Rhus Dermatitis Research Articles

Poison ivy (Toxicodendron radicans) leaf shape variability: Why plant avoidance‐by‐identification recommendations likely do not substantially reduce poison ivy rash incidence

Societal Impact StatementAvoidance of poison ivy plants is currently the primary approach to prevent the estimated 30–50 million annual poison ivy skin rash cases. The “leaves of three let it be” mnemonic device lacks specificity to differentiate poison ivy from other three‐leaflet native plants. This report demonstrated that poison ivy leaves show marked total leaf shape variability that likely confounds accurate poison ivy plant identification, and significantly undermines a poison ivy avoidance strategy for mitigating poison ivy rash cases. Therefore, there is an ongoing need to develop prophylactic medical procedures to prevent poison ivy rash that do not depend on human poison ivy plant identification.Summary Urushiol is the natural product produced by poison ivy (Toxicodendron radicans) that is responsible for millions of cases of delayed contact allergenic dermatitis in North America each year. Avoidance of poison ivy plant material is the clinically recommended strategy for preventing urushiol‐induced dermatitis symptoms. However, poison ivy leaf shape is anecdotally notoriously variable, thereby confounding accurate poison ivy identification. This study focused on quantitative analyses of poison ivy and a common poison ivy look‐alike (American hog peanut) leaf shape variability in North America to empirically validate the high degree of poison ivy leaf shape plasticity. Poison ivy and American hog peanut iNaturalist.org records were scored for seven attributes of compound leaf shape that were combined to produce a total leaf complexity score. Both the mean and the distribution of poison ivy total leaf complexity scores were significantly greater than that of American hog peanut. Non‐metric multidimensional scaling analyses corroborated a high degree of poison ivy leaf shape variability relative to American hog peanut. A poison ivy accession producing frequent palmate penta‐leaflet compound leaves was evaluated using linear regression modeling. Poison ivy total leaf complexity was exceedingly variable across a given latitude or longitude. With that said, there was a small but significant trend of poison ivy total leaf complexity increasing from east to west. Palmate penta‐leaflet formation was significantly correlated with a stochastic leaflet deep‐lobing developmental process in one unusual poison ivy accession. The empirically‐validated poison ivy leaf shape hypervariability described in this report likely confounds accurate poison ivy identification, thereby likely resulting in many accidental urushiol‐induced clinical allergenic dermatitis cases each year.

Evaluation and Management of Toxicodendron Dermatitis in the Emergency Department: A Review of Current Practices.

Toxicodendron dermatitis is an underappreciated disease seen in the emergency department. Although self-limiting, symptoms can be distressing and can last for weeks if untreated, particularly with re-exposure. Continuing research has improved our understanding of specific inflammatory markers that are associated with exposure to urushiol-the compound responsible for Toxicodendron dermatitis-although consensus for treatment remains varied and poorly supported. Owing to the lack of recent primary literature on the topic, many providers rely on historical precedent, expert opinion, and personal experience when treating this disease. This article provides a narrative review of the literature currently available on the effects of urushiol on key molecular and cellular functions and the prevention and treatment of Toxicodendron dermatitis.

Botanical Briefs: Toxicodendron Dermatitis.

Toxicodendron dermatitis is a type IV hypersensitivity reaction resulting from exposure to urushiol found in poison ivy, poison oak, and poison sumac. The dermatitis presents as a pruritic erythematous rash with vesicles and bullae in areas that were in contact with the plant. Symptoms present after 24 to 48 hours and can be managed with a variety of treatments, depending on severity. Avoidance is the principal way to prevent Toxicodendron dermatitis, highlighting the importance of educating patients on identification of plants.

Poison Ivy Dermatitis Treatment Patterns and Utilization: A Retrospective Claims-based Analysis.

