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Getting at the Itch

The coasters sang its tune:  Poison ivy Lord’ll make you itch. Poison ivy is elusive, clever and conniving. It camouflages itself in the undergrowth, its three-leaf danger going undetected by the unwary. It counts on nature’s attention-getters to distract its victims, to weaken the vigilance of those whom it has affected before. Most folks don’t know it got them until about 48 hours later.

The allergic breakout and unavoidable itching begins a tug-of-war between self-control and weakness of the flesh. I won’t scratch, I won’t scratch, I won’t scratch thinks poison ivy’s poor prey, who then gives in and excoriates the patches of irritation on his skin. The intensity of the discomfort may not drive a person quite to insanity, but it will have him looking hard at the display of metal brushes in the hardware store. Temptation to perform a full Silkwood-style scrape-down with the bristles will have him itching like a madman.

Urushiol oil, a resin in the plant’s leaves, flowers, berries, stem and roots, causes the rash of clear blisters that dermatologists refer to as contact dermatitis. “Wherever the resin touches,” says Dr. Sanders Callaway of Dermatology Specialists of Augusta, “that’s where you’re going to get the poison ivy.” It can take only minutes for the oil to bind to the skin.

There are many misconceptions about the poison ivy rash. Two of the most popular beliefs are that it is spread over the body by scratching and that it can be spread from one person to another via broken blisters. Dr. Callaway assures people that neither of these fears is true. Only urushiol oil causes the rash, not fluid from the rash’s blisters. The rash itself is not contagious. Without thorough washing, however, the oil can stay on the skin and under the fingernails for an extended time and continue to be spread anywhere on the body the person touches or scratches. Thus, it’s essential to properly wash exposed areas, including under the nails.

New areas of rash and itching can develop after the initial outbreak. “This is where the myth of spreading it on the body by scratching probably comes from,” says Dr. Callaway. The real cause may be due to either the pattern of the immune system response or to re-exposure via the plant directly or an object that has the plant resin on it.

The urushiol oil can cling to objects, such as clothes and gardening tools. “The resin is potent and can remain potent for years,” Dr. Callaway warns. Because urushiol is clear, its presence cannot be visually detected. Anything that has the oil on it, including a pet’s fur, can transfer it to human skin. It’s easy to get the impression that poison ivy is being passed person to person via broken blisters when actually urushiol oil on a shared object or on clothing is the culprit.

A third misconception about poison ivy often results in coating oneself with calamine lotion. Crusty pink splotches on the arms and legs tell a story opposite of what was thought to be true. The person who says, “I walked through poison ivy and never broke out. I’m not allergic,” should beware. First, every part of the plant contains the toxin, but it must be bruised, broken or crushed in some way to release the resin. So, it is possible to touch the plant and not breakout. Second, the appearance of an allergic reaction, says Dr. Callaway, depends on how much exposure a person has had to the resin. “With poison ivy, a person has to develop sensitivity to it before he will break out,” he explains. Therefore, the first contact doesn’t result in a response. “The second and subsequent times you’re exposed to it,” says Dr. Callaway, “that’s when you’re going to get a reaction.” Even two instances of contact with the plant that don’t lead to a reaction cannot guarantee a person permanent immunity. “I think ultimately with repeated exposures almost everyone becomes sensitive to it,” says Dr. Callaway.

Reactions vary in severity depending on how much urushiol oil contacts the skin. Brushing against the leaves transfers less oil than, say, touching bare skin to a broken stem.  Dr. Callaway reports that some research has linked a single, massive allergic reaction to poison ivy to a degree of decreased reaction on future contact. Even so, he discourages intentional intense exposure to poison ivy with this end in mind. The extent of the reaction necessary to achieve any resistance, and the misery the person would suffer, is not worth it, he says. It’s better to avoid contact with the plant all together.

If caught in that unpleasant state of balancing self-control with the overwhelming desire to scratch the flesh from your bones, take heart. Poison ivy is a self-limiting affliction that will resolve on its own. Symptoms clear up within two to four weeks after they present.

