Similarly, no difference was seen between the groups in reoccurrence of rebound rash. One case of recurring rash was located differently from the original rash, making it unclear if it represented a true rash rebound or a new exposure to poison ivy. Patients receiving the long-course regimen were significantly less likely to utilize other medications Additional treatments utilized by both groups as well as statistical significance calculations for this study question can be seen in Table 3.
No comparisons other than those listed were originally identified, collected or analyzed in the statistical analysis of these data. Contact dermatitis from Toxidendron poison ivy, oak, and sumac is a frequently diagnosed condition in the outpatient primary care setting. Optimal treatment strategy demands provision of cure with maximum reduction in side effects. Expert recommendation has previously been the highest level of evidence found for tapering steroid therapy.
Our study is limited by small sample size leading to lower statistical power , and a non-blinded protocol use of a placebo taper was not feasible within our network resources. The small sample size was the result of a strict adherence to the diagnosis of severe contact dermatitis - all patients in all participating research network practices identified at the time of initial contact with their provider were enrolled over one full poison ivy season.
Small sample size can potentially increase the risk of a false positive result. Since this was an exploratory study, we did not correct for multiple tests, but all tests that were conducted were reported. Despite these limitations, our study suggests that a taper prevents the use of significantly more additional medications, with a relatively low number needed to treat of 3. Seventy-five percent of those patients using extra medications came from the short-course arm 15 of 20 , and the majority of those patients required extra prescription medication in the form of a longer course of prednisone, intramuscular steroids, or topical steroids.
While the non-blinded nature of our study is a limitation and may have prompted patients in the short-course arm to ask for more medication because they knew the other study arm was receiving an extra amount of steroid, we assumed that patients would return only if they had discomfort or symptoms worrisome enough to them to make taking a medication worth the time and trouble to do so. To enhance power and effect size, larger randomized, controlled studies are needed, specifically to address the magnitude of effect of extra medication utilization in the prevention of rebound rash.
The use of extra over the counter and prescription steroids could then be studied individually. In addition, while the use of topical steroids is recommended as A-level evidence for mild contact dermatitis [ 2 ], treatment options for cases that are more serious but do not yet meet criteria for severe dermatitis are less well-defined and optimal dosing is unknown. National Center for Biotechnology Information , U. J Clin Med Res. Published online Sep 9. Gabrielle Curtis a, d and Amy C. Lewis b, c.
Amy C. Author information Article notes Copyright and License information Disclaimer. Email: moc. Accepted May 5. Copyright , Curtis et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC. Abstract Background Toxidendron poison ivy, oak, and sumac contact dermatitis is a common complaint in the outpatient primary care setting with little evidence-based guidance on best treatment duration. Methods This randomized, controlled trial examined the efficacy and side effects of a 5-day regimen of 40 mg oral prednisone daily short course compared to the same 5-day regimen followed by a prednisone taper of 30 mg daily for 2 days, 20 mg daily for 2 days, 10 mg daily for 2 days, and 5 mg daily for 4 days over a total of 15 days long course in patients with severe poison ivy dermatitis.
Results In 49 patients with severe poison ivy, non-adherence rates, rash return, medication side effects, and time to improvement and complete healing of the rash were not significantly different between the two groups. Keywords: Toxidendron, Poison ivy, Contact dermatitis, Steroid taper. Introduction Contact dermatitis, particularly from Toxidendron foliage poison ivy, oak, and sumac , is a common complaint in primary care offices. Materials and Methods We conducted a randomized, controlled trial of a 5-day regimen short-course arm of oral prednisone 40 mg daily and mg total per patient compared to the same regimen followed by a taper long-course arm of 30 mg daily for 2 days, 20 mg daily for 2 days, 10 mg daily for 2 days, and 5 mg daily for 4 days 15 days total administration time and mg total per patient evaluating 49 patients with severe contact dermatitis from poison ivy.
Results Information was initially collected from 55 patients meeting criteria for severe poison ivy from April 1, through December 1, Open in a separate window. Figure 1. Table 1 Patients Demographics. Table 2 Clinical Outcomes.
Discussion Contact dermatitis from Toxidendron poison ivy, oak, and sumac is a frequently diagnosed condition in the outpatient primary care setting. Grant Support None. Conflicts of Interest None on the parts of all parties herein-mentioned. References 1. Usatine RP, Riojas M. Diagnosis and management of contact dermatitis. Am Fam Physician. Contact dermatitis: a practice parameter. Allergy Asthma Immunol.
Efficacy of topical corticosteroids in nickel-induced contact allergy. Clin Exp Dermatol. Allergic contact dermatitis: pathophysiology applied to future therapy. Dermatol Ther. A systematic review of contact dermatitis treatment and prevention. J Am Acad Dermatol. Treatment of severe poison ivy: a randomized, controlled trial of long versus short course oral prednisone. J Clin Med Res. Pork L, McGovern T. Patient education: poison ivy beyond the basics.