IntroductionPoison ivy (toxicodendron) dermatitis (TD) resulting from contact with poison ivy, oak, or sumac is a common form of allergic contact dermatitis that impacts millions of people in the United State every year and results in an estimated 43,000 emergency department (ED) visits annually. Our objective in this study was to evaluate whether healthcare utilization outcomes are impacted by prescription practices of systemic corticosteroids.MethodsWe used a health claims database from 2017–2018 of those treated for TD. Descriptive statistics and logistics regression models were used to characterize trends.ResultsWe included in this analysis 115,885 claims from 108,111 unique individuals (93.29%) with 7,774 (6.71%) return claims within 28 days. Of the return claims, 470 (6.05%) were to the ED. Emergency clinicians offered no oral corticosteroid prescription 5.27% (n = 3,194) of the time; 3276 (86.26%) prescriptions were for a duration of 1–13 days, 410 (10.80%) were for 14–20 days, and 112 (2.95%) were for >21 days. Further, we found that shorter duration oral corticosteroids (odds ratio [OR] 1.30; 95% confidence interval 1.17–1.44; P <0.001) and initial treatment for TD at the ED compared to primary care clinicians (OR 0.87 [0.80, 0.96]; P <0.001) and other non-dermatologists (OR 0.89 [0.80, 0.98]; P = 0.01) places patients at an increased risk for return visits with healthcare clinicians when controlling for drug group, duration of treatment, and initial treatment location.ConclusionDespite recommendations to treat TD with oral steroids for at least 14 days, most emergency clinicians offered this treatment for shorter durations and was associated with return visits. Emergency clinicians should consider treatment of two to three weeks when providing systemic steroid coverage when there are no limiting contraindications, especially as patients who present to the ED may do so with more severe disease. Additional education may be needed on appropriate treatment pathways for TD to reduce healthcare utilization associated with undertreatment.

Establishing Consensus on the Treatment of Toxicodendron Dermatitis.

Toxicodendron dermatitis (TD) is a common form of allergic contact dermatitis that affects millions of Americans every year. Studies have shown that although there are general recommendations for the treatment of TD, there are no treatment algorithms for clinicians to follow when patients present with TD. The objective of this study was to achieve consensus on the treatment of TD to create practical guidelines for physicians who treat TD. Data were collected from March 2020 to April 2021. This study included semistructured focus groups and a Delphi Study with dermatologists to achieve consensus. A total of 51 dermatologists were included in the Delphi. Final agreement with proposed severity criteria ranged from 90.9% to 100.0%. Primary indicators of disease severity were body surface area, presence and severity of pruritus, and anatomic locations of eruptions with 77.4% agreement. Final agreement for the treatment algorithm was over the threshold majority agreement at 67.6%. Literature guiding the treatment of TD is scarce. The use of the Delphi method and focus groups can help expand dermatological resources both within dermatology and to other specialties that may need to treat skin conditions.

Medical Care at California Wildfire Incident Base Camps.

The California Emergency Medical Services Authority manages and deploys California Medical Assistance Teams (CAL-MAT) to disaster medical incidents in the state. This analysis reviews diagnoses for ambulatory medical visits at multiple wildland fire incident base camp field sites in California during the 2020 fire season. Clinical data without personal health information were extracted retrospectively from patient care records from all patients seen by a provider. Results were entered into Excel spreadsheets with calculation of summary statistics. During the 2020 fire season, CAL-MAT teams deployed 21 times for a total of 327 days to base camps supporting large fire incidents and cared for 1756 patients. Impacts of heat and environmental smoke are a constant factor near wildfires; however, our most common medical problem was rhus dermatitis (54.5%) due to poison oak. All 2020 medical missions were further complicated by prevention and management of coronavirus disease (COVID-19). There is very little literature regarding the acute medical needs facing responders fighting wildland fires. Ninety-five percent of clinical conditions presenting to a field medical team at the wildfire incident base camp during a severe fire season in California can be managed by small teams operating in field tents.

