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<td align="middle" width="100%"><a name="Poison Ivy"><big>Poison Ivy</big></a>
(Toxicodendron radicans)

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<p align="center">The leaves of Poison Ivy are compound, each leaf comprised of 3 leaflets. In general, the stalk of a leaf, whether simple or compound, is the petiole, and the stalk of a leaflet is a petiolule.

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<p align="center">The fruit of Poison Ivy is referred to botanically as a drupe, and is greenish-white in color.
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<p align="center">A close look at the compound leaves of Poison Ivy shows 3 leaflets with distinct petiolules, one of them long and clearly differentiated from the blade of its leaflet.</tbody></img></img></img>

Poison Oak
(Toxicodendron diversilobum)

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<p align="left">Poison-oak is usually a shrub, though it sometimes becomes a vine several inches in diameter that grows high into the oak trees attached by air-roots. The leaves DO come in threes. They are shiney, without prickers, and the middle leaf has a distinct stalk.
<p align="left">It is harder to identify Poison Oak in the winter, when it loses its leaves and looks like erect bare sticks coming from the ground.
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<p align="left">Poison Oak is highly variable. It varies from shrub to vine. The leaves vary from red to green. It has erect stems, leaves in threes, small greenish flowers, and smooth seeds that are about 1/4 inch across. It is often lush in coastal canyons, but sparse in the mountain woodland. It is deciduous, and often looses its leaves in late summer, leaving it hard to recognize. The erect branches give a clue.
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<td align="middle" width="100%"><a name="Poison Sumac">Poison Sumac</a>
(Toxicodendron vernix)

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<p align="left">(Toxicodendron vernix) can be found mainly in the eastern United States. It grows in peat bogs and swamps. To identify Poison Sumac, look for the fruit that grows between the leaf and the branch. Nonpoisonous sumac has fruit growing from the ends of it's branches.
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<p align="left">Poison Sumac is a woody perennial shrub or small tree growing from 5 - 25 feet tall. It is commonly found in the eastern part of the United States but also grows as far south and west as Texas. It reproduces by seeds grown on drooping clusters of white, berry-like fruits. Leaves are arranged in an alternate pattern on the vine.
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<p align="left">There are about 7-13 leaflets forming a feather-like appearance. The foliage has brilliant orange or scarlet coloring in the fall.</tbody></img></img></img>


<font face="Arial"><a name="The Culprit:">The Culprit:</a>


<font face="Arial">All of these plants contain an oily resin called Urushiol ("you-ROO-shee-ol") which causes the rash. Urushiol has as its dermatitis-producing principle, pentadecylacatechol. This chemical does not evaporate and dries quickly on clothing, shoes, animals and tools.


<font face="Arial">Urushiol remains potent for a year or longer. Therefore, it is important to wash any tools, shoes or clothing after exposure to poison ivy. The resin will remain active on these articles and can cause a rash months, or even years, later. Removal of the oil with an effective cleanser, such as Tecnu<sup>®</sup> is helpful to avoid contaminating unsuspecting victims in the future.


<font face="Arial">It has been estimated that 70 percent of the population is susceptible to poison ivy. Dark-skinned individuals seem less susceptible than others. Elderly individuals and infants are not as susceptible to the resin but they can still get it. Children become susceptible by age 3 and are highly susceptible by age 12. You can develop the reaction at any time during your life. Sensitivity is just a matter of being exposed enough times until the body becomes allergic to the Urushiol.


<font face="Arial">Those who are exposed usually pick up the resin on their legs and palms and then transfer it to other areas, often their face and genitals. It only takes about 15 minutes for the resin to begin to bind with the keratin (top) layer of the skin, which then sets the inflammatory process into motion. It is noteworthy that a rash rarely breaks out on the palms, since the keratin layer of the skin is often too thick for the resin to bind there.


