Exposure to Poison Ivy can cause a painful and itchy rash, which can take several weeks to manifest.

Find out what you should do if you get caught with poison ivy, poison sumac, or poison oak. And find out when prednisone is appropriate (or not).

Watch now!

Poison Ivy Treatment Myths

Transcription autogenerated from the video above so some errors are possible

There are so many myths about how to treat Poison Ivy rash floating around the internet and I’m here to bust some myths for you about Poison Ivy treatment. 

I’ve got 9+ Myths to bust for you about treating Poison Ivy. So why would I even be answering this? 

First of all, I have a patient who wrote me this email and it includes one of the myths.

“Hi Dr. Megan! I currently have poison ivy and have finished day 4 of the 6 day blister pack. The poison ivy doesn’t seem to be getting better. It’s still itchy in 2 main spots, contacted areas are developing from small circles to larger rash areas. Is it advisable or will it help me to extend my taper to take 2 doses of 4mg pills each day, starting tomorrow, then 1 dose of 4mg pill for a few days after? I have another prescription for Medrol dose pack. But unsure what the value (if any) would be of extending the taper. Thank you!!”

People are wondering, how long do I take prednisone? When will I feel better if I take prednisone? And what about all the other treatments for Poison Ivy? Do they work? What should I do?

Myth #1 Poison Ivy reaction shows up immediately

If you brush by Poison Ivy, you’re going to get a reaction immediately and that’s what I kind of figured is what it would be.

Having not personally ever been exposed to poison ivy myself, I’ve had other rashes from bushes as I’ve been hiking in the woods but I’ve never had poison ivy and those rashes. They were pretty quick within about 15 minutes, but that’s not necessarily how poison ivy is.

Truth:

Poison Ivy takes a little bit of time to react. Reaction from poison ivy can be anywhere from 4 hours to 4 days.

If it’s your first exposure, it’s even possible to go way up to 21 days after your exposure to have a poison ivy rash. Kind of mind-blowing. It’s at least how I felt.

Myth #2 Hot shower can help

If you immediately take a hot shower, that can help and it’s a little more nuanced than that. 

What is causing this reaction? It’s the oil that is inside the plant. You have to actually break the plant in order to be exposed to the oil. It’s called Urushiol, and it’s from the Japanese meaning lacquer or resin. It coats you and it’s sticky. 

Truth:

If you just use straight-up water or hot water, it’s not really gonna get rid of it. You actually need to use something that is going to dissolve that oil.

• Step 1: If you know you were exposed, you wanna immediately put gloves on and use the gloves to take off contaminated clothing.
• Step 2: You’re gonna wash at least three times after the exposure.

How do you wash?

Myth #3 Need a fancy expensive Poison Ivy treatment

You have to go and buy some fancy expensive poison ivy treatment. That’s not true.

Truth:

They’ve done studies and shown that using a dishwashing soap like Dawn, that lovely blue gentle dishwashing soap on a washcloth is as effective and a lot cheaper than the fancy expensive oil remover treatments.

You put the soap on a washcloth, get it wet, and then you wanna wipe in the same direction. You don’t wanna rub, because that might rub the oil into places that it wasn’t.

So you wanna just rub away and then rub away and keep rubbing in one direction and then rinse out the cloth, do it again, rubbing in one direction, and do that three times with a soapy dishcloth.

There are no fancy expensive treatments for poison ivy that works. There is one possibility, and that is if there is a cream or an oil that is designed specifically for poison ivy. For people who are exposed to it often. It’s designed to create a barrier to protect your skin in advance of exposure, is designed specifically for poison ivy.

For people who are exposed to it often like a firefighter or a landscaper or something and you’re frequently exposed to it. I’ve heard maybe one called Tecnu, it might be helpful. Those ones have some evidence that they can help. 