412 Comparisons of oral corticosteroid treatment patterns for toxicodendron dermatitis

Toxicodendron Dermatitis (TD) is a common form of allergic contact dermatitis that affects millions of Americans every year. While some cases remain mild and can be managed with over-the-counter remedies, many patients experience significant pruritus from the eruptions and can require systemic medical intervention to ease the symptoms. The objective of this study is to evaluate medical claims associated with TD outpatient visits and compare healthcare utilization outcomes depending on the days’ supply of the initial oral corticosteroid prescription. For this study, we used Truven MarketScan© claims from 2017 with a diagnosis of TD (ICD-10: L23.7) for outpatient and pharmaceutical claims. During this time, 70,120 individuals incurred 151,672 claims for TD. Only 37.9% (n=26,571) patients received a prescription for oral corticosteroids on their initial visit. Of those that received a prescription for an oral corticosteroid, 83.9% (n=22,287) were given a 1 to 13 day supply, 13.8% (n=3,659) were given a 14 to 20 day supply, and 2.4% (n=625) were given a 21 day supply or more. Of those who had a second visit for TD (n=3,138), 38.3% (n=1,203) were not given an oral corticosteroid at their initial visit, 53.6% (n=1,682) were given an initial oral corticosteroid prescription with a day supply of 1 to 13 days, and the remaining 8.1% (n=253) having an oral corticosteroid prescribed for 14 days or more at their initial visit. The results of this study found that oral corticosteroids are relatively under-prescribed for TD as the majority of literature regarding the treatment of TD suggests a minimum course of 14 days. Also, those with TD who receive no prescription or a prescription with a shorter duration (i.e. 1 to 13 days) at an initial office or ED visit make up the majority of those who have a return visit for TD as well, which could in turn impact the cost and quality of care that these patients receive. Future studies are needed to determine how prescribing practices impact the cost of care for patients and identify means of reducing that cost burden.

Phytodermatitis: A Brief Review of Human Skin Reactions Caused by the Kingdom Plantae

Many organisms of the kingdom Plantae may cause skin reactions when contacted or ingested. Those involved in work and recreation in the great outdoors as well as gardeners and other plant enthusiasts are well aware of this. While Toxicodendron dermatitis from poison ivy, oak, and sumac is the most common cause of allergic contact dermatitis (ACD) in the United States, this is just the tip of the iceberg. Numerous other species of plants are also known causes of ACD, producing a multitude of molecular culprits.

Postexposure prevention of Toxicodendron dermatitis by early forceful unidirectional washing with liquid dishwashing soap

Postexposure prevention of Toxicodendron dermatitis by early forceful unidirectional washing with liquid dishwashing soap

New route for taming poison ivy’s itch

A casual brush with poison ivy can cause agonizing itching for an estimated 10 to 50 million Americans every year. But exactly how the plant inflicts such misery is still somewhat of a mystery. By exposing mice to poison ivy’s oily allergen urushiol, Sven-Eric Jordt of Duke University and colleagues have now pinpointed a molecular pathway that helps transmit an itch signal through nerve cells. Antihistamines and corticosteroids are commonly prescribed to people with a poison ivy rash. But “the antihistamines just don’t work,” Jordt says, and although steroids help with inflammation, they’re ineffective against itch. “So from all perspectives, it is necessary to revisit the mechanisms and identify a more efficient treatment,” he adds. The researchers looked for genes that were transcribed at higher levels in mice whose skin was brushed with urushiol compounds compared with nonexposed mice (Proc. Natl. Acad. Sci. USA 2016, DOI: 10.1073/pnas.1606608113). Unsurprisingly, several genes

Protective Effect of ELI-21C-76C Against Poison Ivy and Poison Oak Dermatitis in a Guinea Pig Model

Poison ivy (Toxicodendron radicans), poison oak (T. diversilobum), and poison sumac (T. vernix) are the primary causes of contact dermatitis in the United States, affecting 10–50 million Americans every year. The prevalence of sensitivity to poison ivy and poison oak in the general adult population ranges from 50% to 70% with peak frequency for sensitization occurring between the ages of 8 and 14. Outdoor activities as well as outdoor occupations which relate to firefighting, forestry and agriculture are at high risk, costing significant medical expenses and worker's disability. During our ongoing studies aimed at the discovery of an effective prophylactic treatment for toxicodendron dermatitis, we have developed a series of novel agents and tested the efficacy of these agents in an in vivo animal model. Here, we present the protective effect of our pro-drug ELI-21C-76C in our guinea pig experimental model.

Immunotherapy of Allergic Contact Dermatitis

The term 'immunotherapy' refers to treating diseases by inducing, enhancing or suppressing immune responses. As allergy is an excessive, detrimental immune reaction to otherwise harmless environmental substances, immunotherapy of allergic disease is aimed at the induction of tolerance toward sensitizing antigens. This article focuses on the historical developments, present state and future outlook for immunotherapy with haptens as a therapeutic modality for allergic contact dermatitis. Inspired by the effectiveness of immunotherapy in respiratory allergies, attempts were undertaken at curing allergic contact dermatitis by means of controlled administration of the sensitizing haptens. Animal and human experiments confirmed that tolerance to haptens can be induced most effectively when the induction of tolerance precedes attempted sensitization. In real life, however, therapy is sought by people who are already sensitized and an effective reversal of hypersensitivity seems more difficult to achieve. Decades of research on Rhus hypersensitivity led to a conclusion that immunotherapy can suppress Rhus dermatitis, however, only to a limited degree, for a short period of time, and at a high risk of side effects, which makes this method therapeutically unprofitable. Methodological problems with most available studies of immunotherapy of contact allergy to nickel make any definite conclusions impossible at this stage.

