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Leaves of Three, Let It Be!

By: Trenton Dunn, Pharm.D.

Many of us in Arkansas may have heard this line once or twice as we grew up and played outside or even as we venture outdoors as adults, “leaves of three, let it be.” This sage advice specifically deals with the plants having a hallmark three leaves that protrude from a single stem: poison ivy, poison oak, and poison sumac which contain chemical urushiol.  In the United States, data estimates that nearly 80% of the population is sensitive to this chemical and as high as 50% will have a reaction when contact is made in nature.

How do I recognize Poison Ivy?

In Arkansas, poison ivy is the primary offender.   If looking for this in the wild, it is known as a “climbing vine” with small hairs coming off the vine.  It typically grows up poles, trees, buildings, and slopes but can be found along trails, streams, and rock walls.  The leave pattern will have three leaves coming from one central stem.  Another marker to look for would be a black tarry liquid that has hardened near an area you suspect has poison ivy.

Can I get Poison Ivy just by being near a plant?

Usually the plant must be disturbed or damaged in order for it to “defend” itself.  The fluid from within the plant is where the chemical is found.  Contact with this fluid from this plant is what causes the skin to become inflamed.  When rustling around an area that has poison ivy it is easy to damage the plant just enough to get a small amount of the fluid to extrude.  This small amount of fluid would be enough to cause a reaction.  Outside of cases where the leaves have been burned, the chemical should not be present in the air around the vine.

shutterstock_92879602What happens if I’ve been exposed to Poison Ivy?

Symptoms of the contact dermatitis usually begin to appear anywhere from 4 hours to 4 days later.  The results is usually streaked lines of raised inflammation with vesicles (fluid filled sacs) or papules where the contact occurred.  The symptoms can peak from 1 day later to 2 weeks later.  The rash can appear as though it’s spreading, though this is actually the result of the varying thickness of skin across the body and not the fluid that’s leaking from the rash.  If not careful, it’s possible to re-expose if clothing or fingernails have the active black resin still present.  Untreated and without complications, the entire process should resolve itself around 3 weeks.

Help! I’ve just walked through some Poison Ivy, What do I do?

The most important thing to do is to clean the area as soon as possible.  Studies have shown that as much as 50% of the offending chemical can be removed if washed within 10 minutes but falls sharply to 10% in 30 minutes and 0 at 2 hours.  Despite not being able to remove the actual resin after 2 hours, washing can significantly reduce the severity of rash.  Using a simple face wash or typical soap that’s used for handwashing for at least 2 minutes is suitable enough to remove the offending material.  Do not harshly scrub the area as this can actually make the dermatitis worse.  A commercial product, Tecnu, is available that has been shown to be effective at removing the resin from poison ivy though Dial soap has also shown to be effective at a much lower cost.  After the resin has been cleaned off the skin and fingernails, it’s important to remove anything worn during the contact and wash with warm soapy water as well to prevent re-exposure.

I have a Poison Ivy Rash. What can I do?

First things first: do not scratch! We are not worried about spreading the fluid anymore because the area has been cleaned and finger nails scrubbed; however, scratching and breaking the blisters can allow a bacterial infection to set in, complicating the situation.  One of the simplest things to treat itching is a cool shower.  Not being able to stay in a cool shower all day, the next best bet for itching is calamine lotion; it is not recommended to use either topical Benadryl or benzocaine as they can actually cause a topical reaction themselves.  Though substantial variance between patient responses is common, topical hydrocortisone cream applied four times a day has helped many people with itching and inflammation.  If the weeping lesions is the primary concern, a topical astringent such as Domeboro can dry the area up nicely.  Itching being a problem while lying in bed at night, a first generation antihistamine (diphenhydramine, chlorpheniramine) can be used to provide just enough sedation to sleep.

Thanks for the info, but I still have questions.

Good news! All of our pharmacists at Collier Drug Stores are well versed in helping out with personalized regimens and recommendations regarding your specific poison ivy battle and enjoy being able to help.  Come by any of our locations and we will be excited to get you going in the right direction.