By 
Type in “poison oak or poison ivy treatment” into Google and you will be overwhelmed by the 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. The mind has a much more difficult time blocking the itching sensation than painful stimuli. Because these plant rashes manifest differently across a spectrum of people, there is no “one-size-fits-all” cure. The internet is full of drastic suggestions, from pouring diesel fuel to scrubbing with pure bleach. I caution against this advice as I see unacceptable permanent scars and pigment alterations long after the rash has faded. Since poison oak and ivy rashes resolve on their own within 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 skewed by the fact that I see the most challenging cases; in that I see the people for whom most of the over-the-counter (OTC) products didn’t work.
1. “Sasquatch Itch Cream”: Ideally, you wouldn’t need this treatment, but the world is not 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 extinguisher” because it is formulated to soothe contact and quench the smoky rash. Once the resin binds to the skin cells, the outer membrane of the cell is permanently altered. The immune system no longer recognizes the skin cell as its own and unleashes an attack against it. This is where Sasquatch Itch Cream works; crush 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 that soldiers could complete their missions and not stay in the medical tent. Now primarily used by survivors and hiking enthusiasts to make their adventures less irritating. Landscape professionals and telephone line climbers are also gravitating to 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 stands behind” (according to the website). Retail: $ 24.99 Not available in store, but a quick Google search will find it.
2. Isopropyl Alcohol (Isopropyl Alcohol) – As boring as this product may sound, nothing beats the price. Alcohol wipes can be purchased for pennies on the dollar compared to other washes and solvents. Although poison oak and poison ivy resin is not soluble in water, a few wipes from the alcohol wipe will do the trick. They travel well in almost any circumstance and environment. Most pharmacies carry them along with your diabetic supplies, so don’t be afraid to ask if you can’t find them in the aisles. Mineral spirits available at all hardware and art supply stores are another alternative. Retail: $ 3 to $ 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 in skin cells. The mast cell remains inside your skin freshly loaded with histamine granules. Under a microscope, it resembles a balloon filled with tiny marbles waiting to burst. The release of these histamine granules is the main conjurer of both the rash and the itch. The oral formulation can cause sedation and is the active ingredient in many nighttime sleeping pills. Therefore, caution is advised if you are unsure of its sensitivity. This virtually ubiquitous cream is available at any supermarket, gas station or pharmacy. Retail: $ 2-5 for 1-2 ounces. Oral non-sedating histamines include claritin, zyrtec, and allegra, to name a few. Neither of these are currently available in topical formulation.
4. Calamine lotion: This old resource won’t go 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 their 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. Calamine works best if it is kept refrigerated in my experience. Retail $ 5-10
5. Technu: Short for “New Technology”, this product primarily serves 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 deordorized 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 washing with Dial soap. Whichever resin wash method you choose, it should be done within 15 minutes of exposure. Once the resin has fused with the skin cells, the immune system will go ballistic and create that nasty rash. Interestingly, Technu was first formulated to remove radioactive dust in the 1960s. Retailer: Technu $ 15-39.99.
6. Ivy Block – This is my favorite preventative product for poison oak and poison ivy. The idea of smearing impure clay on your skin to absorb plant resin sounds reasonable to any Neanderthal. But I thank the good folks at Ivy Block for creating a stylish and safe formula acceptable to the modern man. The use of medicinal clay is well documented in ancient Mesopotamia and Egypt and probably dates back much longer. A proprietary form of bentonite clay locks the resin out of contact with the skin’s immune system. It should be applied 15 to 20 minutes before exposure is anticipated. I like this product because it is safe for children, effective and with a little imagination connects us to our ancient medicinal roots. It is such a good oil absorber that bentonite can be used to treat acne and excessive skin oil (Clearasil 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. All the major drug stores have their own generic version for a few dollars less. Retail: $ 4-5 per 1-2 oz tube.
8. Hydrocortisone: Perhaps nothing evokes as much fear in my patients as hydrocortisone. People automatically remember images of a bloated relative who had been taking “cortisone pills” for years. Over-the-counter topical hydrocortisone is hard to get into if it’s used for a week or two. Like Sasquatch Itch Cream, it turns off inflammation at the cellular level. However, it does not provide any immediate or intermediate relief. A good application of hydrocortisone can take up to 48 hours to work. Technically you can buy OTC at 2.5%, but it is difficult to find, as 1% seems to be the preference of the manufacturers. Retail: $ 3-7 1-2 ounces (usually more if mixed with aloe).
9. Ivarest: Billed as a “double 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 slight residue it leaves behind, you can’t say it’s wearing it. It’s an elegant formula at a fair price for the mild annoyances of 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 that it wouldn’t compare more favorably to soap or rubbing alcohol than Technu.
10. Triamcinolone Injection: Yes, this is not available without a prescription and may not be on this list. But he’s my workhorse at the office. If the above treatments fail, a good intramuscular gulp of triamcinolone will return you to your old self. It is available in almost every emergency room and doctor’s office. 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.”