If a patient has had a poison ivy rash for one week, how long would steroids be prescribed at this point? — ZENA VATMAN, FNP, Stamford, Conn.


The first step in the management of a patient with contact dermatitis, such as rhus dermatitis (poison ivy), is decontamination: the individual should wash the area thoroughly with lots of hot water and pat dry.


Copious rinsing and decontamination of all clothing or other materials that may have come into contact with the plant is required. Local care with topical corticosteroids and anti-pruritic compounds (including oatmeal baths, Burrow solution, or others) should be applied to the skin to relieve symptoms. Topical antihistamines are generally not helpful.


In cases in which lesions are widespread or remain symptomatic after a few days, systemic steroids are an option. A short course of prednisone will provide quick relief. In general, five to seven days of a full dose followed by tapering during the next week is adequate. Naturally, the choice to prescribe systemic steroids must be made in light of any other comorbidities or chronic medications that the patient may be on at the time. — Claire O’Connell, MPH, PA-C, teaches in the PA Program at the New Jersey Medical School and Rutgers University, Piscataway, N.J. (199-1)



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