<font face="Arial">The best thing to do if you know you've been exposed to poison ivy / oak / sumac is to wash your skin immediately with rubbing alcohol (or Tecnu<sup>®</sup>), in which the resin is soluble. Beer or other beverages containing alcohol will help to dissolve the resin if rubbing alcohol is not available. Soap works, but not as well. If the oil has been on the skin for less than six hours, a thorough cleansing with strong soap, repeated three times, may lessen or even prevent a reaction.


<font face="Arial">If you do wash with soap, make sure you do it in the shower so the resin is washed down the drain, not deposited in a slick on the sides of the tub to spread to others. If you can wash the area with plain cold water within a few hours of being exposed you may be able to remove a lot of the urushiol. Use a LOT of COLD water. Be aware that the water is simply spreading the oil around; the idea is to use enough water to wash all of the oil from your body.
<p align="center"><font face="Arial">Do not use hot water which can open your pores to the oil.


<font face="Arial">The resin is absorbed quickly into the skin. If the oil is on your skin for as little as ten to fifteen minutes, it can lead to an allergic reaction. The eruption is characterized by redness, papules (bumps), vesicles (blisters) and linear ("in a line") streaking. Mild cases can last 5 to 12 days. More severe cases can last up to 30 days or longer.


<font face="Arial">The eruption usually appears within two or three days but may occur within eight hours. The eruption rarely is delayed longer than ten days.


<font face="Arial">Once the rash appears, the original oil has all bonded to the victim's skin, so it can't be spread to others.


<font face="Arial">Contrary to popular belief, the fluid in the vesicles or blisters is not allergic and will not spread the rash. The blisters are the body's natural allergic reaction to poison oak and poison ivy. If the blisters break and ooze, the fluid does not contain the oils that cause spreading. The rash will frequently break out in stages and continue spreading for the first 1 or 2 days.


<font face="Arial">If new areas of rash appear after 3 days, you are probably getting re-exposed to the plant oils, most likely from contaminated clothing, tools, or even your cat or dog (their fur protects them but can harbor the oil for a prolonged period of time). As mentioned above, the resin will remain on any exposed (but uncleaned) objects such as clothing or equipment. If you put on your exposed shoes a week later, you can wipe the resin from your shoes onto your face or other areas.


<font face="Arial">Interestingly, the urushiol can be vaporized when exposed to a fire. If you have a neighbor who is burning poison ivy, the resin will rise with the smoke. If you are downwind when the resin cools off and rains back down to earth, you could receive a coat of urushiol on any uncovered areas resulting in a surprise case of poison ivy.


<font face="Arial">Under no circumstances should you burn the plant; the smoke is as potent as the plant itself. Inhaling the smoke can produce a systemic reaction, including potentially serious, and life-threatening, lung inflammation.



<font face="Arial"><a name="Treatment:">Treatment: </a>
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<font face="Arial">Most of the treatments are aimed at reducing the itching until the self-limited rash runs its course, which takes about two weeks. Since easing the itching is the important result, trial and error works very well. If one of these suggestions seems to work, by all means, stick with it. If it's not working or seems to worsen things….please stop.


<font face="Arial">Never break the blisters! An open blister can easily become infected and lead to blood poisoning. If the blisters break, cover loosely with a sterile bandage. In severe cases, see your doctor.</dir>
<ul>[*]<font face="Arial">Compresses.[/list]
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<font face="Arial">Most people find that cool compresses in one form or another are quite soothing. Try using a towel or wash cloth soaked in either plain tap water, Epson salt water (up to about 2 tablespoons of salt per cup, stir until the salt dissolves) or Burow's Solution (an astringent solution -- you can make it yourself using Domeboro tablets or powder--available over-the-counter). This can help relieve the intense itching and remove any dry crust that has formed as a result of the rash. Let the water dry on the area, leaving a salt dust covering. Do this a couple of times a day (or more).


