ASK THE DOCTOR: Leaves of three, let it be
By DR. JIM MITTERANDO

Q What do you recommend to prevent and treat poison ivy, which my child gets every summer? It got really bad last year and the doctor put him on steroid pills. Is this safe?

A Poison ivy is a terrible nuisance but not dangerous. If untreated, most poison ivy rashes will clear in about three or four weeks. A prescription will clear it up faster.

Most over-the-counter remedies for poison ivy do not work. Calamine lotion -- makes a mess and does not relieve itching. Oatmeal baths just produce a ring around the tub and do not cure the rash. Anti-itch lotions such as Caladryl or Benadryl cream occasionally can cause an allergic rash and are not recommended.

Try covering blisters with wet, cool wash cloths. That will help them dry up faster. To treat excessive oozing, soak the wash cloth in water containing Burow’s solution, then apply to the blisters.

Benadryl pills and other antihistamines such as Tavist, Allegra, Claritin and Zyrtec can reduce the itchiness, but do not shorten duration.

The mainstay of treatment is a steroid cream such as hydrocortisone. Often people require stronger prescription steroid creams or even steroid pills. When necessary, oral steroids are taken for 10 to 14 days. The dosage is slowly reduced to avoid a rebound rash. Oral steroids, generally safe short-term, do have side effects including, jitteriness, insomnia, increased appetite and bloating.--

I prefer to treat poison ivy with topical creams. Steroid pills are more effective when the rash is widespread.

Exposure
The rash and blisters are caused by resin - a colorless, sticky oil in the leaves, stems and roots of the plant. If you have contact with poison ivy, wash the affected skin with soap and cold water immediately. The oil starts penetrating the skin within 10 minutes.

If you’re exposed the rash can develop days - even weeks - later. It often shows up on body parts at different times, up to a week apart. This delay misleads people into believing that the rash has spread and is ‘‘contagious.’’

Even scratching or touching blister fluid cannot spread the rash to body parts or another person. Scratching, though, worsens the itch, prolongs the rash and may cause a skin infection.

People often worry about poison ivy causing swelling of the eyelid. It temporarily looks bad but does not threaten eyesight and is no worse than poison ivy elsewhere on the body.

Prevention
To prevent resin from contacting skin, wear long sleeves and pants when possible and practical.

Carefully remove all exposed clothing and wash it. People unable to avoid contact with poison ivy may want to consider applying a barrier cream such as IvyBlock (bentoquatam). Even with such protection, you need to wash off exposed skin immediately.

Wear gloves when handling poison ivy in the yard or garden and then wash them when finished.

Poison ivy plants are hard to get rid of. Spray-on herbicides such as Round-Up and Ortho Brush-B-Gon poison ivy killer can be effective, but they kill nearby plants.

Don’t burn poison ivy - it can cause airborne allergic reactions and should never be done.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2003 The Patriot Ledger
Transmitted Tuesday, July 01, 2003