How a dermatologist knows it's summer – Poison Ivy and allergic contact dermatitis

As a dermatologist, I think about the world from a different perspective and my experience with common activities is not what you would expect. To me, a day at the water park is filled with applying sunscreen to all different body parts, lotion for this part, spray for this part, and a stick for this part, and making sure to cover every spot that a UV ray of sunshine could reach.

Preparing for an average outdoor run, something I enjoy involves:

• A running hat. I don’t wear a wide brim because it would slow me down, (don’t tell my colleagues)
• Sunscreen on the back of the ears and neck
• Long sleeves and pants

And finally, yard work!

I don’t do a lot of yard work, but when I do partake in an outdoor activity that may come within 3 feet of a bush or a branch of a harmless small weed. I’m bringing out the big guns:

• a fun wide-brim hat
• the long sleeves

But this time, the “aftercare” experience is the most impressive and slightly overreaction.

Battling Poison Ivy and Allergic Reactions in Summer's Arrival

The post-yard work clean-up involves removing all the possible vegetation-contaminated clothing and putting them in a special isolated laundry basket. Then washing my hands and arms as if I’m about to enter the operating room to perform neurosurgery.

My approach to normal involves fun activities that can sometimes be quite overwhelming. It all comes from the fact that I get to observe the most extreme skin reactions, especially poison ivy.

For me, the arrival of summer is not marked by the arrival of June or simply the fact that temperatures reach 90 degrees daily but by a much more accurate and consistent metric, which is the sudden onset of patient phone calls. They reported, “I have an itchy rash, that I’ve never seen before, and it's been spreading all over. I’m certain, that I have something contagious and, I need help right away.”

This is poison ivy or some form of plant-based allergic contact dermatitis. Early intervention is needed to help prevent the next 2-3 weeks from becoming a miserable and uncomfortable skin experience.

WHAT IS POISON IVY?

Poison ivy is a plant-based ALLERGIC CONTACT DERMATITIS. For your immune system, it's an over-activation and a non-harmful plant substance that contacts your skin. It’s a great example of something with good intentions, specifically your immune system, that wants to protect you from harmful and dangerous pathogens such as:

• staph aureus
• harmful bacteria
• viruses

Your immune system gathers the troops specifically to the site where the poison ivy has contacted the skin and prepares to get rid of it.

Now, here’s the thing about the immune system, it doesn’t mess around. When it gets turned on it hears the sirens being blown, it goes from one lonesome guardian to millions of soldiers armed with all sorts of heavy artillery. However, it takes time to go from a single watch guard to a whole military fleet so it can take 1-2 weeks for a full allergic contact dermatitis, or poison ivy, response to develop.

The Challenges in Diagnosing Poison Ivy Rash

As such, people often don’t connect the inciting event, the actual point of contact, to the terrible itchy poison ivy rash that has broken out on the exposed areas of their body. It is the challenge the dermatologist faces in trying to piece together the clinical presentation of the skin eruption with the patient’s history over the previous 2 weeks.

It's not unusual for me to suggest the diagnosis of poison ivy but the patient denies any possible exposure and won’t accept the diagnosis. On several instances, I’ve received follow-up phone calls from patients who only hours or days after the clinic visit can recall a walk in the local forest preserve a short bike ride, or 30 minutes in the backyard cleaning up some leaves.

Recognizing and Treatment to Prevent Poison Ivy

There are several key poison ivy symptoms. It's pruritic – the medical term for itchy but it’s not just itchy like eczema is itchy, it's uncomfortable. The patient has trouble sleeping and concentrating at work – it can drive someone crazy and the skin reaction can be alarming. This is why it's important to recognize this breakout early and stop poison ivy itch before it becomes a full-blown explosive inflammatory process in the skin.

The skin can blister and look like a serious burn. It can look scary and could leave poison ivy scars. For milder cases, it can be more subtle pink plaques, often in linear patterns, or irregularly shaped patterns. I’ve seen several cases, where the poison ivy rash on the skin is very subtle and hard to detect. However, the discomfort and itching are extreme and disproportionate to the observed poison ivy spots.

CAUSES OF PLANT ALLERGIC CONTACT DERMATITIS

Warming: This paragraph contains unnecessary, and way too long Latin names of plant families and species.

Poison ivy is the term I use to describe plant allergic contact dermatitis. It's basically like calling all soda by the name of Coca-Cola. The most common cause of allergic contact dermatitis is the plant family of Anacardiaceae which belongs to the Toxicodendron genus.

The actual names of the plants, which normal humans use are:

• poison ivy
• poison oak
• poison sumac

Poison ivy is the most commonly encountered and is present in every state in the continental U.S., another plug for all of us moving to Hawaii. The actual material within the plant that causes the poison ivy rash on the skin is named urushiol.

Less common plant species that are also part of the Anacardiaceae family are:

• Japanese Lacquer tree
• Mango tree
• Cashew tree
• Indian marking nut tree
• Ginkgo tree

I’m no botanist and don’t plan to be one soon or in my next life. But, what I take from all these details about urushiol-containing plants is a lot of them, that can cause this intense allergic contact dermatitis. People can be warned to look for the typical 3-leaf plant to avoid treating poison ivy rash. In truth, most people are oblivious and do not find these plants but still end up getting exposed during common outdoor activities.

Unseen Dangers of Poison Ivy

Another interesting concept is that poison ivy rash is not necessarily from direct contact with the poison ivy plant. It may be from direct contact during activities such as weeding or gardening, that’s the obvious scenario. However, I’ve seen poison ivy symptoms occur from people taking a walk in the local forest preserve or hiking trail and contacting a plant that is overhanging a hiking trail. People often overlook or are unaware that poison ivy can also occur from aerosolized plant material.

So, lawnmowers or burning plants can also be an effective way to cause poison ivy symptoms. These types of aerosolized allergic contact dermatitis can be severe and disfiguring because it can develop on a person’s entire face and neck.

Role of Pets in Spreading Allergens

Keep in mind that animals can carry the urushiol material from plants. More often than I would expect, I have identified the source of an allergic contact dermatitis skin reaction to the fact that my patient sleeps with his or her dog. It’s an endearing scenario but people need to consider that dogs roam the outdoors run through all sorts of plant material and have all sorts of exposures that are not washed off after entering the house.

Pay attention to the fact that pets are exposed to plant material and carry plenty of bugs so be aware of poison ivy and bug bites from your most endearing pet that sleeps in your bed at night. Advising people to change this pattern can be met with some harsh resistance, another challenge of diagnosing and treating poison ivy.

POISON IVY TREATMENT

The way I think about treating poison ivy is – prednisone, prednisone, prednisone, and a little non-sedating antihistamine. But seriously, oral steroids for poison ivy, most commonly given as prednisone, can be very helpful in shutting down the unwanted overreaction of the immune system. I’ll sometimes give steroid poison ivy medicine as well which can help directly heal the poison ivy rash traumatized skin.

So, please, when summer arrives and you develop a weird itchy rash that you’ve never seen before and are afraid that you have something contagious, find a dermatologist right away to prevent several weeks of misery and healing. I highly recommend Dappledoc to get your best treatment for poison ivy right away without ever leaving your house. You can even submit your case at 3 am when you can’t sleep from all the scratching and I’ll be there to help you.