Memorial Day ranks as the number one day for exposure to poison ivy. Synonymous with gardening, picnicing, hiking and sending your kids off to camp, poison ivy, oak and sumac seem the ubiquitous outdoor plague.That means come Tuesday, an itchy, blistery rash may accompany your post-holiday blues. This year, plan ahead. Stock up on your poison ivy prevention - and use it. And if poison ivy plagues you each and every summer, it doesn't hurt to gather your remedies...just in case.

Poison ivy, oak and sumac for all intents and purposes are one and the same, as they each contain the same "poisonous" oil (aka resin) known as urushiol and each plant creates the same characteristic "poison ivy" type of rash.

You won't know when the resin gets onto the skin. It's just not noticeable. But give yourself 1-2 days (for those with a past poison ivy history) or as long as 9 days for those novices and you will begin to experience the discomfort of itching, swelling, redness and finally watery groups of blisters.

Often the rash appears in streaks. This streakiness is really mirroring where each branch or rhus covered leaf came into contact with the skin.

A Rash Move?

It doesn't take much of the plant oil to cause a rash. Fun fact of the day, it takes only 1/4 oz of urushiol to cause everyone on Earth to break out! So you can understand that it doesn't take much contact with a plant to cause a rash.

Where the largest concentration of the resin contacts the skin, the rash breaks out first and is typically the worst in severity. Where smaller and smaller amounts of the plant resin are spread, these areas can break out over approximately a 3 week period. Touching the actual rash will not spread the rash! The most common myth associated with poison ivy is probably the mistaken notion that scratching the blister fluid creates a contagious situation. Only contact with the resin causes the allergic reaction, and I would hope that it would be long washed off before the rash breaks out. This is another reason to wash well immediately after coming indoors.

Urushiol oil can remain capable of causing a rash for up to 5 years on dormant surfaces. Take this into account. Toss your dirty clothing immediately into the washing machine and wash them. Too many moms find themselves with poison ivy after doing the family laundry that has been drenched in poison ivy sitting in the hamper for several days (or more).

Can't figure out where your poison ivy came from in January? How about those logs you carted in for the fireplace. Or did the family cat or dog make an appearance after playing gleefully in a patch of poison oak or sumac? And finally, did your garden tools sit untouched (and unwashed) throughout the winter only to be taken out eagerly for springtime gardening and provide you your first taste of poison ivy for the season?

Botany Lesson

"Leaves of 3 let them be". Seems pretty straightforward. Certainly the plants of poison ivy and oak typically have 3 leaflets per stalk. Poison sumac on the other hand actually can have anywhere from 7-13 leaves. If you live on the west coast, you are far more likely to encounter poison sumac, so be wary! The rest of us in the U.S. and Canada are probably going to stumble across poison ivy or oak.

Poison ivy tends to be red early in the spring and becomes green later in the season. During the fall, just like deciduous trees, they can change to their autumn hues.

Did you know that poison ivy can flower? It can make berries. The leaves can vary in size on the same plant, be straight or scalloped, and look shiny or dull. Poison ivy can climb 10 feet or more, it can appear like a shrub or creep along the ground. It is truly the great pretender. But whatever the appearance of the plant when you find it, your rash will look the same.

Block It

So what can you do about it? First of all, if you know in advance you'll be in an area likely to have one or more of these plants, PREPARE! Ivy Block contains the active ingredient bentoquantum, shown in studies to help neutralize urushiol and prevent the rash of poison ivy. When applied to the skin at least 15 minutes before contact helps prevent or diminish the gum from causing the actual dermatitis. Of course wearing long sleeves and pants helps as well. Do not apply Ivy Block to skin that already has the eruption, it's meant for prevention, not treatment.

A Jewel Of A Weed

A cousin to those garden impatiens, jewelweed has long been touted by alternative medicine supporters as a natural alternative for helping wash away plant oils and also helping reduce itching associated with full blown poison ivy. It's way back in the medical history books, but a study published back in 1958 in the Annals of Allergy showed that of 115 patients treated with jewelweed, 108 responded well to treatment. Jewelweed is thought to contain tannin, the active ingredient in tea leaves that helps reduce swelling and inflammation in skin tissues (remember those tea bag compresses for under eye puffiness?).