Myth #4 Poison Ivy can spread to others

Truth:

Poison Ivy can spread to other people is false. At least the poison ivy rash can’t. The contact dermatitis is not contagious, it cannot spread to other people. Even if you have blisters and they pop, what is in the blisters is not actually poison ivy it is not the urushiol. It’s actually your body’s reaction like the white blood cells and the puss. All of that stuff is not actually the poison ivy. 

What is true about this is that urushiol can get under your fingernails, it can be on your pet, it can be on your clothes, it can be on your garden tools, it can be on all of these things and that can spread. Like your dog going around your house. The dogs usually don’t get a reaction like humans do. But if that dog tracks this around the house, yes that can spread it. 

So cut your fingernails, and get the oil out from underneath your fingernail beds. Wash them really well with that dish soap.

Myth #5 Anti-itch medicines help relieve itching

Anti-itch medicines help relieve itching. Like Benadryl, those are so helpful for relieving itching and that’s what you’d normally think when it comes to itching. But when it comes to poison ivy itching, it actually doesn’t have evidence that it helps. 

People who take this kind might be like, “I need it so I can sleep at night because I itch at night.”

Truth:

The studies show that even if you take it, the amount of itching doesn’t change. The amount of scratching and itching doesn’t change, and the quality of sleep is worse. 

Only take it if you’re completely desperate. Like you absolutely cannot sleep, and if you’ve taken on the past and you know it helps you sleep. Because there’s a few people that actually that makes them wide awake.

What about antihistamine creams or lotions or anesthetic creams containing numbing things like benzocaine? Those are not helpful and are not advised, so avoid those. They are just not the best thing for you. 

Myth #6 Use an Over-the-counter Antibiotic if you get a skin infection

If you get a skin infection complication like your blisters pop or your scratch gets so bad that it bleeds and then it starts getting infected, just use an over-the-counter antibiotic to rub in there.

Truth:

You should avoid antibiotic ointments or creams containing neomycin or bacitracin to the skin when it is that reactive and inflamed. They could actually make the rash worse.

In addition to that, many people are allergic to those ingredients and the actual top reaction like contact dermatitis is actually as common from those ingredients themselves. They’re the most common cause of contact dermatitis. And these days many bacteria are actually resistant to these drugs. 

If you are getting an infection, you need to see a doctor and get an oral antibiotic to treat it. The creams and ointments are not good enough for this kind of infection. 

Myth #7 Steroid creams should be avoided

I just mentioned all these other kinds of creams to avoid. Do we also avoid steroid creams? And the answer here is actually no, you should not avoid them. 

Truth:

Potentially if used within the first few days, steroid creams can be helpful. If you get symptoms and they’re itchy, red and it’s getting swollen, then a steroid cream can help.

But the over the counter available kinds that you don’t need a prescription for, such as hydrocortisone. 1% cream or 0.5% cream are too low of a dosage of potency to actually work. They’re not usually very helpful, they’re just not quite enough to get you over the edge. 

You usually need a prescription strength steroid cream. But if you were to use a prescription strength steroid cream, they are often expensive and they don’t necessarily work as well as a pill or an injection.

Myth #8 Everyone who gets Poison Ivy should take prednisone

The steroid pill is the most common. People may also be prescribed methylprednisolone or Medrol dosepacks for poison ivy treatment. The truth of the matter is most people throughout history have survived without steroid treatments.

Truth:

For the majority of people who are exposed to poison ivy doing nothing is going to be just fine. Your symptoms will resolve within 1-3 weeks. 

Somehow we’ve survived as a species, even though poison ivy has been a constant bane to our existence. Even if you are exposed, you don’t have to take a prescription steroid to treat it. You only want to take a prescription steroid like prednisone for poison ivy rashes, if it is severe.

Talk to your doctor about what that means. Be very clear about precisely how severe your situation is. Generally, severe means it’s covering at least a fourth of your body. It’s in a very sensitive area such as your face, eyelids, mouth, and genital areas, and involving two or more body areas. 