Response of Grindelia camporum Greene vegetative growth, flowering and resin content to the growing media variation

Gum weed or gum plant (Grindelia camporum Greene, family Asteraceae) is a conspicuously resinous, herbaceous perennial medicinal plant native to the arid regions [1]. Flowers were used clinically for the treatment of asthma, bronchitis, and poison ivy rash [2]. Its resin content is similar to the resin acid (abietic acid) that constitutes rosin (pine resin) and would have the same uses as a principal product in industry. Furthermore, gum weed is an arid adapted plant that grows well under harsh desert condition in low level of irrigation, thus it appears to satisfy the requirements established for new crops in arid environment [3].

Treatment of the Poison Ivy Rash with a Topical Over-the-counter Agent: A Randomized Controlled Trial

Treatment of the Poison Ivy Rash with a Topical Over-the-counter Agent: A Randomized Controlled Trial

Ability to develop rhus allergic contact dermatitis in a patient with psoriasis receiving etanercept

Ability to develop rhus allergic contact dermatitis in a patient with psoriasis receiving etanercept

Toxicodendron dermatitis in the UK

We present two cases of Toxicodendron dermatitis, one acquired in the United States but presenting in the United Kingdom (UK), the other a recurrent dermatitis following importation of the plant to the UK. Poison ivy, poison oak and poison sumac are native to North America and belong to the genus Toxicodendron. This group of plants is of interest to the dermatologist because they contain a mixture of potent sensitisers which cause a severe allergic contact dermatitis. The dermatitis can present to the dermatologist in Europe after an individual has been in contact with the plant whilst visiting an endemic area. The plants have the potential to grow in Europe and it is therefore possible for an individual to be sensitised and subsequently to develop the rash without leaving the continent.

A systematic review of contact dermatitis treatment and prevention

Contact dermatitis (CD) is a common occupational disease. There have been no systematic reviews of CD treatment or prevention. Multiple databases were systematically searched. Using independent double review and published quality review criteria, articles were rated as good, fair, or poor. Treatment benefit data were tabulated and conclusions were based on the rated strength of published evidence. In all, 49 studies met inclusion criteria. Barrier creams containing dimethicone or perfluoropolyethers, cotton liners, and softened fabrics prevent irritant CD. Lipid-rich moisturizers both prevent and treat irritant CD. Topical skin protectant and quaternium 18 bentonite (organoclay) prevent rhus dermatitis. Diethylenetriamine pentaacetic acid (chelator) cream prevents nickel, chrome, and copper dermatitis. Potent or moderately potent steroids effectively treat allergic CD. There were no macrolide immunomodulator trials that met inclusion criteria. This review did not include studies of children, animals, or non-English language publications. A limited number of interventions effectively prevent or treat irritant and allergic CD, but well-controlled, outcome-blinded studies, particularly in the area of allergic CD prevention are needed.

