Tag: allergic contact dermatitis

Is Handwashing Drying Your Child’s Skin?

A rash on their hands might mean that you have to change how your kids wash their hands and not that they have to wash less often.

Do your kids get dry, red, and itchy hands, especially during the winter months when it gets cold?

Hand sanitizier and handwashing may be drying your child's skin.

Believe it or not, it’s probably because they are washing their hands very frequently, which is a good thing these days.

Is Handwashing Drying Your Child’s Skin?

Of course, many other things could be causing a rash on your child’s hands, but if the rash is on both hands, is worse each winter, and there are no other symptoms, then it is probably from handwashing.

Is it from excessive handwashing?

Not necessarily.

“The best way to prevent the spread of infections and decrease the risk of getting sick is by washing your hands with plain soap and water, advises the Centers for Disease Control and Prevention (CDC). Washing hands often with soap and water for at least 20 seconds is essential, especially after going to the bathroom; before eating; and after coughing, sneezing, or blowing one’s nose. There is currently no evidence that consumer antiseptic wash products (also known as antibacterial soaps) are any more effective at preventing illness than washing with plain soap and water. In fact, some data suggests that antibacterial ingredients could do more harm than good in the long-term and more research is needed.”

Q&A for Consumers | Hand Sanitizers and COVID-19

You might just need to change up how your child washes their hands, making sure that they:

  • use a moisturizing soap (Dove, Basis) or soap-free cleanser (Cetaphil, Vanicream Free & Clear), avoiding harsher, antibacterial soaps
  • apply moisturizers (Aquaphor, Vanicream, Cetaphil, Cerave, Eucerin) within a few minutes of washing, keeping in mind that greasy ointments typically are the best, followed by creams, and then lotions, although kids sometimes don’t like the feel of greasy ointments
  • avoid the frequent use of hand sanitizers, as they contain high concentrations of alcohol and can be drying, so limit the use of hand sanitizers to when soap and water isn’t available and even then, try to use a hand sanitizer with a moisturizer

But what if your child’s hands do get red and irritated? Simply applying a moisturizer probably isn’t going to be much help then, is it?

Probably not, so that’s when it’s time to also apply a steroid cream to calm the flare up. While you can start with over-the-counter hydrocortizone cream twice a day (don’t apply at same time as the moisturizers), you might need a medium strength prescription steroid cream for all but the mildest cases. In some cases, a more potent steroid might even be needed for a short time.

And of course, you should think about what else might be causing a rash on your child’s hands, especially if they aren’t quickly getting better with steroids and moisturizers:

  • does your child also have ulcers in their mouth or a rash on their feet, which might indicate Hand Foot and Mouth disease?
  • has your child recently been bitten by a tick?
  • does your child have a honey colored crusty rash on one hand, a sign of impetigo?
  • is your child working with new chemicals, solvents, wearing gloves, or doing anything else that could be triggering an allergic reaction or contact dermatitis on their hands?
  • do other people in the house have an itchy rash on their hands and arms, which could be a sign of scabies?

Fortunately, hand dermatitis from excessive hand washing and cold winter weather is typically easy to diagnosis and treat and isn’t often confused with other pediatric conditions.

More on Hand Dermatitis

Treating Hard to Control Poison Ivy

While poison ivy isn’t contagious, it can make you miserable if you don’t learn to avoid it and treat poison ivy rashes properly with anti-itch creams and steroids.

Poison ivy growing on a tree, ready to give your kids a rash.
It is better to learn to avoid poison ivy than to get a rash and have to get it treated. Photo by Vincent Iannelli, MD

It is usually not hard to identify a child with a poison ivy rash, especially a classic case of poison ivy, which might include a child with a known exposure to poison ivy after a camping trip, hike in the woods, or day at the lake, who a few days later develops a red, itchy rash all over his body.

The problem is that many parents don’t remember the “known exposure,” especially if it is the child’s first poison ivy rash.

The Poison Ivy Rash

Aerial roots on the stems can help you identify poison ivy, and yes, they can trigger a rash too.
Aerial roots on the stems can help you identify poison ivy, and yes, they can trigger a rash too. Photo by Vincent Iannelli, MD

After exposure to the leaves, stems, or roots of a poison ivy plant, children develop symptoms of poison ivy within 8 hours to a week or so, including:

  • an intensely itchy rash
  • red bumps that often may be in a straight line or streaks, from where the poison ivy plant had contact with your child’s skin
  • a rash that appears to spread, mostly because the rash appears at different times depending on how big or small a dose of the urushiol oil that area of skin got, with the rash appearing first on the spots that got exposed the most
  • vesicles and blisters that are filled with fluid

Keep in mind that children exposed to poison sumac and poison oak, other members of the genus Rhus or Toxicodendron, can get these same symptoms that we generically refer to as poison ivy symptoms.

(Using medical terminology, these children develop rhus dermatitis or allergic contact dermatitis, an intensely pruritic, linear, erythematous, papulovesicular rash after exposure to the urushiol oil in poison ivy.)

