1. Use an OTC antihistamine. Over-the-counter antihistamines are every bit as good as prescription antihistamines. The primary benefit of using these is decrease in itching, though they may decrease swelling a little. The main side-effect is drowsiness with certain antihistamines, though this can be a benefit if the itch is keeping you awake. The non-sedating antihistamines are Claritin (loratadine) and Zyrtec (cetirizine). The sedating antihistamines are Benadryl (diphenhydramine), chlorpheniramine, and doxylamine (found in sleep aids and Nyquil). If these are effective in decreasing your symptoms and the appearance of the rash is not a concern, an antihistamine may be all you require. The rash will go away on its own if you can wait it out – which usually takes 2 to 4 weeks.
2. Use an OTC topical preparation. Calamine lotion and oatmeal baths help relieve the itch but do not actually decrease the rash. 1% hydrocortisone cream is effective at reducing the itch and healing the rash in mild cases. For a more severe reaction, prescription medication may be needed. Hydrocortisone decreases the body’s reaction to the offending oil, making the rash appear less red and irritated. Any of these may be used in addition to an antihistamine.
3. Call your doctor for a prescription. Your doctor may be willing to prescribe you medication over the phone, or may require you to come in for an appointment to make sure your self-diagnosis is correct. Prescription options include stronger steroid creams, steroid shots, and steroid pills. For small areas of rash, the creams are most appropriate. However, for larger areas or rash on the face (especially if the eyes are swollen shut) steroid injections or oral medications are appropriate. Usually the rash begins to improve by 24 to 48 hours after initiating treatment. Don’t make the mistake of stopping the medicine as soon as the rash appears better – it will likely return if you quit too soon. A five day treatment plan is the minimum, but often 10 to 14 days of medication is advisable.
4. Watch for secondary infection. Any open area of skin can become infected. If the area of redness is increasing, or especially if you see pus (not just clear blister fluid), see your doctor to learn if you need an antibiotic.
5. Do not use triple antibiotic ointment or Benadryl cream. When applied to the skin, both the neomycin in triple antibiotic ointment and the active ingredient in Benadryl cream (diphenhydramine) can cause a rash that looks just like poison ivy. Many a patient has made the problem worse or confused the diagnosis by using these over-the-counter preparations. (Diphenhydramine (Benadryl) taken orally does not cause this problem.)
Lastly, an ounce of prevention is worth a pound of cure. Avoid contact with the leaves, stems, and roots of the plants, all of which contain urushiol. If you pull the plants out, use disposable gloves and throw both the plants and gloves away. Burning the plant can put the chemical in the air and cause a serious rash to anyone exposed to the smoke.