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Poison Oak

PoisonOak

Having treated thousands of cases of poison oak in my career, I’d like to share with you what I’ve learned about this miserable affliction.

The poison oak plant which is so prevalent in our locale, contains an oil in its sap called urushiol. This oil is found in all parts of the plant; leaves, stems, and roots. Even in extremely minute quantities, like a billionth of a gram, it can cause a very severe allergic reaction to our skin. This usually occurs within 24-36 hours after exposure.

Eighty five percent of our population is susceptible to this rash and a lucky fifteen percent have a natural resistance to it.

You can be exposed to the oil by direct contact with any part of the plant, or by indirect contact with an object such as your own hands, clothing, tools, or anything that may have the urushiol oil on it. There have also been reported cases of smoke from burning poison oak, causing either a skin rash or a reaction in the lungs, although I have never seen this in any patient I’ve treated.

Once you have contact with the oil you have only a matter of minutes to wash it off before it will bind to the skin and begin the allergic rash. The best way to remove the oil from the skin is to rinse with lots of water and then wash with soap and water. Most any kind of soap will do. Also, wash any object which may have come in contact with the oil with soap and water, including the clothes you were wearing. And don’t forget to do the same to your shoes, tools and pets. Urushiol oil can remain active on inanimate objects for over a year.

There are a number of over the counter products including Technu and Zanfel, which are to be used on the skin after exposure to poison oak, to remove the oil. I have heard mixed reviews on their effectiveness. For now, I’ll stick with water and soap.

Poison oak rash never becomes systemic. It is medically called a “contact dermatitis,” and the only place where a rash can develop is where the urushiol oil has contacted the skin. Poison oak rash can affect almost any part of the body. The rash does not spread by touching it even if it is oozing a liquid, although it may seem to when it breaks out on new areas over a number of days. This may happen because the oil absorbs more slowly on thicker skin, such as the forearms, legs or trunk and faster on thinner kin such as the face and genitals.

Can poison oak rash be prevented before contact with the oil? Some allergy pills or shots have been used with limited success, but in general, they are no longer used, because of potentially serious side effects

A poison oak rash will always eventually clear up on its own if one is willing to wait it out. There are an abundance of home remedies to cure poison oak, none of which have been proven to be effective. However there is effective, proven, and safe medical treatment for those who wish not to suffer for several weeks. Your doctor may prescribe some form of a steroid cream which is stronger and much more effective than over-the-counter cortisone cream. If the rash is more serious and especially involving the face, systemic treatment may be necessary. This involves the use of cortisone pills called prednisone, which is my preferred treatment, or as a steroid shot. Either of these treatments is safe and very effective for most patients. Your doctor will help to determine the best treatment for your particular condition.

The bottom line is that you should avoid contact with poison oak, wash your skin and clothing as soon as possible if you do come in contact, and see your doctor for effective medical treatment if symptoms persist or worsen.

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Poison Oak

Poison Oak

It’s that time of year again when I treat an increasing number of patients suffering from poison oak rash.

Having treated thousands of cases of poison oak in my career, I’d like to share with you what I’ve learned about this miserable affliction.

The poison oak plant, which is so prevalent in our locale, contains an oil in its sap called urushiol. This oil is found in all parts of the plant — leaves, stems and roots.

Even in extremely minute quantities — say, a billionth of a gram — it can cause a very severe allergic reaction in the skin. This usually occurs within 24 to 36 hours of exposure.

Roughly 85 percent of the population is susceptible to this rash, and a lucky 15 percent has a natural resistance to it. Unfortunately, I’m in the first group.

You can be exposed to the oil by direct contact with any part of the plant or by indirect contact with an object that has urushiol oil on it, such as your own hands, clothing or tools. There have been reported cases of the smoke from burning poison oak causing either a skin rash or a reaction in the lungs, although I have never seen this in any patient I’ve treated.

Once you make contact with the oil, you have only a matter of minutes to wash it off before it will bind to the skin and begin the allergic rash.

The best way to remove the oil from the skin is to rinse with lots of water and then wash with soap and water. Most any kind of soap will do. Also, wash any object that may have come in contact with the oil using soap and water, including the clothes you were wearing.

Don’t forget to do the same to your shoes, tools and pets. Urushiol oil can remain active on inanimate objects for more than a year.

There are a number of over-the-counter products, including Tecnu and Zanfel, that are sold to be used on the skin after exposure to poison oak to remove the oil. I have heard mixed reviews on their effectiveness. For now, I’ll stick with water and soap.

