-History and physical done.
-cool compresses
-oral antihistamines for the itching.
-A 10- to 14-day tapering course of oral prednisone, starting at 60 mg
-Counseled patient that in the future, she should wash the area ASAP. “It has been demonstrated that the resin can be inactivated with any type of soap, thereby preventing the reaction, but the sooner the better. Approximately 50% of the resin can be removed by soap and water within 10 minutes of contact, but after 30 minutes only about 10% can still be removed.” The ABFM
There is erythema with multiple bullae and vesicles, some of which are in a streaked linear distribution on the arms.
-itching is intense.
-caused by urushiol, a resin found in poison ivy, poison oak, and poison sumac plants.
“Direct contact with the leaves or vines will result in an acute dermatitis manifested initially by erythema, and later in more severe cases by vesicles and bullae. This is a type IV T cell–mediated allergic reaction, so it typically takes at least 12 hours and often 2–3 days before the reaction is fully manifested. Depending on the degree of contact (i.e., the amount of resin on the skin), the rash often progresses over a couple of days, giving the impression that it is spreading. Also, delayed contact with resin from contaminated clothing, gloves, or pets may result in new lesions appearing over several days. Brushing against the leaves of the plant causes the linear streaking pattern characteristic of poison ivy dermatitis. It has been demonstrated that the resin can be inactivated with any type of soap, thereby preventing the reaction, but the sooner the better. Approximately 50% of the resin can be removed by soap and water within 10 minutes of contact, but after 30 minutes only about 10% can still be removed.
Therapy depends on the severity of the reaction. Group I–V topical corticosteroids are effective for limited eruptions (less than 3%–5% body surface area) but are ineffective in areas with vesicles or bullae.
Group I–II fluorinated agents are at the strongest end of the spectrum and are not recommended for use on the face or intertriginous areas.
Short bursts of low-potency oral corticosteroids such as a methylprednisolone dose pack have a high rate of relapse as the taper finishes, so the expert consensus is to use a higher dosage tapered over a longer period, generally 10–14 days, in order to prevent a relapse.
Most experts recommend oral corticosteroids over intramuscular corticosteroid suspensions, which may not provide high enough concentrations in the skin (SOR C).
However, 40–80 mg of intramuscular triamcinolone (or an equivalent) is an alternative to oral treatment, especially if adherence is an issue.
Pruritus can be treated with oral antihistamines. Secondary infection, which is common with vesiculobullous involvement, is treated with appropriate oral antibiotics.” ABFM
Habif TP: Clinical Dermatology: A Color Guide to Diagnosis and Therapy, ed 5. Mosby Elsevier, 2010, pp 138-139.