Type “poison oak or poison ivy treatment” into Google and you’ll be overwhelmed with options. Which product works best? When you scratch your skin to the bone and lose sleep, people look for anything. The itchy sensation is called “pruritus” in medical terms. People say that it is often worse than physical pain. It is much harder for the mind to block itchy sensations than painful stimuli. Because these plant rashes manifest differently in a spectrum of people, there is no “one size fits all” cure. The internet is full of drastic suggestions, from putting diesel fuel in it to scrubbing it down with plain bleach. I caution against this advice as I see permanent scarring and unacceptable pigmentation changes long after the rash has disappeared. Since poison ivy and oak rashes resolve on their own in a few days to a few weeks without treatment, it is difficult to establish concrete causal relationships regarding which remedies work best. The following list is my professional opinion as a dermatologist. This list may be biased by the fact that I see the most challenging cases; in that I see the people for whom most over-the-counter (OTC) drugs didn’t work.
1. “Sasquatch Itch Cream”: Ideally, you wouldn’t need this treat, but the world isn’t perfect. If you have to reach for it, it probably means an itchy rash is forming on your skin. I call this the “poison ivy fire extinguisher” because it’s formulated to calm on contact and extinguish the burning rash. Once the resin binds to skin cells, the cell’s outer membrane is permanently altered. The immune system no longer recognizes the skin cell as yours and launches an attack against it. This is where Sasquatch Itch Cream works; stomp this attack. However, this product is not for the pure naturalist, as it contains powerful synthetic anti-itch compounds and some cortisone. Sasquatch Itch Cream was designed for the military, specifically as a means of ensuring soldiers could complete their missions and not be delayed in the medical tent. It is now mainly used by survivalists and hiking enthusiasts to make their adventures less irritating. Landscape professionals and telephone line climbers are also gravitating towards this product en masse. In short, this product is designed with your misery in mind. Works. It works well. It works fast. One also has to love a product that “Sasquatch endorses” (according to the website). Retail Price: $24.99 Not available in store, but a quick Google search will find it.
2. Rubbing alcohol (isopropyl alcohol): As boring as this product may seem, nothing beats the price. Alcohol wipes can be purchased for pennies on the dollar compared to other washes and solvents. While the resin from poison oak and poison ivy is not water soluble, a few wipes with an alcohol wipe will do the trick. They travel well in almost any circumstance and environment. Most pharmacies sell them along with their diabetic supplies, so don’t be afraid to ask if you can’t find them on the aisles. Mineral spirits available at all hardware and art supply stores are another alternative. Retail: $3-$7 for 100 wipes.
3. Benadryl (diphenhydramine): One of the substances released by the skin that causes itching is histamine. Diphenhydramine has been around since World War II and is a powerful histamine receptor blocker on skin cells. The mast cell remains inside your skin loaded with histamine granules. Under a microscope, it looks like a balloon filled with tiny marbles just waiting to burst. The release of these histamine granules is the main trigger for both the rash and the itching. The oral formulation can cause sedation and is the active ingredient in many nighttime sleep aids. Therefore, caution is advised if you are not sure how sensitive you are to it. This virtually ubiquitous cream is available at any supermarket, gas station, or drug store. Retail: $2-5 for 1-2 ounces. Non-sedating oral histamines include claritin, zyrtec, and allegra, to name a few. None of these are currently available in topical formulation.
4. Calamine Lotion: This old standby isn’t going away, and for good reason. It is inexpensive and offers a small degree of immediate relief. Zinc oxide and iron are the two main components, but its anti-itch properties are attributed to the phenol it contains. It is sold in many different formulations, but my favorite is Caladryl (which also contains generic benadryl). Everyone probably has a childhood summer memory of their bubblegum pink limbs, compliments from Grandma on that sunburn or poison oak rash. However, it wasn’t until several years ago that the US Food and Drug Administration officially recommended its application for poison oak and poison ivy. In my experience, calamine works best if it’s kept refrigerated. Retail $5-10
5. Technu: Abbreviation for “New Technology”. This product serves primarily as a wash for poison oak resin. This product is extremely popular and its parent company has been a marketing genius in promoting it. The main ingredient is deodorized mineral spirits and some alcoholic compounds (See #2). While it works for many people, a study in the International Journal of Dermatology concluded that it offered no cost benefit compared to Dial soap washing. Whichever method of resin washing is chosen, it should be done within 15 minutes of exposure. Once the resin has fused with the skin cells, the immune system will go haywire and cause that nasty rash. Of interest, Technu was first formulated to wash away radioactive dust in the 1960s. Retail: Technu $15-39.99.
6. Ivy Block – This is my favorite preventative for poison oak and poison ivy. The idea of smearing impure clay on your skin to soak up plant resin sounds reasonable to any Neanderthal. But thanks to the good folks at Ivy Block for creating an elegant and safe formulation acceptable to the modern man. The use of medicinal clay is well recorded in ancient Mesopotamia and Egypt and probably dates back much earlier. A proprietary form of bentonite clay prevents the resin from coming into contact with the skin’s immune system. It should be applied 15-20 minutes before exposure is anticipated. I like this product because it is safe for children, effective and with a little imagination it connects us with our ancient medicinal roots. It absorbs oil so well that bentonite can be used to treat acne and excessive skin oiliness (Clarasil is one such product). Retail $8.99-25.99.
7. Gold Bond Itch Cream: Originally made by Tennesseans and later sold to the French, Gold Bond combines topical zinc with the soothing calm of menthol and pramoxine. Every major drugstore chain has its own generic version for a few dollars less. Retail: $4-5 per 1-2oz tube.
8. Hydrocortisone: Perhaps nothing causes as much fear in my patients as hydrocortisone. People automatically recall images of a bloated relative who had been taking “cortisone pills” for years. It’s hard to get into trouble with over-the-counter topical hydrocortisone if you use it for a week or two. Like Sasquatch Itch Cream, it shuts down inflammation at the cellular level. However, it does not provide any immediate or intermediate relief. A good hydrocortisone bath can take up to 48 hours to start working. You can technically buy OTC at 2.5% but it’s hard to find as 1% seems to be the manufacturers preference. Retail: $3-7 1-2 ounces (usually more if mixed with aloe).
9. Ivarest – Advertised as a “dual relief” cream, Ivarest Poison Ivy Itch Cream is a reasonably solid product at a good price. Contains generic benadryl (see 3) and calamine (see 4). There is also some benzyl alcohol that calms on contact. What I like about Ivarest is the neutral toned calamine it contains. Aside from the smell and the soft residue it leaves, you can’t tell you have it on. It’s an elegant formula at the right price for minor discomforts caused by poison oak and ivy. Retail: $4-8 bottle. Ivarest is also sold as a wash in a liquid-to-foam technology. I am not aware of any credible studies on this wash compared to Technu or just plain soap. However, I have a feeling it wouldn’t compare more favorably to soap or alcohol than it would to Technu.
10. Triamcinolone Injection: Yes, this is not available without a prescription and may not belong on this list. But it’s my workhorse at the office. If the above treatments fail, a good triamcinolone intramuscular injection will bring you back to your old self. It is available in almost all emergency rooms and doctor’s offices. Cost: $30-100 (plus office visit)
Of course, the best treatment is prevention. Learn what noxious plants look like in your area and how to identify them. To learn more about poison oak and ivy, you can read the article “A Dermatologist Reflects on Poison Oak.”
