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Question: Recently diagnosed with contact dermatitis poison oak. Was initially prescribed with otc Eucerin anti-itch, calamine. Week later the rash spread so bad on both arms, back, neck swelling on face, ears and feet. I looked like a leper. Return to the Dr. UpToDate discusses avoidance of the offending substance for 2 to 4 weeks, use of topical corticosteroids of medium to strong potency for a limited time without defining the duration , and use of systemic corticosteroids in severe cases, prescribing a course of prednisone at 40 mg daily for 4 to 6 days followed by 20 mg for 4 to 6 days.
Because the rash may persist for more than 2 weeks, it makes sense to prescribe oral steroids for longer than 5 or 7 days.
Skip to main content. Clinical Inquiries. What is the best duration of steroid therapy for contact dermatitis rhus? This rash is usually self-limiting and resolves one to two weeks after exposure. Redness and intense pruritus also develop, followed by papules, vesicles and sometimes bullae.
Lesions can appear in streaks, suggesting plant contact. Fluid from the lesions is not sensitizing to others. Complications include secondary bacterial infections and, rarely, erythema multiforme and urticaria. Management should include thorough washing with soap and water, preferably within 10 minutes of exposure, as this may prevent dermatitis. All contaminated clothes should be removed as soon as possible and cleaned. The dose should be tapered gradually over a week or two.
That allows your own body to compensate as the steroid is withdrawn. When I get poison ivy, I swell up like a balloon. The blisters are the size of half golf balls and when they finally start draining, it takes days before the oozing stops.
Twice in my life I spent over a week in bed prior to finally going to the doctor for help. I was only able to get up to use the bathroom, which was agony. For me, a typical course of poison ivy lasts over two weeks. Prednisone is a life saver in my case. For a severe allergic reaction like yours, corticosteroids like prednisone can be extremely helpful. A slow taper over a week or two is generally recommended. Dropping the dose too rapidly can lead to symptoms of adrenal dysfunction such as muscle weakness, fatigue, dizziness, fainting, headache, nausea, loss of appetite and low blood sugar.
Side effects of prednisone or other strong steroids can include insomnia, irritability and mood swings, fluid retention, elevated blood pressure, headache and dizziness. Be alert for more serious complications such as blood clots or susceptibility to infections BMJ , April 12,
❾-50%}Poison ivy rebound after prednisone. Back to the Basics: Poison Ivy (Toxicodendron) Dermatitis
Scant evidence exists for the best duration of steroid therapy for contact dermatitis due to plants rhus. Review articles recommend 10 to 21 days of treatment with topical or oral corticosteroids for moderate to severe contact dermatitis due to plants strength of recommendation [SOR]: C , based on review articles.
The primary reason given for the duration of 2 to 3 weeks is to prevent rebound dermatitis. Evidence for the best treatment of rhus dermatitis is negligible. Most recommendations stem from review articles and expert opinion. When it is exposed to the air, it may turn black, causing spots to appear on the leaves.
The rash associated with exposure to urushiol develops anywhere between 4 hours and 4 days after exposure. The rash is intensely itchy, red, somewhat swollen and generally has fluid-filled blisters that present as lines or streaks. The rash can appear on different parts of the body at different times. Remember that poison ivy is not contagious; you cannot pass it from one person to another.
However, the oils from the plant can be carried on clothing, on garden tools, under fingernails or even on pets. Therefore, other family members can develop dermatitis, particularly if they are sensitized to urushiol, without ever coming in direct contact with the plant. Teach your children to recognize plants in the Toxicodendron family. Poison ivy is a vine that either climbs vertically or spreads out through grasses.
In the summer, leaves are green, while the plant may have red leaves and white berries in autumn. It is found in wooded areas, but also along rivers, lakes and ocean beaches. Even dead plants can cause an allergic reaction.
I apologize I cannot be more helpful. Marder, D. We cannot search for an empty value, please enter a search term. Question: Recently diagnosed with contact dermatitis poison oak.
Was initially prescribed with otc Eucerin anti-itch, calamine. Treatment of mild to moderate rash includes application of cool compresses or diluted aluminum acetate solution, such as Burow's solution, or calamine lotion. Use of topical antihistamines and anesthetics should be avoided because of the possibility of increased sensitization.
Early application of topical steroids is useful to limit erythema and pruritus. However, occlusive dressings should be avoided on moist lesions. Refractory dermatitis can be treated with oral corticosteroids such as prednisone, with an initial dosage of 1 mg per kg per day, slowly tapering the dosage over two to three weeks. Shorter courses of steroids may be followed by severe rebound exacerbations shortly after drug therapy is discontinued.
Oral antihistamines may help reduce pruritus and provide sedation, when needed.
If your family enjoys time in the woods while hiking or camping, you may have been affected by the rash caused by poison ivy, poison oak or poison sumac. This itchy allergic reaction is caused by exposure to oils found on plants in the Genus Toxicodendron. The allergenic compound found in these plans is called urushiol.
Interestingly, the same substance is also found in ginko fruit and mango peels. This colorless oil is found in all parts of the plant. When it is exposed to the air, it may turn black, causing spots to appear on the leaves.
The rash associated with exposure to urushiol develops anywhere between 4 hours and 4 days after exposure. The rash is intensely itchy, red, somewhat swollen and generally has fluid-filled blisters that present as lines or streaks. The rash can appear on different parts of the body at different times. Remember that poison ivy is not contagious; you cannot pass it from one person to another. However, the oils from the plant can be carried on clothing, on garden tools, under fingernails or even on pets.
