Parenting: Children

Recently, second grade teacher Pat Henry was faced with a spate of absences in her rural Pennsylvania classroom. No, it wasn’t a highly infectious bug like chicken pox or the flu; it was something much simpler and just as potentially debilitating – poison ivy.

“Two of the children had it on their faces so badly that their eyes were swollen shut, and they had to be put on steroids,” says Henry. “They both missed school for an entire week.”

In the case of Henry’s students, several of the pupils were neighbors and played together in the same stand of woods where they probably were exposed to the plant. A different child’s doctor theorized that he got it from his cat, but there were at least two others who had never had poison ivy before and how they got it remains a mystery to their parents and doctors alike.

How the Body Reacts
That doesn’t surprise Dr. Anthony J. Mancini. Dr. Mancini is a pediatric dermatologist at Children’s Memorial Hospital in Chicago, and the rashes from poison ivy, poison sumac and poison oak are all too familiar to him. He notes, in fact, that he doesn’t really lump all three plants into one category called “poison ivy” as many do, but admits that the net result is the same – intense itching, redness, blisters, swelling and misery.

In the case of the mystery exposures, Dr. Mancini says that one of the notable features of reactions to the poison plants is that an initial reaction can come up to 20 days after exposure. This can be particularly puzzling for a patient who has never had a poison plant reaction in the past.

“There are subtle immune differences in everyone, so as a result, some people may never react to poison plants,” says Dr. Mancini. “Some people may be prone, but it may take more than one exposure for them to have a reaction. Since that initial reaction can come up to three weeks after exposure, it’s not always easy to pinpoint what the child was doing that exposed him or her to the plant.”

Actually, it’s not the plant that’s the problem, but the poisonous sap, called urushiol, that the plants have in their stems, leaves and roots. When a person comes in contact with the plant, the urushiol gets on their skin and absorbs very quickly. As Dr. Mancini notes, the initial reaction can take a while, but subsequent reactions appear very quickly – usually within 12 to 48 hours.

Dealing With Poison Ivy
Unfortunately, if you don’t know you’ve been exposed, there isn’t much you can do to prevent an outbreak once it starts.

“If you are a person who knows you tend to have severe reactions, you can contact your doctor as soon as the first patch appears, explain that this may turn into a problem for you and ask for the oral steroid prednisone,” says Dr. Mancini. “But beyond that there’s not much you can do.”

Dr. Mancini also cautions that steroids are not to be given lightly, especially to children. There are side effects, and it’s a treatment that’s usually reserved for severe cases. A severe case is when the rash is on the face and eyes or there is extensive involvement over at least 25 percent of the skin surface or a secondary infection.

A secondary infection is characterized by pus, fevers, severe scabbing or expanding redness. Most of these secondary infections are a direct result of scratching the rash, so the best action when the break out starts is to immediately soothe the itching with cool compresses and a topical anti-itch cream such as calamine lotion, cortisone cream or Aveeno cream.

Parents should make sure children’s nails are short and clean and monitor them to make sure they are scratching. Using oral antihistamines, such as Benadryl or its equivalent, can also help to control the severe itching.

Avoiding Poison Ivy
But the first line of defense is to avoid the plant altogether. Helene Lobas, a Pittsburgh-area C.R.N.P. who treated one of the second grade students for his severe breakout, recommended to his mother that she find some pictures of poison ivy, oak and sumac and, after he recovered, take a little nature walk through their woods, pointing out the plant as they went and teaching him how to recognize and avoid it.

The old saying, “Leaves of three, let it be,” is a good guide, but sometimes the plants can have up to five leaves, so a good field guide is a better idea. Dr. Mancini adds that dressing for hiking – long-sleeved shirt, shoes and socks, long pants tucked into socks – is a good idea for any foray into the woods.

Unfortunately, it’s not possible to always avoid the oil completely. The oil can get on the fur of pets and transfer to human skin by petting and holding a cat or dog.

If you do know you’ve been exposed to the oil, wash well with soap and water, and wash all clothing that may have come into contact as well. Dr. Mancini is skeptical about anecdotal evidence that the urushiol stays on inanimate objects such as gardening tools and clothing for any length of time, but there are other experts who are just as firmly convinced it’s true. It’s probably better to be safe than sorry. If it’s been near poison ivy, wash it.

Dr. Mancini also has high praise for products on the market such as Ivy Guard, which prevents the oil from absorbing into the skin, but there are so many factors that influence a reaction – such as humidity, temperature and condition of the skin – that there are no magic weapons.

When you do have poison ivy, it can’t be spread from person to person or from one part of your body to another, but it may seem that way because you can keep breaking out over a period of a week or so. This is merely the skin’s own timetable for reacting to the irritating oils.

The fact is that this problem that’s caused by nature can really only be cured by time. The rash usually runs its course in 14 to 21 days. It may seem like the longest 21 days of your life, but it will eventually go away.