FS11.5 Toxicodendron dermatitis in the United Kingdom

We describe two cases of Toxicodendron dermatitis, one acquired in the United States but presenting in the United Kingdom, the other a recurrent dermatitis following importation to the UK. Poison ivy, poison oak and poison sumac are native to North America and belong to the genus Toxicodendron. This group of plants is of interest to the dermatologist because they contain a mixture of potent sensitisers which cause a severe allergic contact dermatitis. The dermatitis can present to the dermatologist in Europe after an individual has been in contact with the plant whilst visiting an endemic area. The plants have the potential to grow in the UK and it is therefore possible for an individual to be sensitised and subsequently to develop the rash without leaving the UK. A 35‐year‐old American man who lived in the UK visited his family in Marietta, Georgia USA. Shortly before his return to the UK he cut some plants back in his mother’s garden. Two days following his arrival back in the UK he developed a widespread pruritic and painful vesicobullous eruption. He required admission for intensive potent topical corticosteroid therapy and the eruption settled over the next two weeks. The plant he had been pruning was subsequently identified as poison sumac (Toxicodendron vernix). A 54‐year‐old woman living in Wales was referred to the Contact Dermatitis Investigation Unit because during the summer months for the previous four years she had experienced an intermittent, intensely pruritic, vesicular and in parts linear eruption affecting her face, arms and legs. This responded slowly to potent topical corticosteroids. She is a keen gardener and suspected that it was related to a plant in her garden. She was patch tested to our Standard Series, Plant Series and all the plants in her garden. She showed ++ allergic reactions to sodium metabisulphite, propolis and a strong vesicular reaction to the leaf of one of the plants from her garden Inspection of the plant revealed that it had three leaflets per stem. She had taken a cutting whilst visiting friends in Pennsylvania in 1996 and on returning to the UK had planted it in her garden. It grew but had never flowered or produced seeds. Once the cause of her dermatitis had been confirmed our patient took the necessary protective measures and removed the plant including its roots from her garden. She has not experienced any further problems with her skin. She contacted her friends in the USA who knew precisely where she had picked the plant. A further specimen was taken to the local Conservation Office where it was confirmed to be poisonivy. Poison ivy and poison sumac belong to the genus Toxicodendron which is native to North America and Mexico. They cause an allergic contact dermatitis when there is exposure to a bruised portion of the plant. This leads to the oleoresin, urushiol coming into contact with the skin. 25–60% of North Americans are reported be allergic to poison ivy and its relatives. The importation of plants into the UK is restricted by law. It is clear that this plant grew in its new habitat but did not extend beyond the confines of the garden. With frequent and more extensive air travel it seems reasonable to speculate that similar occurrences have taken place and that plants not endemic to Europe should be considered in those with suspected plant dermatitis.

Identification and investigation of disease outbreaks by ESSENCE

S i119 entered by the BCDS into a database and analyzed using descriptive statistics and graphing techniques. Daily values are analyzed using a variation of the Shewhart control chart method. Graphs have four components: (1) daily data plotted for each syndrome, (2) an average of all values plotted to date, (3) upper and lower confidence levels (99.7%) for the average, and (4) upper statistical control limits (99.7%) for daily data. Approximately two or three triggered investigations occur per week. Data from 12 of the 16 hospitals showed a significant trend in fevers during February 2002, mirroring data from the state’s Influenza Sentinel Surveillance Network during the same weeks. Several of the hospitals also showed an increase in rashes in the summer that corresponded to poison ivy and Rhus dermatitis season. No large-scale community outbreaks have occurred since the system’s inception to test its ability to detect naturally occurring outbreaks. Identification and Investigation of Disease Outbreaks by ESSENCE Kendall Brown, Julie Pavlin, Jay Mansfield, Eugene Elbert, Virginia Foster,

Consultation with the Specialist: Contact Dermatitis

1. Sheila Fallon Friedlander, MD* 1. 2. *Assistant Professor, Departments of Pediatrics and Medicine, UCSD School of Medicine; Division of Pediatric Dermatology, Children’s Hospital, San Diego, CA. Some physicians believe that contact dermatitis is a rather esoteric topic with little relevance to the daily practice of general pediatrics. In reality, contact dermatitis is an extremely common occurrence in the pediatric age group. Some authors estimate that it accounts for approximately 20% of all dermatitis seen in childhood. Although many forms, such as Rhus dermatitis (poison ivy/oak) and diaper dermatitis, are easily recognized and treated, even “diaper rash” occasionally can present a therapeutic challenge and cause significant discomfort to the infant. Other forms of contact dermatitis may be more difficult to diagnose. A photocontact reaction from the juice or rind of lemons and limes termed phytophotodermatitis causes an eruption that often is misdiagnosed as a burn or occasionally even as child abuse. This can lead to inappropriate and costly evaluations. Of greater concern, contact reactions sometimes can lead to life-threatening situations. Latex, a product of the rubber tree, can cause reactions ranging from mild contact dermatitis to anaphylaxis. Children who have spina bifida or congenital urologic anomalies are at increased risk for this allergy because of increased exposure to latex in catheters or gloves. Therefore, primary care clinicians must be familiar with the basic concepts relating to contact dermatitis. Reasonable queries that might arise, which are addressed in the following discussion, include: The exact incidence of contact dermatitis is unknown. However, two studies evaluating healthy children showed a 20% incidence of positive reactions to one or more patch tests. Almost 50% of infants develop diaper dermatitis, most …