<font face="Arial">A fan blowing over the cool compress will diminish some of the heat of the itching and help to dry up some of the ooze coming from the rash. As the skin is cooling, the blood vessels compress and that cuts down on the itching and the new ooze. This is especially good during the two or three worst days of the rash. Along the same lines, some dermatologists recommend rubbing an ice cube gently over the rash several times a day, then letting the skin air dry. Soaking in a tub, particularly using an oatmeal bath such as Aveeno®, can also be very soothing to the itch. Be sure the bath is cool or lukewarm -- but not hot -- as heat tends to make the rash even more inflamed. (I'm aware that some people maintain that a VERY hot shower can dull the pain and relieve some itching. I, personally, do not recommend heat therapy for Poison Ivy).</dir>
<ul>[*]<font face="Arial">Topicals[/list]
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<font face="Arial">After cooling your skin (using any of the forms mentioned above) coat the rash with a lotion such as Calamine®. This continues to help relieve the itching and dry up the blisters. Be sure to check the expiration date on an old calamine bottle in your medicine cabinet, since it may not be effective after the expiration date. Calamine may not seem to do much, in some cases, but I don't think it will hurt anything and is worth a try in the early stages.


<font face="Arial">Be sure the lotion does not contain benzocaine, zirconium, or a topical antihistamine, such as Benadryl® (which is in Caladryl®). These can actually make the rash worse by producing their own allergic reactions when applied to already sensitive skin.


<font face="Arial">Smearing on 1% hydrocortisone cream (available over-the-counter without prescription) may give some relief, but is nowhere nearly as effective as the potent topical corticosteroid preparations available from your physician by prescription. These can help suppress the itching and give temporary relief, but do little to hasten the drying up of the rash.


<font face="Arial">Special Note: For on-the-trail treatment and prevention you can't beat nature's own remedy, jewelweed. The Native Americans used Jewelweed. It is usually found in moist, shaded areas and is identified by it's waxy leaves. After a rain or heavy dew, water beads up on the waxy leaves and looks like jewels. It's almost always found close to ivy, so it's usually availible when you need it. Crush a few leaves and stems and rub them on your skin, or crush and soak in water for a larger amount. You can also put a mess of jewelweed in a large glass container and make a "sun tea" out of it to use as a compress (not to be taken internally) to help soothe the eruption if it develops.</dir>
<ul>[*]<font face="Arial">Antihistamines[/list]
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<font face="Arial">Benadryl® is available over-the-counter without prescription and can help with the itching. Taking Benadryl® at nighttime will make most people drowsy and help them sleep through the night without itching. Again, don't use Benadryl® cream or spray topically, because this can cause its own reaction. Several other antihistamines (Atarax® , Periactin® , etc.) are available by prescription when you see your doctor and may be more effective than over-the-counter products.</dir>
<ul>[*]<font face="Arial">Steroids[/list]
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<font face="Arial">In moderate to severe cases of poison ivy, poison oak, or poison sumac it is a good idea to see your doctor. Sometimes an oral corticosteroid such as prednisone may be useful.


<font face="Arial">These are not the steroids abused by some body-builders. This class of corticosteroids is produced by your own body and plays an important role in reducing inflammation.


<font face="Arial">Systemic steroids produce rapid resolution of both the itching and the rash. If they are needed, a gradually tapering dosage over about 12 days should be given. There are "Dose packs" available by prescription which make the dosing regimen a bit easier to follow. When taking steroids, I personally recommend taking the entire days dose in the morning after a meal. This is more convenient than dividing the dose during the day and is similar to our bodies circadian rhythm of secreting more natural steroid in the morning. Check with your personal physician if a steroid has been prescribed for treatment.


<font face="Arial">The dosage needs to be tapered in order to avoid side effects after discontinuing use. The entire 12 day course should be taken since stopping too early may result in a rebound rash nearly as bad as the original. Some physicians prefer to use an injectable steroid instead of one taken by mouth.


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<font face="Arial">by Charles H. Booras, MD


<font face="Arial">Source: <font face="Arial">http://jaxmed.com/articles/Diseases/poison_ivy_dermatitis.htm</dir>

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