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Inclusion criteria were age 14 or greater, the ability to give informed consent (informed consent could also be obtained from a legal guardian) and a rash consistent with severe poison ivy. The goal of treatment with both groups was the resolution of symptoms.
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Severe poison ivy is diagnosed when patients have clear exposure and consistent rash or rash and known history of reaction PLUS, one of the following: 1) rash > 20% body surface area 2) rash on hands, feet, face or genitals 3) involvement of two or more body areas.Ī consistent rash is defined as one that is pruritic, burning or irritating on skin directly exposed or in contact with exposed clothing or hand transfer or a linear rash with vesicles and a history of reaction to poison ivy in the past. Patients from the practices of participating physicians in the PCHIP PBRN were enrolled in the study at the time of initial contact with their primary care provider while seeking treatment for severe poison ivy dermatitis.
Poison ivy 1992 trial#
We conducted a randomized, controlled trial of a 5-day regimen (short-course arm) of oral prednisone (40 mg daily and 200 mg total per patient) compared to the same regimen followed by a taper (long-course arm) of 30 mg daily for 2 days, 20 mg daily for 2 days, 10 mg daily for 2 days, and 5 mg daily for 4 days (15 days total administration time and 340 mg total per patient) evaluating 49 patients with severe contact dermatitis from poison ivy.
These were the initial and only study questions identified and reviewed for face validity prior to study initiation by approximately 20 physician members of the Primary Care Health Improvement Project (PCHIP) PBRN and all studied measures are reported below. Our study addressed the question of whether a 5-day regimen of corticosteroid therapy at doses higher than a Medrol Dosepak ® is as effective as the same regimen followed by a tapering dose of corticosteroids for initial control and treatment of symptoms (as evidenced by whether the rash improved with study treatment and lengths of time to improvement and resolution of rash, as well as use of other medications for treatment after initiation of the study protocol) compliance and side effects with the study protocol and prevention of rebound rash from severe poison ivy dermatitis. Upon finding little literature support and no clear evidence of which method of treatment was more effective, we undertook this study. Practice patterns within the supporting practice-based research network (PBRN) varied widely from short course doses of steroids to long course doses inclusive of a taper leading us to question the evidence base behind both regimens. Expert recommendation for treatment in this area includes use of oral steroids for severe cases, variably described as either involving greater than 20% of body surface area, the presence of severe blistering or itching, or involvement of the face, hands, or genital area. Expert opinion and one case report on the commonly prescribed Medrol Dosepak ® (total of 84 mg of methylprednisolone tapered over 6 days) note this regimen to be insufficient and likely to cause rebound rash. It is commonly thought that too short a treatment course allows for rebound dermatitis after initial improvement. Several recommended regimens exist in the current literature.
Oral corticosteroids are often used for treatment, but no randomized controlled trials have been found supporting a particular dosing regimen. Contact dermatitis, particularly from Toxidendron foliage (poison ivy, oak, and sumac), is a common complaint in primary care offices.
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