Most people don’t have the stamina to endure the extreme itching caused by the poison ivy rash without self-medicating or seeking a physician’s care. Pharmacies carry several over-the-counter (OTC) treatments for poison ivy. Oral antihistamines, such as Benadryl, can relieve the itch and dry the blisters. It may also cause drowsiness and enable a person to sleep through the night without discomfort. ­­Lotions containing hydrocortisone or other corticosteroids also aid in relief of itching, but they are not a cure and do not speed recovery.

Do not self-treat with topical anesthetics or topical antihistamines. Any lotion or ointment containing diphenhydramine, benzocaine or zirconium should be left on the shelf. Applying these to already irritated skin can cause secondary allergic reactions and compound the misery. Calamine lotion and oatmeal baths, medicine cabinet staples for treating poison ivy, soothe the itch more effectively.

Mild cases of poison ivy are manageable with OTC steroids. Dr. Callaway advises patients, “When you can’t sleep or it’s affecting your daily activity, seek medical attention.” Also see a doctor if the rash appears on the face or genitals or a high percentage of the body is affected. Difficulty breathing or swelling of the tongue or eyelids demands immediate medical intervention.

It’s possible to touch the plant and not breakout. The appearance of an allergic reaction depends on how much exposure a person has had to the resin.

Moderate to severe cases of poison ivy are treated effectively with prescription topical steroids and in some cases prescription oral steroids. Patients must follow dosing directions carefully when using these medications. Applying the lotion more than recommended can result in a secondary reaction. Failing to take the full three-week course of oral steroids as prescribed can result in a vicious rebound of symptoms.

Aside from the unbearable itching, sufferers worry about how the red and angry rash looks to others. Covering the skin with long sleeves and long pants relieves embarrassment, but may exacerbate the symptoms. When the affected areas become hot, the itch heightens. Keeping affected areas cool can reduce inflammation and itching by constricting the blood vessels. Wear loose fitting clothes and keep the rash uncovered, if possible. Ice packs and cool compresses offer relief too.

Anyone who has ever suffered a case of poison ivy will testify that prevention trumps treatment. “People need to learn to identify it,” says Sid Mullis, extension coordinator for Richmond County. Poison ivy may be a vine or a bush. It has bright green, shiny leaves in alternating clusters of three. 

Mullis says, “The best way to protect from exposure is to wear long pants, long sleeves and gloves.” Use of an OTC protective lotion, such as Ivy Block, prior to working outdoors may provide additional security. “There’s some benefit,” says Dr. Callaway, “if you’re highly allergic and apply it liberally.” Though available, allergy shots and pills touted to prevent sensitivity to urushiol are not promising defenses. “There’s no way to desensitize people,” says Dr. Callaway.

If poison ivy comes into contact with skin, scrub thoroughly with soap and water. Using cold water will keep pores closed, creating a barrier against the resin’s penetration. Depending on a person’s sensitivity, the resin stimulates the body’s response within five to 30 minutes, so don’t wait to wash. Don’t forget to rinse any tools, too, that may have urushiol on them and to remove and launder clothing.

Eliminate poison ivy in your landscape by spot-treating it with an herbicide or pulling it out. Always wear gloves, even in winter. Poison ivy is deciduous and looks dormant, but the resin in the vine or stem is still potent. If it can’t be pulled out or spot-treated, Mullis recommends severing the vine and using a small spray bottle to immediately coat the fresh cut with a solution of five parts water to one part brush-cutter herbicide containing triclopyr.

Do not burn poison ivy. Think about what the urushiol oil does to the skin with mild contact. “Imagine if you inhale that resin what it can do to those airways,” says Dr. Callaway. Once it is airborne with smoke, it can drift downwind and affect other people. Dispose of poison ivy in regular leaf and limb pickup. Check for the presence of poison ivy and remove it before burning brush.

    Tempted to wear shorts while weed-eating or to pull unidentified vines from your shrubbery with bare hands? Stop! Remember that little ditty by the Coasters: You’re gonna need an ocean/ Of calamine lotion/ You’ll be scratchin’ like a hound/ The minute you start to mess around/ Poison ivy/ Poison ivy. 

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