Poison Oak: Recognize/Avoid/treatment options

Poison Oak: Recognize/Avoid/treatment options

I know a lot of people in other cities and countries who are literally stuck inside during this period of quarantine. We are fortunate in the Bay Area that we are allowed outside for air and exercise. On all of your excursions, you should have a mask handy in case social distancing is the least bit tricky. Pee before you go and bring along a little bottle of hand sanitizer. Last week I was taking a walk with my brother-in-law Richard. I am fortunate enough to have him on my ‘quaranteam’. We don’t get to hug, but we do go on nice long walks together. We make sure to pay attention to all the beautiful flowers, birds and views along the way. We lovingly swear at each other when the one who was leading the way takes a route that ends up requiring us to climb up some absurdly steep hills. So there we were, maintaining a proper single file along some trails. I usually follow the advice that warns to stay in the center of the trail, but in this new climate of social distance, when anyone comes by in the other direction, everyone politely pushes against the bushes alongside to give people space. As we moved as far to the side as we could to make room for a passing bike rider, Richard asked, “What does poison oak look like”? Yikes. We got lucky. The greenery in this particular location was innocent, but it occurred to me that this might be a timely reminder for everyone to brush up on their knowledge about poison oak (so that they don’t brush up on the plant….) The weather is just getting warmer and when I was still working as the advice nurse at Noe Valley Pediatrics, this was the typical time of year for me to get multiple calls about poor little patients with probable poison oak. Nearby Glen Park is a common culprit, but by no means the only one. The symptoms start with a small itchy rash that then spreads over the next several days into weepy, nasty blisters. The rash can begin within a few hours of contact, but it might not actually show up for several days. It usually takes about 2 weeks to clear up. At least three out of four people coming into contact with the plant will end up with a problem, but some folks are much more sensitive than others. As with most allergies, the reaction tends to get worse with each exposure. The substance that the skin is reacting to is an oil called urushiol (ooh-roo-she-all). Urushiol is found in all parts of the poison ivy, oak and sumac plants. When urushiol gets on the skin it binds to the skin within 10-20 minutes. At that point the urushiol becomes extremely difficult, if not impossible, to get off the skin with simple soap and water. The oil can linger under the fingernails. The rash itself is NOT contagious, but if you still have oil under the nails, it can be spread from the scratching. The key is to wash any possible areas that came in contact with the plant immediately after any possible contact. If you are spending time outdoors please keep a product called Tecnu in your backpack. Simply apply Tecnu to dry skin, rub vigorously for two minutes, and rinse with cool water or wipe off with a cloth. When used within 2-8 hours after exposure to poison oak, ivy or sumac, Tecnu can remove urushiol oil before the rash begins. Once a poison plant rash has started, washing with Tecnu is still somewhat useful because it helps remove any free oil on the skin allowing the natural healing process to begin without the possible spreading of poison ivy or oak (re-contamination). If you don’t have that, an alcohol based hand sanitizer is helpful. You probably all have little bottles of that in every one of your pockets! Once you are home from your walk, some folks use dishwashing detergent. Dawn is especially good at removing oil. Avoid using warm water because that will enhance the penetration of the oil. Poison ivy and oak oil can also spread from contaminated clothing, shoes (don't ignore the laces), backpacks, gloves, tools and pets. Sports equipment such as golf bags and gardening tools are other possible sources. Since urushiol oil does not evaporate, it can remain on these items for months or even years at a time. Get in the habit of washing any suspicious objects before storing them so that they don’t cause trouble later on. All exposed clothes should be removed and soaked in a pan with Tecnu prior to being washed. Pets are actually a pretty common culprit for spreading poison oak. If you have a dog, try to keep them on the paths if you are out hiking; dogs can get the oil on their fur and it will transfer to humans when you snuggle them. Pets can be wiped off with tecnu prior to being washed off with a pet shampoo. If you aren’t the dog owner, but can’t resist petting all the dogs that you pass, make sure you wash your hands! It is a good idea to learn how to recognize poison oak even though the plant can spread the oil when there are no leaves, so nature isn’t making it all that easy to avoid. Most of the time there are three leaves. At some points there may be little flowers and berries. During some seasons the leaves turn red. If there are thorns it isn’t poison oak (of course now you will be calling me about thorn issues. Stay on the path!) It is rampant all over the Bay Area, but if you are heading up to the mountains you can take some comfort in knowing that poison oak does not grow above 4300 feet. If you are in the vicinity where Poison oak is being burned, be careful, burning can cause irritated airways, eyes...etc. Know your area. Many places will have warning signs posted that there is poison oak in the area but don’t rely on that. If the time for prevention has passed and you or your child has poison oak, it usually takes a couple of weeks until it clears. Dr. Ted from Oath Pediatrics wants to remind people that it is self limiting and will eventually go away. For a mild case, taking Zyrtec or Benadryl, oatmeal baths and topical steroid creams can give some relief. There is also a good product called Domeboro gel. Dr. Schwanke strongly preferred Zyrtec to Benadryl as an oral antihistamine because it lasts longer and won't "turn your kid into a zombie". Of course if you are looking for a little Zombie at night, you might do Zyrtec in the morning and Benadryl for the night time dose. Dr. Fast, my ‘go to’ allergist, strongly recommends hitting any poison oak hard and fast with oral steroids. Be aware that while most people tolerate them with absolutely no issues, others may get a bit hyper. My daughter Alana was on a course of steroids once and that week she got out the trusty sewing machine that Sandy’s dad had bought for her. She ended up spending entire days sewing pairs of pajamas, one after another, because she didn't seem to know what else to do with her body. (This was many years ago, but since it seems that you are not permitted to throw away something that your daughter makes for you, Sandy still has his pair and has been wearing them this month.) Steroids can make you feel weird but a short term course is not dangerous. A less than 10 day course does not need to be weaned down although many pediatricians have their own favorite method of prescribing them.  Dr. Hurd has a more cautious approach with the steroids so if the rash is mild enough, she would rather stick with the topical symptomatic relief remedies. If the rash has spread to the face or genitals (with boys, that is pretty much a given) then the oral steroids are likely needed. If your child is a repeat offender and has moderate to severe reactions with poison oak exposures, don’t waste your time. Get the treatment started soon to avoid misery. Be prepared. Stay on the paths. Wash of any areas of skin that have had potential exposure. Most importantly, make sure to scrub your hands especially under the nails, when coming in from a hike. Knowledge is power and prevention is key!  Good for you for getting outside!!