corneal exam and close follow up with ophthalmologist would be appropriate.
Hopes this helps.
Matthieu

Susan M. -

Is Depo-Medrol IM an option for plant contact dermatitis? Our clinic does not carry injectable triamcinolone but we have Depo-Medrol out the wazoo. Would an injection of Depo-Medrol 80 mg once weekly for 3 weeks be an option? I have been using a 12 day oral prednisone taper, but sounds like even that is not long enough. Thanks!

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