Case history
Case history #1
A 12-year-old boy presents with marked edema and blistering of his face. It is itchy, but he is otherwise well and afebrile. A diagnosis of cellulitis is considered until linear streaks of vesicles are noticed on his arms. Further history reveals he climbed a tree covered in vines of poison ivy during the weekend. Despite treatment with medium-potency topical corticosteroids, the rash continued to spread, with new blisters appearing on his legs and genitalia.
Case history #2
A 40-year-old housewife presents with intermittent severe dermatitis of the arms and face, responsive to potent topical corticosteroids. A contact dermatitis is considered, but no obvious allergens are identified. Social history reveals her husband is a forestry worker; she cleans his work clothes and is thereby exposed to poison oak oleoresins.
Other presentations
Contact dermatitis usually follows direct exposure and contact with the sap (oleoresins) of the plant.[6] Most cases follow direct exposure during outdoor activities such as walking, hiking, or camping in the forest. Occupational exposure may occur in forestry workers, rural firefighters, and gardeners.[7][8] The oleoresins may also be carried on the fur of domestic pets or livestock, clothing, forestry equipment, gardening tools, and even family members (connubial dermatitis). The antigen is heat-tolerant and can be transported by smoke from burning plants.[1][2][3][4] Exposure may also occur from Toxicodendron extracts present in consumer skin care products.[9][10]
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