The scourge of summertime yard workers, campers, and hikers is upon us. Poison ivy, oak, and sumac are all present in East Texas. They typically grow in vines with poison ivy usually having three leaves per stem, thus the old adage “Leaves of three, let it be.” They are called “poison” because of the chemical urushiol which can be found on the leaves, stems, and roots. A person usually has to come in direct contact with the plant; however, the oil may be transmitted by fomites (such as tools or pets that you then contact) or even in the smoke of a burning brush pile.
Poison ivy causes what we call a contact dermatitis - a reactive, inflammatory skin disorder. This is a type of allergic reaction to urushiol, which explains why some people may get it much worse than others. (Countless other plants and chemicals can cause a contact dermatitis.) The rash is variable. A classic case causes small blisters on a red base often arranged in lines, but other presentations may include large blisters or just red bumps. It usually itches intensely. People get the impression that the rash is “spreading” since it may break out in different places over time; however, this is actually due to the fact that different areas of skin have different sensitivities and may take longer to react. It is not contagious.
Treatment usually involves steroids due to their anti-inflammatory properties. Small areas can be treated with creams but larger areas require systemic treatment, either pills, an injection, or both. Calamine and other similar lotions may have some soothing effect for the skin, but we think their role is limited. Benadryl or stronger antihistamines may be prescribed for severe itching. The best advice is avoidance: wear long sleeves, long pants, and gloves when dealing with thick foliage and unknown vines.
If you have suffered from an abscess or other type of skin infection over the last few years then you are part of a growing patient population. Visits to urgent care centers and emergency rooms for skin infections have increased about 50% over the last 10 years (Emerging Infectious Diseases, 11/06). The cause of this "epidemic" is MRSA, or methicillin-resistant staph aureus. Staph is ubiquitous and has caused infections for ages, but the 1970's and 80's brought a disturbing trend of resistant germs. (A bacteria may develop resistant to an antibiotic through genetic transformation or mutation after prolonged exposure to it.) Initially limited to hospitals, nursing homes, or other close quarters, MRSA began to spread through the community in the 90's and is now responsible for most skin infections.
Many skin conditions look the same in the early stages and are difficult to diagnose. Most abscesses start as a small red bump or boil. They are commonly thought to be spider or other insect bites. (Brown recluse bites become necrotic and form an ulcer.) If seen by a physician at this point, an antibiotic used for MRSA may be prescribed in addition to warm compresses. However, despite doing everything right, a pus-filled cavity may develop. Once it reaches this stage, taking antibiotics are of marginal benefit and incision and drainage must be performed. This can usually be accomplished under local anesthetic. The wound is often packed to allow for additional drainage over the next few days. Despite the pain and short term disability caused by an abscess, significant complications and hospitalization are rare.
MRSA is contagious. It can spread to other body parts by a process called autoinnoculation. Some people may become carriers and suffer recurrent infections. It can spread to other people, especially those in close proximity. If you think you have a skin infection, see your doctor. Do not share personal items such as clothing, towels, and washcloths. Good local wound care, hygiene, and frequent, thorough hand washing are all very important. Take antibiotics as prescribed. Call the doctor if you develop high fever, vomiting, or have failed to improve in 2-3 days. Remember: MRSA is out there but prompt recognition and treatment may keep a small red bump on your bottom from becoming a major pain in the butt.
Have a good day!
Bill Wallace, MD, Tyler Urgent Care