What is the first-line treatment for poison oak?

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Elsevier ClinicalKey Clinical Overview

Treatment Supportive care is the mainstay of management Limit absorption When wet tobacco leaves contact the skin, nicotine and other nicotinic agents can be absorbed (green tobacco sickness); therefore, decontaminate the skin with soap and water There is no role for enhanced elimination techniques such as acidification of the urine or forced diuresis Cardiovascular support Avoid treating hypertension with adrenergic antagonists, as the hypertension is usually transient and often proceeds to hypotension Treat hypotension with IV fluids and consider vasopressors if the patient has had adequate volume resuscitation but still has a mean arterial pressure less than 65 mm Hg Treat bradycardia with atropine Respiratory management Parasympathetic tone may cause increased respiratory secretions, bronchorrhea, bronchospasm, and bronchoconstriction Treat with atropine For respiratory muscle weakness or paralysis, consider early intubation and mechanical ventilation Cyanogen toxicity Some plant parts (eg, pits, seeds) contain cyanogenic glycosides that impair cellular respiration leading to tachypnea, tachycardia, and hypotension Initial treatment is hydroxocobalamin Alternatively, may use a sodium nitrite and sodium thiosulfate Mitotic inhibitor toxicity There is no specific antidote Mainstay of therapy is aggressive supportive care IV fluids to correct hypovolemia Hypotension resistant to adequate volume resuscitation with IV fluids may require vasopressors such as norepinephrine Infections, including sepsis, may occur due to leukopenia, necessitating the use of antibiotics Colony-stimulating factors may be necessary to treat bone marrow suppression Water-insoluble calcium oxalate crystal exposure Mainstay of treatment is supportive care Respiratory support For severe oropharyngeal edema and swelling, intubation may be required Decontamination Wash affected skin with soap and water Flush exposed eyes with copious amounts of water Dermatitis may be treated with topical or oral steroids and antihistamines

Treatment Decontamination Wash affected skin with soap and water Flush exposed eyes with copious amounts of water Dermatitis may be treated with topical or oral steroids and antihistamines Ocular exposures may be treated with topical anesthetics Consider ophthalmologic evaluation Allergic contact dermatitis Decontaminate the skin with soap and water and wash all clothes that may have been exposed to the plant Treat pruritus with oral antihistamines, lukewarm baths with baking soda or colloidal oatmeal, cool compresses, or calamine lotion For mild signs and symptoms, treat with topical steroids Avoid mid-potency steroids in areas with vesicle or bullae formation due to their ability to thin the skin Low-potency formulations (eg, 1% hydrocortisone) may be used in lesions involving the face or genitalia For moderate to severe signs and symptoms, consider systemic corticosteroids such as prednisone (or its equivalent) Dose: 1 to 2 mg/kg/day for 7 to 10 days (max dose of 60 mg/day) followed by taper over 7 to 10 days

2.

Elsevier ClinicalKey Clinical Overview

Special Considerations Primary prevention measures for Toxicodendron contact dermatitis (poison ivy/poison oak/poison sumac) Plant identification and avoidance of contact with culprit plant is key Protective clothing may be helpful; however, allergen may remain on clothing for days Measures if exposure is likely: Remove all contaminated clothing Wash whole body with hot/warm water and dish soap or mild soap Wash all clothing with soap and water before reuse Treatment involves symptomatic relief and medication therapy Soothing measures include use of cool compresses and calamine lotion For mild limited dermatitis, recommend use of super–high-potency topical corticosteroids For severe cases too extensive for topical treatment alone, especially when involving sensitive areas such as the face, recommend systemic corticosteroid