History

The history in cases of possible Toxicodendron toxicity should include questions about the following:

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 that has been outside in an area with Toxicodendron species

Physical Examination

The dermatitis 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

Characteristics of moderate-to-severe cases are as follows:

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

Uncommonly, dermatitis from exposure to poison ivy may include black spots. The spots consist of urushiol oleoresins, which harden within minutes of exposure to air to form a black resin.^{[8, 9]}

Erythema multiforme is an atypical presentation of toxicodendron dermatitis reported after sumac ingestion.

Differential Diagnoses

Lofgran T, Mahabal G. Toxicodendron Toxicity. 2020 Jan. [QxMD MEDLINE Link]. [Full Text].
Cardinali C, Francalanci S, Giomi B, et al. Contact dermatitis from Rhus toxicodendron in a homeopathic remedy. J Am Acad Dermatol. 2004 Jan. 50(1):150-1. [QxMD MEDLINE Link].
Botanical dermatology: allergic contact dermatitis. Electronic Textbook of Dermatology. Available at http://telemedicine.org/botanica/bot6.htm. Accessed: August 13, 2020.
Thoo CH, Freeman S. Hypersensitivity reaction to the ingestion of mango flesh. Australas J Dermatol. 2008 May. 49(2):116-9. [QxMD MEDLINE Link].
Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Bronstein AC, Rivers LJ, et al. 2020 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021 Dec. 59 (12):1282-1501. [QxMD MEDLINE Link]. [Full Text].
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. 2005 Jul 23. 149(30):1697-700. [QxMD MEDLINE Link].
Gach JE, Tucker W, Hill VA. Three cases of severe Rhus dermatitis in an English primary school. J Eur Acad Dermatol Venereol. 2006 Feb. 20(2):212-3. [QxMD MEDLINE Link].
Rader RK, Mu R, Shi H, Stoecker WV, Hinton KA. Dermoscopy of black-spot poison ivy. Dermatol Online J. 2012 Oct 15. 18(10):8. [QxMD MEDLINE Link]. [Full Text].
Chastant LR, Davis T, Libow L. Black-spot poison ivy, a report of 3 cases with clinicopathologic correlation. JAAD Case Rep. 2018 Mar. 4 (2):140-142. [QxMD MEDLINE Link]. [Full Text].
Tadjimukhamedov FK, Huang G, Ouyang Z, Cooks RG. Rapid detection of urushiol allergens of Toxicodendron genus using leaf spray mass spectrometry. Analyst. 2012 Mar 7. 137(5):1082-4. [QxMD MEDLINE Link].
Neill BC, Neill JA, Brauker J, Rajpara A, Aires DJ. Post-exposure prevention of toxicodendron dermatitis with early forceful unidirectional washing. J Am Acad Dermatol. 2018 Feb 1. [QxMD MEDLINE Link].
Stibich AS, Yagan M, Sharma V, Herndon B, Montgomery C. Cost-effective post-exposure prevention of poison ivy dermatitis. Int J Dermatol. 2000 Jul. 39(7):515-8. [QxMD MEDLINE Link].
Davila A, Laurora M, Fulton J, Jacoby J, Reed J, Heller M. A new topical agent, Zanfel, ameliorates urushiol-induced Toxicodendron allergic contact dermatitis. Ann Emerg Med. 2003. 42(4 supp 1):Abstract no 364; s98.
Abrams Motz V, Bowers CP, Mull Young L, Kinder DH. The effectiveness of jewelweed, Impatiens capensis, the related cultivar I. balsamina and the component, lawsone in preventing post poison ivy exposure contact dermatitis. J Ethnopharmacol. 2012 Aug 30. 143(1):314-8. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Abrams Motz V, Bowers CP, Mull Young L, Kinder DH. The effectiveness of jewelweed, Impatiens capensis, the related cultivar I. balsamina and the component, lawsone in preventing post poison ivy exposure contact dermatitis. J Ethnopharmacol. 2012 Aug 30. 143 (1):314-8. [QxMD MEDLINE Link].
Motz VA, Bowers CP, Kneubehl AR, Lendrum EC, Young LM, Kinder DH. Efficacy of the saponin component of Impatiens capensis Meerb.in preventing urushiol-induced contact dermatitis. J Ethnopharmacol. 2015 Mar 13. 162:163-7. [QxMD MEDLINE Link].
Curtis G, Lewis AC. Treatment of severe poison ivy: a randomized, controlled trial of long versus short course oral prednisone. J Clin Med Res. 2014 Dec. 6 (6):429-34. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Contact dermatitis: a practice parameter. Ann Allergy Asthma Immunol. 2006 Sep. 97(3 Suppl 2):S1-38. [QxMD MEDLINE Link].
Shofner JD, Kimball AB. Plant-induced dermatitis. Auerbach PS, Ed. Wilderness Medicine. 6th ed. Philadelphia PA: Elsevier Mosby; 2012. 1232-50.
Oh SH, Haw CR, Lee MH. Clinical and immunologic features of systemic contact dermatitis from ingestion of Rhus (Toxicodendron). Contact Dermatitis. 2003 May. 48(5):251-4. [QxMD MEDLINE Link].

Media Gallery

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

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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, Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

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

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

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and 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.

Chief Editor

Michael A Miller, MD Clinical Professor of Emergency Medicine, Medical Toxicologist, Department of Emergency Medicine, Texas A&M Health Sciences Center; CHRISTUS Spohn Emergency Medicine Residency Program

Michael A Miller, MD is a member of the following medical societies: American College of Medical Toxicology

Disclosure: Nothing to disclose.

Additional Contributors

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

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

Disclosure: Nothing to disclose.

Acknowledgements

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.