Tag: itching

Treating Hard to Control Poison Ivy

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

Treating Hard To Control Eczema

Eczema or atopic dermatitis very commonly affects kids.

Few conditions are as frustrating for parents and pediatricians, because even when properly treated, you can expect eczema to flare up from time to time after it gets better. Eczema is even worse when it isn’t properly treated though.

What Triggers Your Child’s Eczema?

Like other things that are supposed to have triggers, like asthma and migraines, it is often hard to figure out what triggers a child’s eczema.

Dress in soft, breathable clothing and avoid itchy fabrics like wool, that can further irritate your eczema.

National Eczema Association

Common eczema triggers to avoid might include:

  • harsh soaps and cleansers, shampoos, and body washes, including those with fragrances
  • food allergy triggers – milk and eggs
  • environmental allergy triggers – dust mites and animal dander
  • low humidity
  • temperature extremes – either getting too hot or too cold
  • skin infections

And anything else that might make your child’s skin dry and itchy.

Eczema Treatments for Kids

Although there is no cure for eczema, it is usually possible to control your child’s eczema, including getting rid of all or most of her eczema rash and decreasing how often your child has eczema flares.

These basic treatments include:

  • using lukewarm water for daily baths and showers
  • using a soap substitute or cleanser that is unscented, fragrance-free, and dye-free – Cetaphil, Dove, Aveeno
  • using a tar-based shampoo if your child’s scalp is red and itchy – T-Gel
  • daily use of moisturizers, especially within a few minutes of taking a bath or shower (soak and seal therapy)
  • prompt use of a moderate strength prescription topical steroid (like traimcinolone acetonide 0.1% cream) as soon as your child has a flare, with red, rough itchy skin
  • as needed use of oral antihistamines to help control itching during flares – Benadryl
  • keeping your child’s finger nails short to minimize damage from scratching

A written eczema action plan can make sure that you understand how and when to do each of these treatments.

Best Moisturizers for Eczema

Everyone seems to have their favorite eczema moisturizer.

Which is best?

The best moisturizer is probably the one that your child will use and which works to keep his skin from getting dry. In general though, ointments are better than creams, which are better than lotions.

Some favorites include Aquaphor (too thick and greasy for some people), Vanicream Moisturizing Skin Cream, CeraVe Moisturizing Cream, Eucerin Original, and Cetaphil Moisturizing Cream.

Whichever moisturizer you use, be sure to apply it to your child’s skin within three minutes of his soaking in a bath or shower so that you can seal in the moisture (soak and seal therapy).

Treating Hard To Control Eczema

What to do you do when basic treatments aren’t working?

Although a pediatric dermatologist can evaluate your child to see if she needs a systemic medication, phototherapy, or other treatment, most kids with hard to control eczema simply need more education to make sure they are using standard treatments correctly.

  • Is your child bathing correctly?
  • Are you putting on the right moisturizer, using enough moisturizer, and using it often enough?
  • Is your soap too harsh?
  • Are you afraid to use a topical steroid?
  • Are you applying a steroid over a moisturizer, which can make it less effective?
  • Could you be doing more to avoid triggers?
  • Could stress be triggering your child’s eczema?

What’s next?

A Staph skin infection might be a problem. In addition to oral antibiotics, weekly dilute bleach baths might help if this is an issue for your child.

Your child with hard to control eczema might also benefit from:

  • using more moisturizer over his entire body – don’t spot treat the areas that you think are a problem
  • using a thicker moisturizer – put your jar of Aquaphor in the freezer or refrigerator if your child doesn’t typically like using a moisturizer or complains that it stings or burns
  • a prescription barrier cream to control itching – Atopiclair, MimyX
  • a prescription topical Clacineurin Inhibitors – Elidel, Protopic
  • a 504 school plan
  • changing your laundry routine – wash new clothes, use mild, dye free laundry detergent and rinse twice after washing
  • using sunscreen and rinsing after swimming in a pool or excessive sweating, applying a moisturizing quickly afterwards
  • allergy testing to better identify triggers

You might also talk to your pediatrician about wet wrap therapy. With this treatment, you have your child take a bath or shower, applying a topical steroid to the affected areas and a generous amount of moisturizer to the rest of your child’s skin. Next, cover the area in wet cotton clothing or a wet dressing, and lastly, dress your child in dry cotton clothing, removing them all once the clothing dries out. You can then repeat the whole process or start again the next night, continuing until your child’s eczema is under better control.

Wrap therapy can be done with wet pajamas if you have to cover a big area, tube socks with the end cut off if you just have to do his arms, or cotton gloves for hard to control hand eczema. Some experts even recommend using a chilled wet dressing, putting the wet clothes in the refrigerator for a short time before using them on your child.

If you are at the point of considering wet wrap therapy, seeing a pediatric dermatologist might also be a good idea.

What To Know About Treating Hard To Control Eczema

While eczema can usually be controlled and most kids eventually outgrow having eczema, you may need some help to really understand how to really manage your child’s eczema effectively.

More Information About Treating Hard To Control Eczema