Toxicodendron Poisoning Clinical Presentation

  • Author: Steven L Stephanides, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Apr 19, 2011
 

History

  • Known exposure to poison ivy, oak, or sumac
  • Outdoor activities in areas with Toxicodendron species within the previous 8 hours to 14 days
  • History of toxicodendron dermatitis
  • Contact with a pet who has been outside in an area with Toxicodendron species
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Physical

The dermatitidis is highly variable and depends on the sensitivity of the patient and extent of exposure.

Mild cases

In mild cases, classic lesions on exposed skin are secondary to brushing against the plant or excoriations from scratching.

Characteristics of mild classic lesions are as follows:

  • Linear
  • Erythematous, possibly edematous
  • Pruritic or mildly painful
  • May have small vesicles

Moderate-to-severe cases

  • Diffuse areas of erythema and edema
  • Severe pruritus and/or pain
  • Bullae (Note that fluid from bullae does not contain urushiol.)

Erythema multiforme is an atypical presentation of toxicodendron dermatitis.

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Causes

Exposure to urushiol-containing plants

  • Poison ivy (Toxicodendron rydbergii), poison oak (Toxicodendron diversilobum), and poison sumac (Toxicodendron vernix) are most common in North America.
  • Urushiol can also be found in mango plants and Japanese lacquer tree (Rhus verniciflua), although these are not Toxicodendron species.
    • Mango fruit skin can cause reaction in susceptible individuals.[3]
    • Exposure to unroasted cashew nut shells can cause a dermatitis often confused with toxicodendron dermatitis in susceptible individuals. Roasting inactivates the allergen.
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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Steven L Stephanides, MD  Attending Physician, Department of Emergency Medicine, Eisenhower Medical Center

Steven L Stephanides, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Chris Moore, PhD, MD  Medical Director, Department of Emergency Medicine, Virginia Mason Medical Center

Chris Moore, PhD, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT  Associate Clinical Professor; Medical and Managing Director, South Texas Poison Center, Department of Surgery/Emergency Medicine and Toxicology, University of Texas Health Science Center at San Antonio

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael Hodgman, MD  Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare

Michael Hodgman, MD is a member of the following medical societies: American College of Medical Toxicology, American College of Physicians, Medical Society of the State of New York, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

  1. Leclercq RM. [Severe contact-allergy dermatitis due to poison ivy--a plant that is rarely encountered in The Netherlands; a family history]. Ned Tijdschr Geneeskd. Jul 23 2005;149(30):1697-700. [Medline].

  2. Gach JE, Tucker W, Hill VA. Three cases of severe Rhus dermatitis in an English primary school. J Eur Acad Dermatol Venereol. Feb 2006;20(2):212-3. [Medline].

  3. Thoo CH, Freeman S. Hypersensitivity reaction to the ingestion of mango flesh. Australas J Dermatol. May 2008;49(2):116-9. [Medline].

  4. Canavan D, Yarnell E. Successful treatment of poison oak dermatitis treated with Grindelia spp. (Gumweed). J Altern Complement Med. Aug 2005;11(4):709-11. [Medline].

  5. [Guideline] Contact dermatitis: a practice parameter. Ann Allergy Asthma Immunol. Sep 2006;97(3 Suppl 2):S1-38. [Medline].

  6. Botanical dermatology: allergic contact dermatitis. Electronic Textbook of Dermatology. Available at http://telemedicine.org/botanica/bot6.htm. Accessed June 16, 2007.

  7. Cardinali C, Francalanci S, Giomi B, et al. Contact dermatitis from Rhus toxicodendron in a homeopathic remedy. J Am Acad Dermatol. Jan 2004;50(1):150-1. [Medline].

  8. Chapel TA, Chapel J. Toxicodendron dermatitis. In: Emergency Medicine - A Comprehensive Study Guide. 4th ed. 1996:1111-1113.

  9. Davila A, Laurora M, Fulton J. A New Topical Agent, Zanfel, Ameliorates Urushiol-Induced Toxicodendron Allergic Contact Dermatitis. Ann Emerg Med. 2003;42(4 supp 1):Abstract no 364; s98.

  10. Epstein WL. The poison ivy picker of Pennypack Park: the continuing saga of poison ivy. J Invest Dermatol. Mar 1987;88(3 Suppl):7s-11s. [Medline].

  11. Epstein WL. Topical prevention of poison ivy/oak dermatitis. Arch Dermatol. Apr 1989;125(4):499-501. [Medline].

  12. Epstein WL, Epstein JH. Plant-induced dermatitis. In: Auerbach PS, ed. Wilderness Medicine. 4th ed. Mosby; 2001:1088-1107.

  13. Oh SH, Haw CR, Lee MH. Clinical and immunologic features of systemic contact dermatitis from ingestion of Rhus (Toxicodendron). Contact Dermatitis. May 2003;48(5):251-4. [Medline].

  14. Orchard SM, Fellman JH, Storrs FJ. Topical substances which prevent poison ivy allergic contact dermatitis. Acta Derm Venereol Suppl (Stockh). 1987;134:103-6. [Medline].

  15. Sasseville D. Clinical patterns of phytodermatitis. Dermatol Clin. Jul 2009;27(3):299-308, vi. [Medline].

  16. Stibich AS, Yagan M, Sharma V, Herndon B, Montgomery C. Cost-effective post-exposure prevention of poison ivy dermatitis. Int J Dermatol. Jul 2000;39(7):515-8. [Medline].

  17. Tanner TL. Rhus (Toxicodendron) dermatitis. Prim Care. Jun 2000;27(2):493-502. [Medline].

  18. Williford PM, Sheretz EF. Poison ivy dermatitis. Nuances in treatment. Arch Fam Med. Feb 1994;3(2):184-8. [Medline].

  19. Wooldridge WE. Acute allergic contact dermatitis. How to manage severe cases. Postgrad Med. Mar 1990;87(4):221-4. [Medline].

 
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Forearm approximately 10 days after exposure to poison ivy in a garden. Note vesicles and linear areas of the rash.
 
 
 
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