Approach Considerations

Toxicodendron dermatitis is a clinical diagnosis. Laboratory testing is usually not necessary as part of the emergency department evaluation.

Patch testing is discouraged for toxicodendron dermatitis because it might sensitize an unsensitized individual. However, if contact dermatitis is being considered, patch testing for other allergens might be considered.

Leaf spray mass spectrometry, which is a new ambient ionization method, can detect allergenic urushiols directly from poison ivy with no sample preparation; the results show all the urushiols reported using liquid chromatography mass spectrometry methods. The identifications were confirmed with tandem mass spectrometry analysis of the leaf spray ions. Enhanced detection of some urushiols was achieved in the negative mode if chloride anions were added to the spray solvent.^[10]This technique, although not yet readily available, has been used to confirm the diagnosis of black-spot poison ivy, which may clinically resemble melanoma.^[8]

Treatment & Management

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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.