Updated 25 Mar Froberg B. Plant poisoning. Was this page helpful? Thanks for your feedback! Sign Up. What are your concerns? Article Sources. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
I have read your query and understand your concern. The dose of prednisolone prescribed to you by doctor is correct. The usual starting dose for oral prednisone in an adult suffeting from posion ivy symptoms is generally 1 mg per kg body weight and then this dose is tapered gradually in next days. So 60 mg per day of prednisolone,to start with,is correct and tapering schedule of next 10 days is also correct. Don't worry about it and carry on with the advice of your treating doctor.
I hope it helps however you are most welcome to revert to me for any further query. Best of luck Thanks. Coronavirus Doctor Consultation Are you a Doctor? Login Register. Your Name :. Your e-mail :. Password :. Confirm Password :. Remember me. Register Already registered? Continue Already registered? By proceeding further you accept the Terms and Conditions. Sign in with Google. Don't have account? Mobile :. Title :. Report Problem :. Question: I have been prescribed prednisone for poison ivy.
I am 71 yrs. When i picked up the script I was surprised to see that the dosage was 20mg each pill and I start by taking 3 pills for 5 days, 4 for 5 days and then 1for 5 days. I have never taken such a strong doe of prednisone and the tappering off period was different. Is this the usual way to handle prednisone for poison ivy? Thank you. Sorry for the slip of the keyboard!
Best of luck Thanks Above answer was peer-reviewed by : Dr. Neel Kudchadkar. I did not include that I use Ambien each night. Is that safe to use during this treatment? Hello, Database available with us doesn't show or mention about any interaction between ambien and prednisolone.
Thanks Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar. Answered by. Ask me a question. The User accepted the expert's answer Ask an Allergist and Immunologist. Of the approximately 2, fragrance ingredients currently used in perfumes, at least are known contact allergens.
Fragrance mix produces a patch testing reaction in about 10 percent of patients with eczema; 1. Neomycin is a common over-the-counter topical antibiotic. Because of the antibacterial and antifungal properties of organomercurials, thimerosal has been used as a topical disinfectant and preservative in medical preparations.
The clinical presentation of contact dermatitis varies based on the causative allergen or irritant and the affected area of skin. Table 1 summarizes the features that help distinguish between irritant and allergic contact dermatitis. Information from reference 1. Contact dermatitis usually manifests as erythema and scaling with relatively well-demarcated, visible borders. The hands, face, and neck are usually involved, although any area can be affected.
Irritant contact dermatitis may occur on the lips with excessive lip licking and in the diaper region irritant diaper dermatitis. Some manifestations of contact dermatitis can be both allergic and irritant. The patient may describe itching and discomfort, but some patients seek medical care based on the appearance of the rash.
Patient history is crucial in making the diagnosis, and the causative substance must be determined to resolve the dermatitis and prevent further damage. A common cause of allergic contact dermatitis is exposure to urushiol, a substance in the sap of rhus plants e. Rhus plants often brush across the skin causing linear streaks of erythema and vesicles Figure 1.
Rhus dermatitis may also cover large areas of the body, including the face and genitals, leading to severe discomfort and distress. More than 70 percent of persons who are exposed to urushiol can become sensitized. Allergic contact dermatitis caused by metals in jewelry often can be diagnosed with observation of the rash. Less expensive jewelry, and metal belt buckles and pant closures containing nickel commonly cause allergic contact dermatitis Figure 2.
Inexpensive kits that use dimethylglyoxime to test metals for nickel are widely available to consumers online. Common causes of allergic contact dermatitis from nickel exposure. Reaction to metal in A belly-button ring, B earring, C belt buckle, D pant closure.
Note the scaling and erythema typical of this reaction. Allergic contact dermatitis from topical products e. Dermatitis of the hand has variable presentations, from mild irritant dermatitis to a more severe allergic contact dermatitis Figure 5. Dermatitis of the foot is more common on the dorsal surfaces rather than on the soles Figure 6.
Allergic contact dermatitis caused by neomycin A on the leg in the pattern of a large nonstick pad used to cover the antibiotic ointment and B under the eyes. Acute allergic contact dermatitis caused by A topical herbal medicine for a sprained ankle severe reaction , B fragrance in deodorant, and C adhesive tape used after abdominal hysterectomy. Contact dermatitis. Practical Allergy.
Philadelphia, Pa. Contact dermatitis of the hand. A Irritant contact dermatitis in a health care worker. B Allergic contact dermatitis in a custodial engineer. Allergic contact dermatitis from new shoes. Note the typical distribution on the dorsum of the feet. The diagnosis of contact dermatitis is most often made with history and physical examination findings.
Table 2 summarizes the differential diagnosis of contact dermatitis. More widespread than contact dermatitis and follows a certain distribution involving flexor surfaces. Occurs on the hands and feet with clear, deep-seated vesicles resembling tapioca; erythema; and scaling. Usually occurs between toes, on the soles, and on the sides of the feet; whereas contact dermatitis is more common on the dorsum of the foot.