Treating Poison Ivy

It seems like everyone has their favorite treatments for poison ivy.

These basic treatments for poison ivy are usually going to help control the itch, and might include:

  • oral antihistamines (Benadryl or Atarax)
  • modified Burow’s Solution
  • Calamine lotion
  • Aveeno oatmeal baths
  • over-the-counter or prescription topical steroid creams

Is that all you need?

While these treatments might provide temporary relief and might be enough for very mild reactions, those with more moderate or severe symptoms will likely require systemic steroids.

Does that mean a steroid shot?

That might be what your doctor suggests or what some parents request, but keep in mind that it might wear off too soon, leading your child’s poison ivy symptoms to flare up again (rebound rash). That’s why most experts recommend a longer, tapering course of oral steroids instead of a single shot. A steroid dose pack is also often avoided as treatment for poison ivy, as the dose might be too low and it typically doesn’t last long enough.

Since the poison ivy rash might not go away for as long as three weeks, getting treated with systemic steroids can be an especially good idea if you have a moderate or severe case.

Avoiding Poison Ivy

A classic poison ivy plant in the 'leaves of three, let it be' configuration.
A classic poison ivy plant in the ‘leaves of three, let it be’ configuration. Photo by Vincent Iannelli, MD

Since very few people are actually immune to poison ivy, it is best to learn to avoid getting exposed to it in the first place.

You can start with the old adage, ‘leaves of three, let it be,’ but you really have to look at a lot pictures of poison ivy to get good at avoiding it. And to be safe, learn to avoid the places where poison ivy grows – along tree lines, around lakes and ponds, along trails, and in wooden or wild areas, etc.

Or at least do your best to avoid the plants by wearing long pants, a shirt with long sleeves, and gloves, etc., to avoid skin contact even if you are around poison ivy while hiking, playing along a creek, or fishing near a lake.

What can you do if you have been exposed to poison ivy? If you can rinse the exposed area with rubbing alcohol, like within 10 minutes, then you might avoid a reaction. After that, the oil in poison ivy, urushiol, will likely be stuck and trigger a rash. Of course, you don’t want to be applying rubbing alcohol to a large area of your child’s skin though or allow your child to use it if they will be unsupervised. And be sure to wash it off afterwards.

Commercial products might be more useful (and safer) to help you avoid poison ivy reactions and  include:

  • Ivy Block – was an over-the-counter barrier lotion that was supposed to prevent poison ivy, but unfortunately, it isn’t being made anymore
  • Tecnu Original Outdoor Skin Cleanser
  • Tecnu Extreme Poison Ivy & Oak Scrub
  • Zanfel Poison Ivy Wash

Although it is best to use the products immediately, within 10 to 30 minutes after exposure to poison ivy, if used anytime before you get a rash, you might decrease your symptoms. And if you get lucky, you might not get any symptoms at all.

Myths and Facts About Poison Ivy

Would you recognize this is poison ivy? It will still trigger a rash...
Would you recognize this as poison ivy? It will still trigger a rash… Photo by Vincent Iannelli, MD

As common as poison ivy is, there are many myths and misconceptions about it, including that:

  • poison ivy is contagious (false) – scratching doesn’t spread poison ivy, although it may seem that way as the rash spreads to new areas over the days and weeks after being exposed. That’s only because some areas of a child’s skin that had less exposure to the poison ivy plant than others will get the rash later, not that they are continuing to spread it by scratching.
  • you can get poison ivy from your dog (true) – although not as common as direct contact with a plant, indirect contact, like if you touch the oil from poison ivy that got on your dog’s fur or on your clothing, could trigger a reaction
  • it is easy to spot poison ivy (false) – poison ivy plants are often found growing among other plants, can trigger reactions year round, even when they don’t have any leaves (the stems  and roots can trigger a reaction too), and even dead poison plants can trigger a reaction, which can make it extremely hard to simply use the ‘leaves of three, let it me’ advice to spot plants.
  • birds help spread poison ivy (true) – ever wonder why poison plants grow along tree lines? Birds and small mammals eat the poison ivy berries and then poop out the seeds, allowing new plants to grow wherever the birds commonly hang out, including tree lines, around lakes and ponds, and your garden.
  • it’s easy to get rid of poison ivy plants (false) – poison ivy plants are very persistent and can be hard to get rid of
  • goats like to eat poison ivy (true) – well, goats like to eat everything, but a goat in your yard will likely eat up all of the poison ivy plants.
  • it is easy to identify poison ivy (false) – many other plants mimic the ‘leaves of three, let it be’ pattern, like Virginia creeper and Boxelder
  • burning poison ivy plants is dangerous (true) – the oil that triggers the poison ivy rash can vaporize, meaning exposure to the smoke from a burning plant can cause severe reactions.

And remember that your pediatrician can be helpful if you think your child has poison ivy. (true)

What To Know About Hard to Control Poison Ivy

While poison ivy isn’t contagious, it can make you miserable if you don’t learn to avoid it and treat poison ivy rashes properly with anti-itch creams and steroids.

More About Hard to Control Poison Ivy