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NOVEMBER 2025 TABLEHOPPING

A Different Type of Scratch Off

Maybe it’s a little late in the season but I write about what affects me and what affected me recently was poisonivy. I think I picked it up trying to do a good deed and lift a fallen tree off a walkway used by cyclists and walkers alike. I did not see the leaves of three people talk about but the roots and vines may contain 10-100 times the Urushoil content of the leaves. It could have been poison ivy, oak or sumac I don’t know which but I know it burned like the acid blood from the Aliens movies. The genus name for the plants is toxicodendron…the very name sounds ominous.

My wife wouldn’t go near me for three weeks which is not conducive to my marital bliss but I could understand her concerns. They say you can’t transmit the rash from one person to another but looking at me she wasn’t taking any chances. Since I did not recognize the exposure at the time I didn’t have a chance to scrub it off immediately which is the appropriate thing. I was actually shocked at how much physical damage it could do. I expected a rash and some blisters and intense itching. It looked terrible, felt horrible and bothered me for weeks! It was causing so much reaction it was causing open sores and deep wounds that I thought might scar me for some time. The worst was night itching. Sprained ankles, sore back, cuts and scrapes I usually ignore but as the rash spread and spread into all sorts of delicate places, I had to act. So, I prescribed for my patients what I always do…a short course of fairly powerful oral steroids. What I found out is that it’s not adequate to treat the symptoms. At least not for me and in reflection not for all my patients who called me for another course of steroids after the first dose didn’t work.

Dr. Ponciano D. Cruz, professor and editor-in-chief of American Journal of Contact Dermatitis, published an article by the University of Wisconsin in which he states, “Severe widespread or rapidly evolving eruptions require medical treatment which may range from topical application to systemic administration of higher dose corticosteroids because the natural history of toxic or dendron dermatitis can last up to 4 weeks. It is important that treatment be provided to cover the duration. A common pitfall is to treat with a six-day steroid dose pack that often produces transient clearing of the eruption with a relapse and flare that is sometimes worse than the original dermatitis. It should be recommended that it consists of a tapering dose between 12 and 21 days. The initial starting dose is approximately 1 mg per kilogram and is tapered over 2 to 3 weeks.”

I got the above quote from the package insert for something I took topically for the poison ivy called Zanfel. I’m sure there are many other home remedies and commercially available products, but this is the one I found on the internet and this is the one that helped me. Maybe not as much as the steroids, but it did help with the intense itching. This cream basically binds with the urushiol and thus removes it from the skin. I found it very satisfying somehow because you have to rub it and rub it into the area where the rash is, and by rubbing it you keep exposing the oil to the binding agent, and eventually the oil can be washed off. It’s apparently effective during any stage of the reaction. If you don’t think the oil has really bound to your skin, you can use soap and water, but it’s likely that after a 10-minute exposure it’s bound to your skin and soap and water won’t work anymore. Poison oak apparently is more likely to reoccur/re-erupt than poison ivy, but both respond to this treatment. If you have more itching, you rewash.

Again, if you have your own remedy that works for you—honey mustard, gasoline, or your grandma’s poultice—by all means use them. Grandma is always smarter than me. On the other hand, if you get exposed to this oil, number one, I would try this topical solution and fall, and number two, when I call my doctor for the steroids, I’d ask him for a longer dose than the usual Medrol dose pack. This episode has drastically changed my approach to this issue.

Until next month…get well and stay well

JT BARRY MD