A poison oak rash will always eventually clear up on its own if one is willing to wait it out. And there are abundant home remedies to cure poison oak, none of which has been proven to be effective.

However, there is effective, proven and safe medical treatment for those who wish not to suffer for several weeks.

Your doctor may prescribe some form of a steroid cream that is stronger and much more effective than over-the-counter cortisone cream.

If the rash is more serious, and especially if it involves the face, systemic treatment may be necessary. This involves the use of cortisone pills called prednisone, which is my preferred treatment, or a steroid shot. Either of these treatments is safe and very effective for most patients.

Your doctor will help determine the best treatment for your particular condition.

The bottom line is that you should avoid contact with poison oak, wash your skin and clothing as soon as possible if you do come in contact with any part of the plant, and see your doctor for effective medical treatment.

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Over the years of my emergency/urgent care career I’ve dealt with many different injuries and illnesses seen commonly during the summer months.  I’d like to share some of my thoughts on making this a very safe summer for everyone.

  • Sunscreen –  Almost everyone who spends time out in the sun MUST wear sunscreen to block the harmful, damaging effects of the sun’s ultraviolet rays on our sensitive skin.  Use a sunscreen that offers protection against both UVA and UVB rays and has an SPF rating of at least 30. Apply it liberally and often (at least every two hours).  Parents, protect your kid’s precious skin.
  • Insects –  Beware of the many summer bugs lurking out there.  For mosquito protection use a repellant that contains DEET which when used as directed is safe for adults and children over 2 months of age. Regarding the stinging insects such as yellow jackets, wasps and honeybees, avoid them if they are in your vicinity. If you do get stung by a honey bee (which is the only one of the stinging insects that leaves a stinger behind in your skin), remove it as quickly as possible by any means possible.  It is now OK to just pull it out with your fingers and not waste time finding something with which to scrape it off.  Immediately apply ice to the sting. When out in a woody or grassy area always check your entire body for ticks when you get home. If you find one, remove it as soon as possible by getting a pair of tweezers, grabbing the tick  close to the skin and pulling it straight out.
  • Poison oak –  The best protection is to recognize it and avoid it. If you come into contact with poison oak with your skin, clothing (including shoes and shoe laces), or garden tools, wash off immediately with soap and water.  Poison oak oil must be washed off of your skin with in a few minutes in order to avoid the dreaded rash. Remember, all parts of the poison oak plant contain the nasty oil, including the leaves, branches and roots.
  • Heat –  Heat exhaustion is manifested by extreme sweating, fatigue and cramps. Heat stroke (a life threatening condition) is manifested by lack of sweating, red hot skin,  and a very high body temperature.  Both conditions can usually be prevented by drinking plenty of liquids and avoiding direct sun as much as possible especially between the hours of 11:00 AM and 4:00 PM.
  • Water safety –  4,000 Americans drown every year, mostly men by a factor of 4 times more than women.  Alcohol is frequently involved.  Make sure the kids are supervised in the water every single minute. Watch out for rapid currents, rip tides, rocks, and always be aware of your surroundings.  Boat injuries claim another 700 American lives a year.  Drive your boat sensibly, have enough life preservers on board and do not drink alcohol and drive.
  • Bicycling –  WEAR A HELMET!  No matter how obvious this bit of advice is, I still see people riding without a helmet and I really cringe when I see children without this life saving protection. Head injuries are often very serious, if not deadly, and are inexcusable for lack of a helmet. Be aware of your surroundings and be in control of your bike at all times.  Don’t take foolish chances.
  • Eating –  Summer picnics can be a common source of food poisoning manifested by vomiting and/or diarrhea..  Food left out too long is the usual culprit. Handling uncooked chicken or eating undercooked chicken is also a common source of this illness.
  • Driving –  We all drive more during the summer.  The cheapest form of life insurance while you are in a car is the good old seal belt.  WEAR IT!  Make sure your children are in proper age appropriate car seats.  Hand held cell phone use while driving your car is now illegal. Don’t break the law.

Have a very enjoyable safe summer.

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The good news about poison oak is that about 15 percent of people are immune to its effects. The bad news is that, like me, you’re probably in the other group.

Over the years, I’ve treated several thousands of cases of poison oak and the one thing I’ve learned is to respect it. I’m sure poison oak was created to keep mankind humble.