Burt's Bees Poison Ivy Soap contains a blend of jewelweed, clay (used in a variety of poison ivy remedies to try to lift the urushiol off the skin) and pine tar to help gently cleanse the skin and helps remove the grime left behind from your foray into the great out doors (or your own backyard!). Hopefully it will wash away some of the unwanted plant oils with it. While the FDA has not evaluated jewelweed as an active therapeutic agent for treating poison ivy, if poison ivy is the bane of your summertime existence, it might be worthwhile to try as an inexpensive soap after being outside participating in "high risk" activities (gardening, hiking, etc.).

A Little Night Therapy

When dealing with poison ivy, ideally you've thought ahead and used Ivy Block and avoided the rash altogether.

On the same note, if you know you get poison ivy (oak or sumac) then hopefully you washed after partaking in "high risk" outdoor activities such as gardening or hiking with a soap that would help rinse off some if not all of the plant oils such as Burt's Bees Poison Ivy Soap.

But if these steps weren't taken or for some reason just didn't work, you may find yourself itching one weekend night when seeing a doctor just isn't possible. Here are some steps to take to make it through the weekend in relative comfort:

• Try washing

  It may be time to try washing with your jewelweed based soap or time to take on Zanfel Poison Ivy Cream to try to lift away the urushiol hiding in the skin that is creating the allergic reaction in the first place. The jewelweed soap, like Burt's Bees Poison Ivy Soap can be used all over in the shower. This is NOT the time to take a bath. The last thing you want to do is soak in a tub full of urushiol that has been rinsed off your skin and is now contacting the rest of you!

• Compress blistered areas for 20 minutes twice a day with Domeboro Astringent Solution.

  There's an old medical saying when it comes to dealing with blistery rashes, "if it's wet, dry it" To help dry out blisters quickly and has an antibacterial nature. Follow the packet instructions for mixing. As long as you use a clean washrag each time you dip into the liquid, you can reuse the mixture. No need to waste it! You want to use a damp, not sopping wet compress. I would skip the eye area as you don't want to risk having Domeboro Astringent Solution drip into your eyes.

• Apply a topical steroid (preferably prescription Temovate Gel) to the nonfacial areas of rash twice a day.

  Unfortunately, only 1% hydrocortisone such as Cortaid Advanced Maximum Strength Cream is available OTC, which is usually too weak to be of much benefit. But, it does get you through the weekend before you can get into the dermatologist.

Here's a secret- if you get the syrup form of Zyrtec, you can take a smaller dose to help prevent the likelihood of drowsiness. The beauty of this is that you can titrate the medication to your needs vs. how drowsy you're feeling. Most women for instance get incredibly drowsy taking a single 25mg Zyrtec making it difficult to function.

• Use a topical anesthetic.

  Try items like PrameGel, Zanfel Poison Ivy Cream or Prax Lotion to temporarily blunt the itching. Skip topical anesthetics that contain topical benadryl as they have the potential of causing further contact allergic contact dermatitis.

• Apply a topical antibacterial ointment to any raw, denuded sites to prevent the possibility of infection.

  I usually suggest Polysporin First Aid Antibiotic Ointment or Bacitracin. Do not use Neosporin. There are a significant number of people who are allergic to the neomycin portion of this product and it makes their skin conditions worse.

Z Last Word For Home Therapy (Or Z Is For Zanfel)

Next time you tangle with poison ivy, oak or sumac, remember that your rash is forming due to an allergy to the toxin that has bound to the skin in the areas that it has contacted. If you could lift the urushiol out of the skin cells then you could help reduce the severity or length of time you are suffering.

Zanfel Poison Ivy Cream is a relatively new product that shows promise as helping improve symptoms associated with poison ivy. While not yet FDA approved as "therapy", Zanfel has drawn notice from the medical community including Dr. Dean Edell. And I must add, that I tried it on my nanny's inevitable bout of poison ivy and after a 3 minute treatment she was entirely comfortable, so Zanfel most definitely shows promise in helping deal with the trials and tribulations of this seasonal nuisance.

Now it is important to recall that you are only going to break out where the resin has gotten on to the skin and that it may take up to 3 weeks for all the areas that were going to erupt to do so. Without the luxury of x-ray vision, you can treat areas of rash with Zanfel as they arise to try to speed up your relief. This is not a product I would use from head to toe without any signs of rash visible. It's far too expensive for this. Try your jewelweed soap and see if the "natural" approach works for you. But when you do develop those first signs of itching and redness from poison ivy, you may want to try treating them with Zanfel.

• Rub Zanfel Poison Ivy Cream into the active areas of poison ivy (oak or sumac) rash, and rinse off after 1 minute.

