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    Poison Ivy”

    A common form of contact dermatitis the medic will see in survival scenarios will be related to contact with natural irritants that exist in some plants. In an extended disaster scenario, you’ll spend a lot more time exposed to toxic plants like poison ivy. Even in normal times, warmer weather means more outdoor activities and, thus, more exposure.

    Unless you live in Alaska, Hawaii, or the middle of the desert, there will be a population of poison ivy, poison oak, and/or poison sumac. Once in contact with one or the other, 85% of people will develop antibodies against these plants that will generate an itchy rash of varying degrees of severity.

    As an aside, Alaska has no poison ivy or oak, but it does have cow parsnip. When bruised, the leaves of this plant can leave a chemical on the skin that makes it very sensitive to the sun, causing a blistered burn. Hawaii has the crown flower and the pencil plant; Both of these have sticky white sap that irritates and burns the skin.

    With poison oak or ivy, the old saying goes: “leaves of three, let it be.” Although it’s true these plants come in “leaves of three”, so do many others. The medic must become acquainted with images of poisonous plants native to their area so they can be identified and avoided.

    Poison Oak

    Poison ivy and poison oak are very similar, with the same chemical compound (called “urushiol”) as the main irritant. The oil is in just about every part of the plant, including the vines, leaves, and roots. Winter does not eliminate the possibility of a reaction, as you can react against even dormant vines or shrubs.

    Poison ivy leaves are generally almond-shaped and pointed. Poison oak often looks more like, well, oak leaves, with scalloped or lobed edges. Poison Sumac is a shrub or small tree, growing up to nearly 30 feet in height in parts of the Eastern United States. Each leaf has 7–13 pointed leaflets and the plant produces whitish berries in the fall. In most cases, berries this color are poisonous, leading to the saying “berries white are a poisonous blight.

    For some images of poison sumac through the seasons, click this link: https://www.thespruce.com/poison-sumac-pictures-4071931

    Of course, other plants may mimic the above. One test that suggests you’re dealing with a plant containing urushiol is to crush parts of the plant containing sap in a folded white paper. Urushiol should turn the paper dark in a short while.

    Although poison sumac has the same chemical irritant present in poison ivy and poison oak, it is far more powerful. Simply inhaling smoke from burning poison sumac has been reported to be life-threatening.

    A person can be exposed to urushiol directly or by touching gardening tools, camping equipment, and even pet fur that has been contaminated. Usually, poison ivy exposure isn’t noticed until physical signs appear. Interestingly, deer, dogs, and cats seem to be unaffected and have even been seen eating it.

    The symptoms of poison oak, ivy, and sumac are very similar, since they all contain the same irritant. The reaction proceeds in phases:

    •             The skin exposed becomes red and itchy.

    •             A rash erupts in a pattern of streaks or patches.

    •             The rash develops into red bumps that take several hours to days to fully develop.

    •             In more severe cases, blisters may form.

    •             Itching can become severe.

    Severe reaction to contact with poison ivy

    Is the reaction from poison ivy and its relatives contagious? Technically, the rash is not. You could, however, possibly come in contact with the urushiol irritant if it’s on other people. A poison ivy rash, even one with open blisters, rarely spreads to other areas of the body that weren’t exposed. 

    The best strategy for prevention, of course, is not touching the plant and getting the toxin on your skin. If you can’t avoid exposure, consider these measures before you head outdoors:

    •             Long pants

    •             Long-sleeved shirts

    •             Work gloves 

    •             High-top boots

    Some recommend an over-the-counter lotion called Ivy Block as a preventative. Apply it like you would a sunblock to likely areas of exposure. Theoretically, it will prevent the oil from being absorbed by your skin. Once exposed, however, wash or shower with Fels-Naptha soap, degreasing soaps used for washing dishes, or Tecnu Poison Oak and Ivy Cleanser as soon as possible.

    The resin or oil from the plant that causes the reaction will remain active even on your clothes, so thorough laundering with special agents will be required. Fels-Naptha soap and Tec Labs products will remove residual resin from clothes. These products are more effective than regular detergent and can be used even several hours after exposure. Rubbing alcohol is another reasonable option and easily carried as hand sanitizers or prep pads, but dries the skin.

    Routine body washing with soap will not be useful after 30 minutes of exposure, as your system will already be producing antibodies. Hot water seems to help the oil absorb into the skin, so use only cold water early on. After all the irritant has absorbed, however, hot water baths are actually recommended by some to relieve itching.

    Diphenhydramine (Benadryl) at 25-50 mg dosages 4 times a day will be helpful in relieving the itching (which can be miserable). It’s important to know that the 50 mg dosage will make you drowsy. Unfortunately, calamine lotion, an old standby, and hydrocortisone cream will probably not be very effective in more than mild cases.

    Severe rashes have been treated with the prescription Medrol dose pack, (a type of steroid known as Prednisone). Prednisone is a strong anti-inflammatory drug and will be more effective in preventing the inflammatory reaction that your antibodies will cause.

    Some astringent solutions such as Domeboro have been reported to give relief from the itching. The active ingredient is aluminum acetate, which is similar to the aluminum chlorohydrate in many antiperspirants.

    Fortunately, even an untreated poison ivy or oak rash will go away by itself over 2-3 weeks.

    There are several alternative treatments for poison ivy, oak, and sumac: 

    •             Cleansing the irritated area with apple cider vinegar.

    •             Essential oils mixed with Aloe Vera gel, such as a few drops of tea tree, lemon, lavender, peppermint, geranium, or chamomile.

    •             Baking soda paste

    •             Epsom salt baths.

    •             Jewelweed (mash and apply).

    •             Chamomile tea bag compresses.

    For those who prefer drinking their tea, passion flower, skullcap, and chamomile are all thought to be soothing to victims of poison ivy.

    Certainly, there are more poisonous plants than poison ivy, oak, and sumac, but the treatment is often the same as mentioned above.

    Joe Alton MD

    Dr. Alton

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