Poison oak is an allergic reaction caused by contact with urushiol, which is the oily sap of the poison oak plant. It is the same substance found in other poison plants, like poison ivy and poison sumac. Interestingly, it is also found in mango rinds and the fruit (not the nut) of the cashew tree.

Urishiol is a colorless oil found in all parts of the plant, including leaves, stems and roots. It is so potent that it has been reported that an amount of oil that could fit on the head of a pin could cause rashes to several hundred people.

One can contact poison oak oil in the following ways:
1. Direct contact: touching the sap of the plant.
2. Indirect contact: touching something on which the oil is present, such as the fur of a pet, garden tools, sporting equipment and especially contaminated clothing. The poison oak oil can remain active on these objects for many months. (Continue reading for ways to remove the oil.)
3. Airborne contact: breathing the smoke from burning poison oak. There have been reports of this in literature, but I have never witnessed it with any of my patients.

When urushiol contacts the skin, it penetrates within minutes. A reaction will appear within 12 to 72 hours in those of us who are allergic to it.

A common misperception is the idea that a good shower at the end of the workday will be sufficient to prevent a poison oak rash. I repeat, you have only a few minutes to wash it off of your skin.

The best way to wash it off is somewhat open to debate. Some medical experts would argue that water alone is sufficient to wash the oil off the skin. The water can be any temperature, as there is no proof that heat opens the pores of the skin to allow for more absorption of the oil. I have personally experienced that soap and water does the job, although some would argue that soap might spread the oil. I have never seen nor had this happen. I figure that if soap is universally recommended to use in the washing machine to remove the oil from the contaminated clothes, then it should also work to wash it off your skin.

Whichever routine you wish to use, we can agree that a copious amount of water is necessary. Some authorities maintain that rubbing alcohol should be used to decontaminate the urushiol oil. I could find no controlled studies to verify this.

Remember to also wash your shoes, as one common source of continued recontamination comes from touching shoes and shoelaces after they have had contact with poison oak. Also, be aware that when you take your clothes off at the end of the day to throw them in the washing machine, your hands can become recontaminated and you can thereby spread the oil further on your body.

Once you have bathed and removed the oil from the skin, you can no longer spread poison oak to anybody or anything. But sometimes, no matter what you do, you’re going to end up with a rash. That’s the mystery of poison oak.

Poison oak rash never becomes systemic. It is medically called a “contact dermatitis,” and the only place where a rash can develop is where the urushiol oil has contacted the skin. Poison oak rash can affect almost any part of the body. The rash does not spread by touching it, although it may seem to when it breaks out on new areas over a number of days. This may happen because the oil absorbs more slowly on thicker skin, such as the forearms, legs or trunk.

Can poison oak rash be prevented before contact with the oil? Some allergy pills or shots have been used with limited success, but in general, they are no longer used, because of potentially serious side effects.

I have pulled out poison oak plants while clothed from head to toe and wearing thick, heavy-duty rubber gloves washed frequently in a bucket of soapy water I keep at my side. I very carefully try not to allow my clothing to touch the plant. When my task is done, I run into the house (with my shoes left at the door), throw my clothes in the washing machine and jump into the shower. This has worked fairly well for me.

Once the rash begins, you have several choices to ease the discomfort. A lotion called Technu may help some people, but not others. If the rash forms blisters that begin to weep, applying over-the-counter Domeboro as a wet compress is helpful in drying the rash. Hydrocortisone cream is basically ineffective.

Mild cases can usually be tolerated without treatment and will disappear within a week or two. Depending on the severity, a person can be treated by a health care provider to heal the rash with prescription steroid creams, or if needed, systemic cortisone can be taken as pills for about two weeks or by a single steroid injection, especially if the rash involves the face. Let your provider know which form has worked best for you in the past, or if it’s your first visit for this rash, let your provider determine which method is best. In my experience, the benefit of either cortisone treatment far outweighs any risk.

I’d love to hear your personal remedies for removal and treatment of poison oak.

  • At all cost, avoid exposure to poison oak, either from direct contact with the plant or indirectly through contaminated pets, clothes, tools, etc.
  • If known contact occurs, immediately rinse the skin with copious amounts of water followed by soap and water or an immediate shower.

  • Wash contaminated clothes in the washing machine, and don’t forget to wash your shoes and laces as well.
  • If your rash blisters and oozes, use wet compresses with Domeboro, an over-the-counter treatment.
  • If you can no longer stand the effects of the rash, see your health provider and be open to being treated with some form of cortisone, whether it’s a cream, pill or shot, and then expect a fairly rapid recovery.

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