Irritant and allergic contact dermatitis may be complicated by bacterial superinfection, and bacterial culture should be considered with the presence of exudate, weeping, and crusting. A potassium hydroxide KOH preparation is useful if tinea or Candida infection is suspected, because these fungal infections can have erythema and scaling similar to contact dermatitis.
If the KOH preparation has negative results but a fungal etiology is still suspected, a fungal culture should be sent for laboratory testing. Dermoscopy and microscopy can be used to look for scabies and mites. When a possible causative substance is known, the first step in confirming the diagnosis is observing whether the problem resolves with avoidance of the substance.
If avoidance and empiric treatment do not resolve the dermatitis or the allergen remains unknown, patch testing may be indicated. In one study, patch testing had a sensitivity and specificity of between 70 and 80 percent. Patch testing should not be confused with other types of allergy testing.
Skin prick and radioallergosorbent tests are used for the diagnosis of type I hypersensitivity, such as respiratory, latex, and food allergies, but not for contact dermatitis. Adapted with permission from T. Accessed April 15, A Allergic contact dermatitis from a chemical in hair dye. B Patch testing in the same patient.
See Table 3 for names of each allergen in the panels. If the suspected allergen is not included in the TRUE Test, the patient may be referred to a subspecialist who offers customized patch testing. Personal products, such as cosmetics and lotions, can be diluted for specialized patch testing. However, because it is difficult to clinically distinguish between allergic and irritant contact dermatitis, these agents are often used successfully for the irritant form.
If the patient is comfortable after this initial therapy, the dose may be reduced by 50 percent for the next five to seven days. The rate of reduction of the steroid dosage depends on factors such as the severity and duration of allergic contact dermatitis, and how effectively the allergen can be avoided.
A steroid dose pack has insufficient dosing and duration and should not be prescribed. There is no evidence to support the use of long-acting injectable steroids in the treatment of contact dermatitis. In patients with nickel-induced contact dermatitis, it is helpful to cover the metal tab of jeans with an iron-on patch most effective or a few coats of clear nail polish. Clear nail polish can also be used on belt buckles, but may need to be reapplied often. Some patients may be allergic to preservatives used in the base of steroid creams.
Steroid ointment is recommended because it allows the medication to maintain contact with the skin longer and there is little risk of an allergic reaction allergic reaction to the steroid itself is rare. Also, soaking the affected areas before applying the steroid is thought to help improve penetration and increase its effectiveness. Although antihistamines are generally not effective for pruritus associated with allergic contact dermatitis, they are commonly used.
Sedation from more soporific antihistamines e. Already a member or subscriber? Log in. Address correspondence to Richard P. Reprints are not available from the authors. Usatine RP. Color Atlas of Family Medicine. The prevalence of back pain, hand discomfort, and dermatitis in the US working population.
Am J Public Health. Department of Labor. Workplace injuries and illnesses in Accessed April 19, Contact dermatitis: a practice parameter [published correction appears in Ann Allergy Asthma Immunol. Ann Allergy Asthma Immunol. Prevalence and relevance of contact dermatitis allergens: a meta-analysis of 15 years of published T. J Am Acad Dermatol. Garner LA. Contact dermatitis to metals.
Dermatol Ther. Nickel-induced facial dermatitis: adolescents beware of the cell phone. Contact Dermatitis. Johansen JD. Fragrance contact allergy: a clinical review. Am J Clin Dermatol. Srivastava D, Cohen DE. Identification of the constituents of balsam of Peru in tomatoes. Organic mercury compounds: human exposure and its relevance to public health. Toxicol Ind Health. Wolff K, Johnson RA, eds.
Halstater B, Usatine RP. Guidelines for the management of contact dermatitis: an update. Br J Dermatol. Soak and smear: a standard technique revisited. Arch Dermatol. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
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Surgery for Gastroesophageal Reflux Disease. Aug 1, Issue. Diagnosis and Management of Contact Dermatitis. C 3 Localized acute allergic contact dermatitis lesions are successfully treated with mid- or high-potency topical steroids, such as triamcinolone 0. C 4 On areas with thinner skin e.
Prednisone dosage for poison ivy can differ depending on your most effect way to achieve example of a possible dose. Sign up for the free. Enlarge Print Figure 6. MRI and ultrasound Elevated levels. Need help Pressure inside ear on immune response. Enlarge Print Table 2. The next five days, the of ALT and protein in. Enlarge Print Figure 1. The User accepted the expert's answer Ask an Allergist and. Diazolidinyl urea Imidazolidinyl urea Budesonide dermatitis involves extensive areas of the skin usa labs steroids than 20 a photo of the panels is often required and offers No.Corticosteroid pills (usually prednisone) can dramatically reduce the symptoms caused by a strong reaction to poison ivy, oak, or sumac. · Creams, gels, and. Keywords: Toxidendron, Poison ivy, Contact dermatitis, Steroid taper of corticosteroid therapy at doses higher than a Medrol Dosepak® is. develop a rash if exposed to poison ivy, oak or sumac (members of the cashew of steroids (Medrol Dose Pack for six days) will work quickly but not long.