  After the first wash the itching is supposed to have abated and the rash should ideally improve over the next 24 hours. For most people, no more treatments are required. In this case, a second treatment may be required.

• If itching remains after rinsing, repeat and allow cream to remain on skin for 3 minutes before rinsing.

  Deeper oils that were out of Zanfel's reach the first time begin to move up to the surface with the normal exfoliation process and the itch may return within 224 hours, depending on the severity.

• For stubborn cases, you may repeat your Zanfel Poison Ivy Cream 3 times a day.
• You may still use other poison ivy treatments with your Zanfel for additional relief if needed.

System Overload

Sometimes a systemic reaction to poison ivy can occur. The scenario most commonly seen comes from breathing in smoke arising from fires that contain plant matter covered in poison ivy. If this occurs, the urushiol oil can enter the lungs and set off a severe although unusual reaction that can last as long as 5 weeks. This type of overwhelming poison ivy reaction will typically lead you to see your doctor.

Prednisone Predicament

Here is my pet peeve about poison ivy care. The majority of poison ivy patients make their way intially to the ER or their primary care physicians where they are given either steroid shots, 5 day Medrol dose packs or both. Systemic steroids used in this manner act as a "tease" to the system. Typically the rash will come back worse once the temporary effects of the treatment are gone. This is called "rebound phenomenon". So the poor patient goes back to the doctor, and gets another and possibly another round of short term treatment. By the time they present to a dermatologist the patient is experiencing the rebound phenomenon of the year. It's not unusual for me to have at least 20 patients a summer suffering through this situation. Then these patients end up on long-term systemic steroids and treatment to stop a rash that would have been long gone without therapy.

Bottom line, if your poison ivy is bad enough to deserve systemic steroids, you need a high dose, long term taper of prednisone going from 60mg to 0 over at least a 2 week time frame.

A Shot In The Dark

Also known as immunotherapy or desensitization, allergy shots for the treatment of poison ivy are frequently not effective and are used as an option of last resort for those individuals who are extremely sensitive. Immunotherapy consists of giving a series of allergy shots containing the ingredient to which the patient is allergic to in ever so slightly increasing concentrations. In this manner the system is supposed to become acclimated to the allergen (ingredient to which you are allergic) until there is no longer an allergic reaction upon routine exposure.

Immune Today, Not Immune Tomorrow

While some people certainly have the luck of the draw and are naturally immune to poison ivy, others become so over time. And worse, some people seemingly lose their immunity for no apparent reason at all. After years of being an avid gardener, my babysitter only started developing her annual case of poison ivy after she turned 40! Our systems change, so don't take your immunity for granted.

Weed Whacking

If you have poison ivy, oak or sumac lurking in your yard, by all means, try to get rid of it! While this can be done at any time of year, it is probably best from May through July so you can actually identify what you're trying to kill off. As many weed killers are non-selective there is no sense in killing your prize perennials.

This is not the time to get aggressive and mow through or weed whack your noxious plants. The end result will be hundreds of tiny pieces of toxic plant material that are likely to either sprout into new plants or make it that much easier to contact and break out all over again.

Look for weed killers like Roundup that contains the active ingredient glyphosphate. Read your directions (and follow them!). Do not spray what you don't want to kill off in your yard. Take it from me, I've lost more than one plant with less than vigilant treatment.

If your ivy is acting like ivy, climbing high up trees, tangled hopelessly in your prize shrubs or ten feet up the telephone pole, cut the ivy close to the ground. The portion above will die off. Treat the part still in the ground with your weed killer. Stay vigilant for regrowth in that area and try to catch it early. It is not uncommon to have to retreat an area more than once in order to take control. And keep this in mind, all parts of the poison ivy plant are poisonous all year long!

Once you've pulled or sprayed your unwanted plants, do NOT burn them! The oil will literally go up in smoke and you may end up with a systemic reaction.

Plant oils can also remain upon your garden tools, making them an ideal way to pick up the rash next time you head out to the garden. Make certain to wash them off after use, whether using plain old soap and water or a jewelweed based soap.

Don't let this summer be overshadowed by a battle with a plant. Always remember, "leaves of 3, let them be" and do it! Plan ahead if possible, and know there are options to help you obtain comfort and peace of mind (along with a good night's sleep) should you stray into a patch of poison ivy.

Thank you for taking the time to read through this important information. I hope you have found this article informative.

Audrey Kunin, M.D.

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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