Therefore, other family members can develop dermatitis, particularly if they are sensitized to urushiol, without ever coming in direct contact with the plant.
Teach your children to recognize plants in the Toxicodendron family. Poison ivy is a vine that either climbs vertically or spreads out through grasses. In the summer, leaves are green, while the plant may have red leaves and white berries in autumn. It is found in wooded areas, but also along rivers, lakes and ocean beaches. Even dead plants can cause an allergic reaction.
Poison oak, while less common in Virginia, has leaves that resemble oak leaves. There are three leaflets, but sometimes up to seven in each leaf group.
Poison sumac, more common in swampy areas such as Florida, grows as a shrub or small tree with 7 to 13 leaflets on each stem. While being familiar and avoiding contact with the plants is great protection, it is important to take further precautions, particularly when hiking or doing yard work. Long sleeves, long pants or tall socks provide a layer of protection between the oils and your skin. Heavy vinyl gloves are recommended for yard work that involves handling brush.
Remember to remove and wash any clothes that may have had contact with the plant as soon as possible. Washing with mild soap and water within 4 hours of exposure may prevent the rash from developing. Be sure not to scrub the skin, as this may make the skin irritated and more susceptible to rash.
They leave a clay compound on the skin and must be applied every 4 hours. Once the rash appears, there are many home treatments that will ease the itching and discomfort. Soaking affected skin in oatmeal baths or the use of cool, wet compresses may provide temporary relief. Lotions containing menthol or phenol calamine may help when applied to the rash. Antihistamines taken orally may not provide much relief from the itching, since the itch from poison ivy is not due to histamine.
These medicines may sometimes be used if the itching is interfering with sleep, since the most common side effect of antihistamines is drowsiness. Avoid the use of topical antihistamine creams, products intended to numb the skin such as benzocaine, or topical antibiotic ointments. These all have little benefit and may have concerning side effects. The use of topical corticosteroids may be helpful in easing the inflammation and itching that accompanies the rash.
Using this medication as an ointment preparation may feel better on the skin than a cream. We will evaluate for signs of infection and prescribe oral antibiotics if needed. We may also treat the more severe dermatitis with oral steroids. It is important to remember, however, that most cases of poison ivy dermatitis do not require the use of oral steroids, which have some unpleasant side effects themselves.
For severe cases, steroids are tapered over two to three weeks. If your family takes protective actions and knows what to do immediately after accidental exposure, hopefully no one will suffer from the itchy consequences of urushiol!
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Refractory dermatitis can be treated with oral corticosteroids such as prednisone, with an initial dosage of 1 mg per kg per day, slowly. A steroid dose pack is also often avoided as treatment for poison ivy, as the dose might be too low and it typically doesn't last long enough. For severe cases, steroids are tapered over two to three weeks. It is possible to experience resurgence in the rash, known as 'rebound dermatitis' with shorter. Although steroid hormones may still give patients some relief after the rash has broken out, doctors find that the only way to completely stop a. Oral corticosteroids such as prednisone can bring relief to a bad case of poison ivy within about 24 hours. The dose should be tapered gradually over a week or. Shorter courses of steroids may be followed by severe rebound exacerbations shortly after drug therapy is discontinued. Twice in my life I spent over a week in bed prior to finally going to the doctor for help. Soaking affected skin in oatmeal baths or the use of cool, wet compresses may provide temporary relief. Even dead plants can cause an allergic reaction. The systemic treatments listed include oral or intramuscular corticosteroids, but no discussion of duration is mentioned. Poison oak, while less common in Virginia, has leaves that resemble oak leaves. Now that I am done with Prednisone with hopes of recovery, I am starting to see new rash coming on parts of my body that were not attacked before.Scant evidence exists for the best duration of steroid therapy for contact dermatitis due to plants rhus. Review articles recommend 10 to 21 days of treatment with topical or oral corticosteroids for moderate to severe contact dermatitis due to plants strength of recommendation [SOR]: C , based on review articles.
The primary reason given for the duration of 2 to 3 weeks is to prevent rebound dermatitis. Evidence for the best treatment of rhus dermatitis is negligible. Most recommendations stem from review articles and expert opinion. Rhus dermatitis is one example of a disorder for which we must fall back on our logic and personal experience.
Since the painful itchy blisters and erythema from the oleoresin may take up to 1 week to appear, and because the rash may persist for more than 2 weeks, it makes sense to prescribe oral steroids in severe cases for longer than the usual 5- to 7-day burst. Habif, a popular dermatology text, suggests gradually tapering steroids from 60 to 10 mg over a day course. No published studies compare varying durations of treatment with steroids for contact dermatitis due to plants, including rhus.
Many review articles refer to rebound dermatitis when using courses of oral steroids such as Medrol dosepaks for fewer than 14 days. One case report noted failure of a tapering dose over 5 days of oral methylprednisolone for treatment of poison ivy contact dermatitis. The systemic treatments listed include oral or intramuscular corticosteroids, but no discussion of duration is mentioned.
UpToDate discusses avoidance of the offending substance for 2 to 4 weeks, use of topical corticosteroids of medium to strong potency for a limited time without defining the duration , and use of systemic corticosteroids in severe cases, prescribing a course of prednisone at 40 mg daily for 4 to 6 days followed by 20 mg for 4 to 6 days. Because the rash may persist for more than 2 weeks, it makes sense to prescribe oral steroids for longer than 5 or 7 days.
Skip to main content. Clinical Inquiries. What is the best duration of steroid therapy for contact dermatitis rhus? J Fam Pract. Meadows, MLS. PDF Download. Evidence-based answers from the Family Physicians Inquiries Network.
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