Leaves of Three
by Beverly A. Kipp

Leaves of three, let them be. That is the rhyme that comes to mind when we think of poison ivy. For many of us, the childhood memory of eyes swollen shut and an itchy, oozy rash, making us look like an alligator and feel as ugly as one, sends us into a panic the moment we see that first tiny red dot of poison ivy on our skin. We scrub it, we cover it with creams and lotions, we spray it with numbing sprays, and we hold our breath. Two days later, we call the doctor.

"It's getting worse!" we wail.

"I'm covered with it!" we whine.

"What should I do?" we plead.

What we mean, of course, is--make it go away, and now, before we get any itchier or uglier!! We really want a cortisone pill pack--the supposed magic bullet, the big gun used in treating contact or rhus dermatitis, the technical name for poison ivy, oak and sumac. (In fact other contact dermatitis rashes--caused by for instance sunscreen or makeup--are medically indistinguishable from poison ivy and respond to the same treatment, including eliminating the offending irritant.)

No doubt about it, the "three poisons" are a nuisance, a big nuisance. They can lead to the need for medical attention and prescription medication. But it is the fear of them that makes us get ahead of ourselves.

What exactly is this blight? And what can we do about it? First, the practice of prevention really is our best bet. Learning to recognize and avoid the common weeds, which grow almost everywhere in the United States (though what we mostly encounter in our area is poison ivy), will greatly decrease the likelihood that we will come in contact with urushiol (you-ROO-shee-ol), the oil that actually causes us to break out. Urushiol is found in the sap of each of these plants and, once it touches our skin, begins to penetrate in minutes. How thick the skin it touches, and how sensitive we are to it determines how quickly and for how long we erupt in the well-known rash.

The bad news is that while we like to think of poison ivy as being a quick encounter with aggravation, it normally takes two to five days to erupt and ten or even fourteen days to run its course. And that is from a single encounter with urushiol! If the oil gets on your skin several days in a row, the rash will last even longer. and yes, it is true that each time you get poison ivy, your reaction may be more severe, though the most important indicator remains the amount of oil, how long it stays on the skin, and the area of the body affected.

Now, the good news. First and foremost, neither poison ivy, poison oak nor poison sumac is contagious from one person to another. Equally important, the rash itself does not "spread." While any individual's reaction is unique and can range from a little itchy patch to a mass of confluent vesicles, the skin will really only break out in the area where it has contact with the oil. The leaking blister fluid is a product of our own bodies and does not contain poison ivy sap.

Why then, do so many of us have such vivid memories of being truly covered with it when we were kids? Because we were, in fact, kids, and kids play fearlessly and then treat soap and water as the enemy. A boy playing tag, or hide and seek, or king of the mountain, is not the least bit worried about where he puts his dirty, oily, little hands--neither are girls. Wiping sweat from their eyes, brushing flies from their faces, scratching every itch and relieving themselves when and where the need occurs, leads children to literally infect their squirming little bodies with varying amounts of the inoculating oil. Hours later they may be playing in a hot tub full of bubbles, but the damage is already done.

Some statistics suggest that the sensitivity to ivy, oak and sumac decreases with age. Dr. Jane Ferguson, a pediatrician in Red Hook and Kingston, muses with me that perhaps it is simply better hygiene and a heightened awareness that leads to reduced exposure and results in lower incidences of the malady as kids get older. Still, she says, being cautious pays off.

The same dress promoted to avoid tick exposure is the surest way to avoid exposure to the creeping vines that grow so freely in our backyards and the oil that they shed from every part of the plant. If avoidance fails, the second line of defense is to wash the oil away as quickly as possible--within five minutes or so--with clear cold water (hot water opens the pores and allows more of the oil to penetrate). If the oil is in contact with the skin for a longer period of time, then an abrasive soap, or even the gooey glop that mechanics use to remove grease, and aggressive washing of the skin, will help limit the reaction, according to Dr. Ferguson. Exposed clothes should likewise be washed in detergent, or if you are hiking or camping, in a stream or with a hose. And don't forget your shoes: urushiol sticks to almost any surface and its potency does not readily fade. Indeed the nearly invisible oil easily rubs off onto other surfaces until it is gone--or spread. If that surface is your shoelaces or garden gloves, then every time you suit up for the great outdoors you are re-contaminating yourself before you even get to the screen door. It becomes easy to understand why we have the misconception that the rash starts "spreading" after it has broken out--when in fact whatever "spreading" took place was of oil and may well have taken place over several successive days, insidiously.