So it’s gotta be bad, It needs to be bad. And why does it need to be bad to justify using prednisone? Because the side effects of prednisone itself are terrible. I can’t tell you the number of people who have called me emailed me, messaged me saying, “I wish I had never taken prednisone for this silly rash that was gonna go away on its own.”

Poison ivy rash will go away on its own. If you can possibly tolerate it, avoid the prednisone. Definitely talk to your doctor though. 

Why do I say that? Because I personally had to take prednisone and I’ve talked to thousands of people who’ve taken prednisone. I’ve discovered that prednisone can cause up to 150 side effects and some of these side effects are even worse than poison ivy. I know that’s hard to believe if you’re suffering poison ivy, how miserable it is. But believe me when I say there are some horrible, disabling, debilitating, and disfiguring side effects to prednisone that you want to avoid if at all possible. unless you have something severe going on. 

They did a study of people who took prednisone for poison ivy. The side effects that they had included weight gain, anger, hyperactivity, insomnia, and nausea.

I have a whole chart of possible other ones. A searchable list to be like, is this poison ivy getting worse? Is this something else or is this a side effect of steroids? You can search that list.

Myth #9 Steroid treatment with Prednisone, Methylprednisolone, or Medrol Dosepack is only needed short-term and you’ll know right away if it works.

Steroid treatment either with prednisone, methylprednisolone, medrol dosepack is only needed short term and then you’ll know right away if it works. And that is false. That is a complete myth.

Truth:

Expose yourself to the least amount of steroid possible. Generally, that’s what I advise people, But if the prednisone is going to actually do its job in poison ivy, it needs to be a really quite high dose. 

The Medrol dose pack actually isn’t high enough for most people. You really need between 40-60 milligrams of prednisone per day for at least five days, if not longer. 

Back to this study, they compared people who were given 40 milligrams of prednisone for five days to people who were given 40 milligrams of prednisone for five days and then tapered slowly to a total of 15 days of treatment.

10 days of tapering doing 30, 20, 15, 10, and 5 milligrams over time. For those people, it showed that a longer treatment was more effective than a shorter treatment. A five-day prednisone dosage just probably isn’t enough. You can have rebound rash and itching coming back because it didn’t last long enough that urushiol is just wicked in its ability to cause our body to really react.

Related to that it needs to be at least 14 days and often up to 21 days of treatment. Depending on your size, you might need a higher dose. Or depending on the level of severity of your rush, you might need up to 60 milligrams per day. Between 40 to 60 milligrams generally is the dose for adults.

How fast does Prednisone work for Poison Ivy?

I’ve seen things online that say, you’ll know it’ll work really fast and you might get some relief fairly quickly. You might get some itching or some swelling that goes down. But in that study they asked people; when did you first get relief in the meantime to improvement? The average time to improvement of their poison ivy was between 3-5 days. So it wasn’t immediate. 

It wasn’t after that first dose, as generally is seen with most reasons people take prednisone. 

For those people who took it for longer than five days, when did the rash finally resolve? When did it go away? And the average or mean time to resolution was 11-15 days. So it was about two weeks before people saw the rash resolving.

And that’s why you want to continue the treatment beyond 5 days to 14-21 days instead. Prednisone works after three to five days and you need to take prednisone for 14-21 days. 

Bonus Myth #10 There’s nothing you can do about the steroid side effects

“I have to take this horrible steroid because I have this horrible rash and there’s nothing I can do about all of these horrible side effects. I have 150 possible side effects and there’s nothing I can do about it.”

Truth:

Well, thankfully I’m here to tell you that that is false. That is a myth. There are things you can do about prednisone side effects, and to help you out, I created a free downloadable PDF.  It’s called the Prednisone checklist, and it goes through the side effects and what you can do about them. My top tips on how to cope while on prednisone. 

So you can just sign up below to download your free prednisone checklist so that if you have to take prednisone for Poison ivy, you won’t feel nearly as awful as those poor people who don’t know what you’ll know by downloading this checklist. I’m here to help you not just survive prednisone, but to thrive while on prednisone.