Treatment of Poison Ivy Dermatitis

Treatment Algorithm by Severity

For mild to moderate poison ivy dermatitis, the American Academy of Dermatology recommends applying topical corticosteroids such as hydrocortisone 2.5% or moderate-to-high potency steroids (mometasone furoate 0.1% ointment or betamethasone valerate 0.1% ointment) twice daily to affected areas 1
The American Academy of Dermatology suggests adding oral antihistamines for pruritus relief, such as non-sedating second-generation antihistamines (loratadine 10 mg daily) during daytime, or first-generation antihistamines (diphenhydramine 25-50 mg or hydroxyzine 25-50 mg) at night for their sedative properties 1
For moderate cases, continue topical moderate-to-high potency corticosteroids applied twice daily, and add oral antihistamines for symptom control, with a strength of evidence rated as moderate 1, 2
Consider GABA agonists (pregabalin 25-150 mg daily or gabapentin 900-3600 mg daily) as second-line therapy if antihistamines fail to control pruritus, based on evidence from the American Academy of Neurology 1

For severe poison ivy dermatitis, the American College of Physicians recommends initiating systemic corticosteroids immediately, with prednisone 0.5-1 mg/kg body weight for 7 days, followed by a weaning dose over 4-6 weeks, with a high strength of evidence 2
Continue topical corticosteroids to affected areas, and add oral antihistamines for symptomatic relief, as recommended by the American Academy of Dermatology 1, 2

Use alcohol-free moisturizing creams or ointments twice daily, preferably with urea-containing (5%-10%) moisturizers, as suggested by the American Academy of Dermatology 2
Avoid frequent washing with hot water, and avoid skin irritants including over-the-counter anti-acne medications, solvents, or disinfectants, based on guidelines from the American College of Physicians 2
Apply sunscreen SPF 15 to exposed areas every 2 hours when outside, as recommended by the American Academy of Dermatology 2

Ensure systemic corticosteroid tapers are long enough (4-6 weeks) to prevent rebound flare, with a high strength of evidence from the American College of Physicians 2
Check for increased warmth, tenderness, purulent drainage, honey-colored crusting, or cellulitis, which require antibiotic therapy, based on guidelines from the Infectious Diseases Society of America 2, 3
Systemic corticosteroids are necessary when >30% body surface area is involved or self-care is limited, with a high strength of evidence from the American Academy of Dermatology 2, 3

Over-the-counter hydrocortisone preparations have not been shown to improve symptoms in randomized trials, according to the American Heart Association 4, 5, 6, 7
Prescription-strength topical corticosteroids combined with systemic steroids have demonstrated efficacy in reducing itch duration, as recommended by the American Academy of Dermatology 4, 5, 6

Cool compresses can be used for symptomatic relief, as suggested by the American College of Physicians 4, 5, 6, 7
Oatmeal baths can be considered for widespread pruritus, according to the American Academy of Family Physicians 4, 5, 6, 7

Washing with soap and water can remove urushiol, with 100% removal if done immediately, 50% at 10 minutes, 25% at 15 minutes, and 10% at 30 minutes, as stated by the Centers for Disease Control and Prevention 4, 5, 6, 7
Commercial decontamination products or hand cleaners used within 2 hours can reduce symptoms by 55-70%, as reported by the National Institute of Environmental Health Sciences 4, 5, 6, 7