No wonder some of us rush to the phone with the plea "Doctor, do something!" But what exactly? And when?

Bill Bakey, a physician assistant in Rhinebeck, looks at many variables when treating patients with rhus dermatitis. Fear is one of them. Many people with nightmarish experiences in the recent past are willing to take the low risk of short-term cortisone use rather than wait and see if their worst expectations come true. Some people with fragile skin or other dermatological disorders warrant serious consideration for more potent medication. The most important factor for Bakey, though, is what parts of the body are affected and to what extent. The face's very thin skin and exposure to the sun make it particularly vulnerable to swelling once affected, and someone with more than a few small areas breaking out on the face may very well need something stronger than over-the-counter creams. That is true also of anyone with poison ivy in the genital area or a rash affecting more than 10 % of their total body surface.

So, what about the rest of us with the infernally itching patch or two of the miserable stuff? Here are a few suggestions:

Get the oil off quickly--if you are hiking, baby wipes or the new hand sanitizer and a paper towel help remove it when you can not get to water quickly, At the very first signs of a rash, apply an over-the-counter agent. Calamine lotion, an astringent, or cortisone cream all help to relieve the symptoms. Cut the fingernails short of children who are infected and keep their hands clean so that they do not get a secondary infection from scratching. An antihistamine, while it may help with tolerating the itch, will do nothing to shorten the duration of the outbreak. It may however cause a welcome drowsiness, especially in the wee hours of a hot summer's night.

If blisters start to appear, a drying agent like Burrow's solution or Epsom salts help dry them up. Swimming in a chlorinated pool poses no risk to the person with the rash or to the other swimmers, and may also help to cool the body and relieve the itch. If the rash is "weepy" blisters, wrapping the affected area in a handkerchief soaked in baking soda or commercial oatmeal or colloidal baths for 15 or 30 minutes at a time will give relief or at the very least make you feel like you are doing everything you can.

If none of that works . . . well, call the doctor, and plead. And of course remember, if you feel ill or have a fever, or if you have any questions or concerns, contact your doctor for advice. As for advice...this really is one instance when your mother's was the very best: Leaves of three, let them be.

"Leaves of three" is really leaflets of three and is true of poison ivy and poison oak, but not of poison sumac, which has seven to thirteen leaflets.

Poison ivy is usually a creeping vine, which may send out runners or climb the tallest trees. It sometimes grows as a shrub, but that is not common in this area. It will grow in almost any soil conditions. While it is poisonous to humans, the small, smooth, white fruits are eaten by a wide variety of birds and pas through the digestive tract undamaged, reseeding the vigorous weed as fast as the homeowner can dig it up. Cutting the plant as close to the root base as possible and then applying a small amount of chemical weed killer to the stump with a swab is most successful in eradicating it according to Erin Millus, a horticulturist in Red Hook. Widespread chemical spraying of the vine will slow it down but may not kill the root system and it will return.

Poison oak, a shrub, grows in sandy soil, and is found primarily in states south of New York

Poison sumac growth is primarily confined to swamps, making it unlikely that most people will come into contact with it. It is not the ubiquitous shrub/tree with long lilac-like clusters of red fruit, which is most likely staghorn or perhaps smooth sumac. Poison sumac has white fruit.

Poison ivy, oak or sumac vines or shrubs--including dormant and even dead ones--should never be burned. They all contain urushiol and burning only releases the oil into the air, where it becomes a kind of chemical agent. Handle with care.