eMedicine Specialties > Emergency Medicine > Toxicology

Plant Poisoning, Toxicodendron: Follow-up

Author: Steven L Stephanides, MD, Attending Physician, Department of Emergency Medicine, Eisenhower Medical Center
Coauthor(s): Chris Moore, PhD, MD, Medical Director, Department of Emergency Medicine, Virginia Mason Medical Center
Contributor Information and Disclosures

Updated: Aug 18, 2009

Follow-up

Further Outpatient Care

  • Patients should follow up with their primary care physician.
  • All contaminated clothing and articles should be washed. Pets that have been exposed should be bathed well to remove the oil from their fur.
  • Precautions include watching for secondary bacterial infection of skin lesions.

Deterrence/Prevention

  • Avoid exposure.
  • Protective clothing, such as gloves (nonlatex), should be worn if handling the plants or contaminated objects or animals.
  • A number of barrier creams are available. Although they cannot completely eliminate the reaction, they can significantly diminish the exposure.

Complications

  • Superinfection of skin lesions
  • Hyperpigmentation of healing lesions (usually resolves spontaneously within a few weeks)

Prognosis

  • Complete resolution is expected within 7-21 days.

Patient Education

  • Instruct the patient that the fluid from the bullae is not an irritant and cannot extend the rash.
  • If steroids have been given, caution the patient on the risks of rebound flare if steroid therapy is stopped prematurely.
  • For excellent patient education resources, visit eMedicine's Allergy Center. Also, see eMedicine's patient education article Allergy: Poison Ivy, Oak, and Sumac.
 


More on Plant Poisoning, Toxicodendron

Overview: Plant Poisoning, Toxicodendron
Differential Diagnoses & Workup: Plant Poisoning, Toxicodendron
Treatment & Medication: Plant Poisoning, Toxicodendron
Follow-up: Plant Poisoning, Toxicodendron
Multimedia: Plant Poisoning, Toxicodendron
References
Further Reading
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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. 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].

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

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

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

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Further Reading

Clinical guidelines

American Academy of Allergy, Asthma and Immunology, American College of Allergy, Asthma and Immunology. Contact dermatitis: a practice parameter. Ann Allergy Asthma Immunol 2006 Sep;97(3 Suppl 2):S1-38. 5

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Keywords

poison ivy, poison oak, poison sumac, toxicodendron plant poisoning, rhus dermatitis, urushiol-containing plants, poison ivy, Toxicodendron rydbergii, Toxicodendron diversilobum, Toxicodendron vernix, plant poisoning, toxicodendron exposure, toxicodendron dermatitis, allergic contact dermatitis, allergic phytodermatitis, contact dermatitis

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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.

Medical Editor

Miguel C Fernández, MD, FAAEM, FACEP, FACMT, 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 Fernández, MD, FAAEM, FACEP, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, 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.

Pharmacy Editor

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.

Managing Editor

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.

CME Editor

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, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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