Posts Tagged ‘rash’

Poison Oak


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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Tick Bites

tick bite

In Santa Cruz County, it is reported that less than five percent of the mature Western black-legged ticks and a somewhat higher percentage of the nymphal (baby) stage, carry the Lyme bacteria. Although many people worry after being bitten by a tick, the risk of acquiring an infection is quite low. In this article I’d like to discuss the tick bite and signs and symptoms of Lyme disease.

Neither the tick’s body nor its head burrows into the skin. Instead, the tick attaches by its mouthparts. An infected tick can transmit an infection only after it has been attached, taken blood from its host, and fed for 24 to 48 hours. If you find a tick on you that is unattached and non-engorged, it is unlikely to have transmitted an infection. Look carefully for the immature nymphal ticks, which are the size of a sesame seed. It helps to shower after clearing brush or walking in wild lands.

The proper method of removing a tick is to use a fine pair of tweezers and grasp the tick as close to the skin as possible. Pull it straight out, gently but firmly, without jerking or twisting. After removing the tick, wash your hands and the skin around the bite thoroughly with soap and water.

If, after removal, you see anything remaining in the skin, this represents tiny mouthparts of the tick. It is not the tick’s “head” and it cannot increase the risk of transmission of Lyme disease once the tick body is removed. If you are unable to remove the mouth parts easily, as you would a splinter, leave it alone and the skin should eventually heal. If you are concerned see your doctor.

Quite often, after an obvious tick bite, a red rash may develop at the site of the bite within the first 24 to 48 hours. A rash that develops this quickly after the bite is usually an allergic reaction to the saliva of the tick. It rarely grows beyond 2 inches, needs no treatment and disappears within a few days.

The actual Lyme’s rash, called erythema migrans, is reported to occur in up to 80 percent of infected tick bites. It is described as a red rash that is usually neither itchy nor painful. It develops a few days to a few weeks after a tick bite and is likely to be the first sign of Lyme disease. The rash most often continues to get larger over a period of time and will grow to be well over 2 inches, possibly 8 to 12 inches or more, and may last for several weeks. This rash may sometimes develop a pale appearance in the center, causing a bull’s eye shape.

Either during the time of the rash or shortly thereafter, other symptoms of Lyme disease may appear which resemble these common flu-like symptoms: fever and chills, malaise (achiness), headache, and achy joints.

The rash and/or the above flu-like symptoms may indicate early Lyme disease and you should see your doctor. When recognized during this early stage, most infections can be adequately treated.

If the above symptoms do not occur, are not recognized or are not treated properly, then one might develop late Lyme disease which can more severely affect different parts of the body such as the  joints, the nervous system, and the heart, to mention a few.

The bottom line is that whether you are aware of a recent tick bite or not, if you develop an unusual, unexplainable rash or if you develop flu-like symptoms (without respiratory symptoms), especially outside of the flu season, you should visit your doctor and discuss the possibility of Lyme disease.

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Shingles is a painful rash caused by the varicella-zoster virus, which is the same virus that causes chicken pox. At the moment, there are many cases of chicken pox occurring in our local grade schools. Anyone who has had chicken pox may develop shingles.

After an episode of chicken pox, the virus can remain inactive, often for decades, in cells of the nervous system. Shingles is caused by a reactivation of the virus, which can manifest as a painful rash, always on one side of the body. The rash can be found on almost any part of the body, but it is usually a band of blisters from the middle of the back to the middle of the chest. Pain often occurs several days before the rash. Less commonly, one can have just the pain and not the rash.

Most of the time, shingles occurs only once, but if it does happen again, it’s usually on another part of the body.

About 20 percent of people will develop shingles during their lifetime. Shingles can affect people of all ages, but it is more common in those older than 50 and much less common in younger individuals. It is sometimes more common in those who have conditions that weaken the immune system, such as medical treatments involving the use of cortisone, chemotherapy and radiation.

Shingles is not life-threatening. A full recovery is usually expected within a month or two, although one may rarely have a complication called postherpetic neuralgia. This condition causes the skin to remain painful and sensitive to touch for months, or even years, after the rash disappears.

Shingles cannot be passed from one person to another, but a person with shingles can pass the varicella-zoster virus to a susceptible person, causing chicken pox. Transmission usually occurs through direct skin-to-skin contact with the blisters of a shingles rash.

Several treatments are available from your health care provider:

  • High doses of an antiviral drug can reduce the duration and intensity of the symptoms. Such medications include acyclovir (Zovirax), valacyclovir (Valtrex) or famciclovir (Famvir). The medicines work best when given within the first 72 hours of symptoms.
  • Pain relievers can help control pain. This usually involves some form of a narcotic, such as Darvocet, Vicodin or codeine.
  • Also sometimes helpful in more severe cases of shingles is the application to the rash of an ointment containing capsaicin, the compound that makes chiles spicy, or a skin patch containing the numbing drug lidocaine.
  • Because shingles affects the nervous system, it may require a prescription of Neurontin for those experiencing severe pain.

Home treatment of the shingles rash involves keeping the rash clean with soap and water, applying cold, wet compresses to the blisters, and, for those not taking prescription pain medicine, doses of Tylenol or Advil as needed.

Preventatives are available in the form of vaccines. All children should be routinely vaccinated for chicken pox, as should any adult who has never had chicken pox. Although this vaccine doesn’t guarantee to prevent either chicken pox or shingles, it can reduce the intensity of the disease and reduce the chance of complications.

There is also a vaccine specifically for shingles called Zostavax. It is indicated for those 60 years and older. In studies of people who were given the vaccine, the incidence of shingles infection was reduced, and in those patients who did develop shingles, the severity and duration of infection was reduced.

The bottom line is that if you have a painful rash, it is better to seek treatment from your health care provider sooner rather than later.

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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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