Treating Poison Ivy, Poison Oak, or Poison Sumac

My boyfriend has had poison ivy for four days now and has been using Hydrocortisone to stop the itch. He claims that it will cure the rash. I refuse to see him until he sees a doctor. Am I overreacting?
Silver Spring, Maryland

Treating Poison Ivy, Poison Oak, or Poison Sumac

Dr. Greene’s Answer:

From the tone of your question, I’m guessing that you have had poison ivy at some time in your life and that it was not a pleasant experience. If this is the case, you are not alone — by the time most people reach adulthood they have had some type of unpleasant rash caused by a contact allergy. These allergic reactions can be caused by contact with metals (such as nickel), shoes, fragrances (found in creams and lotions), preservatives (found in cosmetics), topical medications, and by certain types of plants.

Poison ivy, poison oak, and poison sumac together produce more cases of allergic contact dermatitis than all other allergens combined. The resulting rash can range from mildly unpleasant to a true emergency with intense swelling, blistering, and oozing. With even a moderate case, as you may have experienced, the itching can seem unbearable.

In a previous answer, I described some surprising facts about where this rash comes from and how it might spread. In this answer I will focus on what to do once you have been unfortunate enough to contract poison ivy, poison oak, or poison sumac. Most of the treatments are aimed at reducing the itching, until the self-limited rash runs its course, which takes about two weeks. Since easing the itching is the important result, trial and error works very well. If one of these suggestions seems to work, by all means, stick with it.

Most people find that cool compresses in one form or another are quite soothing. Try using a towel or wash cloth soaked in either plain tap water or Burow’s Solution (an astringent solution — you can make it yourself using Domeboro tablets or powder packets available over-the-counter). This can help relieve the intense itching and remove dry crust that has formed as a result of the rash. A fan blowing over the cool compress will diminish some of the heat of the itching and help to dry up some of the ooze coming from the rash. As the skin is cooling, the blood vessels compress and that cuts down on the itching and the new ooze. This is especially good during the two or three worst days of the rash. Along the same lines, some dermatologists recommend rubbing an ice cube gently over the rash several times a day, then letting the skin air dry. Soaking in a tub, particularly using an oatmeal bath such as Aveeno, can also be very soothing to the itch. Be sure the bath is cool or lukewarm — but not hot — as heat tends to make the rash even more inflamed.

After the cooling (using any of the forms mentioned above), coat the rash with a shake lotion such as calamine. This continues to relieve the itching and helps to dry up the blisters. Be sure to check the expiration date on an old calamine bottle in your medicine cabinet, since it may not be effective after the expiration date. Be sure the shake lotion does not contain benzocaine, zirconium, or a topical antihistamine, such as benadryl. These can actually make the rash worse by producing their own allergic reactions when applied to already sensitive skin.

Smearing on hydrocortisone (as your boyfriend has done), or other topical corticosteroids, will help suppress the itching and give temporary relief, but does little to hasten the drying up of the rash. Similarly, taking an oral antihistamine, such as benadryl, can help with the itching quite a bit, although it does not speed up resolution of the rash. Taking benadryl at nighttime will make most people drowsy and help them sleep through the night without itching. Again, don’t use benadryl cream or spray topically, because this can cause its own reaction.

The goal of reducing itching is brought about by cooling (by constricting the blood vessels), by drying the rash, or by quieting down the allergic response.

In severe cases of poison ivy, poison oak, or poison sumac, it is a good idea to see a doctor. Sometimes large blisters need to be drained, and sometimes an oral steroid such as prednisone may be useful. Systemic steroids produce rapid resolution of both the itching and the rash. If they are needed, a gradually tapering dosage over about 12 days should be given. The dosage needs to be tapered to avoid side effects after discontinuing use, and the entire course should be taken since stopping earlier may result in a rebound rash as bad as the original.

Allergy shots are available to help prevent recurrences of the poison ivy, poison oak, or poison sumac rash. Unfortunately, the shots for this are frequently ineffective and should be reserved only for those who are extremely sensitive. Prescription pills containing small amounts of extract from the plants have been used for immunization. However, these pills can cause uncomfortable side effects. The pills are recommended only if given before contact with the plant and only for individuals who come into frequent contact with the plant. Using topical creams (such as Ivy Shield, IvyBlock, Hollister Moisture Barrier, Stokogard Outdoor Cream, or Hydrophil) can also help protect against contracting the rash.

So, to answer your questions —

1) Hydrocortisone cream will certainly help relieve the itching for some people — obviously your boyfriend is one of them.
2) Most poison ivy rashes will self-resolve within 14 days without treatment; probably your boyfriend’s will as well.
3) If his rash is severe or if it doesn’t resolve within 14 days, he should see a doctor.
4) As for whether you are overreacting — having had poison ivy myself, I can understand your reaction, but I’m not sure if your boyfriend does :~>.

By the way, though, the rash itself is not contagious.

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. fred

    Many years ago there was a product available that worked very well to relieve the effects of poison ivy rash. It was even issued to linemen working for the telephone company. It’s name was AntIvy, and one of the active ingredients was a zirconium compound. It also had an antihistamine in the mix. I see that it was discontinued because apparently in some cases it was reported to have caused some sort of skin irritation. Poison ivy rash IS a skin irritation. Anyway, I obtained some zirconium oxide and made up my own poison ivy lotion and for me, at least, it works. It isn’t an instant remedy but it helps quite a bit. AntIvy lotion worked for many other people too. I do not understand just why your advice specifically warns against it.

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  2. Garnet

    Can you get poison oak by drinking surface water. We are on a spring and our water runs on the surface and then is collected in our spring box. We have two filters and a UVA light. I have broken out with a rash for the last two years at the same time of the year. June. We live in Oregon

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  3. Reyna Ortiz

    I have had poison ivy for 2 days — today will be the third. Anyways the rash is on my face on my lips and on my cheeks. I also have it in some other parts. Is it good to use hydrocortisone? Please get back, thank you!

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    • Jackson

      No I would recommend going to a local quick aid asking for a steroid shot and a pack of steroid prescription pills you will see improvement with in the first day and it will be gone in 4 days

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  4. Nicole

    I’ve had poison ivy for a week and a half now and it’s been soooo itchy. The otc cream hasn’t been very helpful in that regard. However, I’ve also been having a bad bout of seasonal allergies and took an Allegra today and it seems to have really helped the itch as well as the respiratory symptoms I’ve been having from the unrelated allergies.

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  5. Jill Hinckley

    I had a small round spot in the inner aspect of my right elbow for over a month. Because I had had eczema in the past, I was convinced this was eczema. It didn’t itch.

    One day I developed this angry, raised rash on the inner aspect of my left arm, below the elbow.
    I associated this with eczema and began treating it with as such, with lotions, keeping moist. (This was first mistake because need to keep poison ivy rash dry.)

    It spread, the itching was unbearable, and I tried countless OTC treatments. The rash continued to spread. I finally got an appointment with a dermatologist 5 days out. M.D diagnosed me with poison ivy. He prescribed two medicines. A steroid ointment and hydroxizine. Well, the ointment was over $100 a tube, so I did not get it.

    I ended up self-treating and found that lukewarm soaks, calamine lotion, vinegar-soaked compresses, hydrocortisone cream helped temporarily. (Tried many things, including alcohol and witch hazel.)

    What did help the most? I think bathing with Dawn dishwasing liquid once to get rid of urishiol oil from plant may have helped. Then soak in astringent helped dry some. Happened upon a remedy that I believe helped. I had an old clay masking agent for face. I used this on rash and I believe this dried out some of the rash.

    This is day 9 and still I have some spreading and itching, but do feel better. But I had to endure the rash and itching for the course of the rash.

    Everything I read said that it didn’t spread from scratching or oozing blisters, but as much as I bathed and laundered, I can’t imagine how else it spread.

    MISERABLE!

    This affliction has been maddening. I don’t know when I was exposed, but possibly on my dog’s fur.

    I do believe I did have eczema.

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    • SJW

      I actually mixed baking soda with a little water and used it like calamine lotion. It really helped to cool the blistered area and seems to be helping dry it up. I read on another site that the substance that causes the rash actually gets into your blood and attach to your white blood cells and thats what makes it pop up on other areas of your body. Also said if you catch it within the first few days you can get a steroid shot or a dose pak and this will block your white blood cells to keep the itchy bumps from spreading.

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  6. beth

    My boyfriend we believe got poison ivy in the back yard Monday. We noticed the rash Wednesday and blisters. He’s covered from his arms, few on face and all over stomach and underarms. The blisters on his arms are huge and stick way up off his skin. Should he go to the ER? In can I catch it, I have slept on couch and try not to touch him, but I get allergy shots weekly. I didn’t this Wednesday due to him having rash and I didn’t wanna have a reaction, but can I catch this from him or by what he touches in the house?

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  7. Stanley Kimmett

    I have poison ivy, which has formed the small blisters. Should I drain/pop and treat these or do whatever I can to not “pop” them?

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    • Colton

      I have always been told by my physician to not pop the blisters. Doing so tends to lead to more spreading do the rash. The blisters themselves are actually sterile and will prevent any infection when left alone. I have had this stuff over 25 times and I am highly allergic… I guess I’ll never learn my lesson ha-ha.

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  8. piper

    I have poison oak and I was wondering what temperature should the shower be?

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    • Smokey@aol.com

      The colder the better. Hot water opens the pores and allows for the rash to spread.

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  9. jonathan

    what do you use to treat poison sumac

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    • Sean Deehan

      Poison sumac, oak, and ivy can all be treated the same way…. with disdain! No seriously, you can treat sumac just like you’d treat oak.

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