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Posts for: April, 2018

April 03, 2018
Category: Rashes
Tags: Rash  

Leaves of 3, Seriously...Let It Be


The mild days of spring have arrived after a rather brutal winter for southeast Louisiana.  I mean, seriously, it snowed twice this past winter!  What’s up with that?!  But I digress.  The trees have returned to their verdant splendor, the grass is beginning to grow to the point of needing to be mowed, and lurking back in the corner of your yard, there it is.  Toxicodendron radicans.  The dreaded poison ivy. (Poison ivy fun fact:  it’s not really an ivy.  It is in the same family of plants as cashews and pistachios.)  Here is a little info about this nasty little vine/bush that may help you to avoid a nasty rash, or to help you deal with it if it happens.  


Poison ivy causes what we doctors call urushiol-induced contact dermatitis.  It actually can be caused by a number of Toxicodendron plants.  In the eastern USA it is most commonly poison ivy or poison sumac.  In the western USA it is most commonly poison oak (although there is an eastern poison oak as well).  The causative agent in all of the plants is an oil called urushiol.  Urushiol actually causes changes in the protein arrangement in your skin cells such that your immune system thinks they are foreign bodies which need to be destroyed.  This is a type IV hypersensitivity reaction or a delayed hypersensitivity reaction.  This means that the reaction is not like the reaction you get with a bee sting or with pollen.  It usually is delayed by 48-72 hours from exposure to the urushiol.


The rash associated with poison ivy affects over 350,000 Americans every year.  Interestingly, 15%-30% of people won’t have any response to the urushiol.  For those who do develop the rash the response varies from mild to severe.  The rash is red and raised and may have small vesicles to large blisters.  It is intensely itchy.  It is NOT contagious and you cannot spread it on your body by scratching.  The liquid that forms in the blisters does not contain urushiol, so that isn’t a source of spread.  If you have developed the rash in various places on your body you can be assured that the urushiol touched you in that location.  You CAN get the rash from urushiol which is on your dog’s fur, on your clothing, or on any other object which has touched the poison ivy plant.  


Poison ivy is a self-limited condition and will typically resolve on its own within 14 days.  That’s little comfort to the person who is itching to the point of near madness.  Lucky for him there are some treatment options.


So what do you do if you are exposed?  First, DON’T PANIC.  (Just kidding.  Who panics from poison ivy exposure?) The best thing to do is wash the skin with soap and water immediately.  If the urushiol is removed it won’t cause the rash.  You should also wash clothing, toys, gardening tools, and anything else that has come in contact with the plant, and that includes Fido.  If you develop the rash it is too late for this as the urushiol is very well and quickly absorbed into the skin.  Once the rash develops topical treatments such as 1% hydrocortisone cream, zinc oxide, and calamine lotion can help alleviate the itching.  Colloidal oatmeal and baking soda added to bathwater may also help some with itching.  If the rash is extensive or with significant facial involvement, injections with corticosteroids or oral corticosteroids may be needed.  These will require a visit to the doctor.  Nota bene, Benadryl and other antihistamines may not help much since the reaction is not mediated by histamine but is cellular mediated.  Occasionally scratching will lead to secondary infections which require antibiotics.  If the vesicles or blisters become filled with pus, it would be best to have them checked by one of our doctors.  


Your mom and them always say an ounce of prevention is worth a pound of cure.  This goes for poison ivy as well.  The best way to prevent poison ivy is to avoid contact with it.  Poison ivy and poison oak are either vines or shrubs which have leaves in clusters of three.  Poison ivy vines are also covered with tiny roots which give it a hairy appearance.  The leaves of both of these plants go from light green in spring, to darker green in summer, to red in autumn.  Even leaves that have fallen from the vines are capable of causing the dermatitis.  Poison sumac looks different.  It is a shrub or tree with 7 or more leaves arranged on either side of the stem.  Of the three plants producing urushiol, sumac is probably the most potent.  Here are some little sayings which will help you know what you should avoid:


Leaflets three; let it be!

Berries white, run in fright!

(and my favorite) Hairy vine, no friend of mine.  


Better yet, here is a photo:



or in real life:



So keep an eye out for these dreaded plants as the weather warms and we begin to explore the great outdoors.  But take courage!  We at Fairway Pediatrics are ready to conquer your itching rash with all the weapons in our arsenal!  




April 03, 2018
Category: Allergies
Tags: Runny Nose   Sneezing   Red Eyes   Cough   Congestion   Allergies  
Hay Fever.  No Hay, No Fever, But Lots of Misery
Hay fever.  It is perhaps one of the most common conditions which we encounter in our practice, and it occurs in up to 40 million Americans.  So what exactly is it?
Hay fever ironically seldom is related to hay and never presents with fever.  It is the common name for seasonal allergic rhinitis, a condition which presents in the spring and fall of each year due to substances in the environment that cause your immune system to go into attack mode.  Some people respond minimally to these substances, others have significant disruptions in their daily lives.  Here are signs, symptoms, causes, and potential remedies which might help you get through this bi-annual menace.
Hay fever manifests as sneezing, stuffy or runny nose, itchy and watery eyes, scratchy throat, and post nasal drip.  Coughing may occur especially when lying down and is worse at night and first thing in the morning.  You may also develop what we call allergic shiners.  Those are the dark circles around the eyes from sluggish blood flow in the veins of your lower eyelids.  You may also notice your child giving you the allergic salute, those times where he takes his hand and pushes the end of his nose up to relieve itching.  If he has been doing this for a long time you may even notice this has caused a horizontal line across his nose.  We call that a transverse nasal crease.  In severe cases the nasal congestion can lead to snoring and mouth breathing.  
Hay fever is caused by various pollens which vary from region to region.  The pollens which cause it are from wind-pollinated plants.  These are tiny particles which are barely visible.  Pollens from insect-pollinated plants are too big and fall to the ground, so they don’t pose any problem.  The pollens most implicated are from trees (such as pine and oak), grasses (such as rye grass) and weeds (such as the dreaded ragweed of early fall).
There are several options for treatment of hay fever that can be discussed with your doctor.  First are antihistamines such as diphenhydramine (Benadryl), loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra).  All of these are now over the counter.  Diphenhydramine must be dosed more often and causes quite a bit of sedation, so it is usually not a first choice,  The other three have much less sedation and can be taken once daily:  win win.  Another option are intranasal corticosteroids like fluticasone (Flonase) and triamcinolone (Nasacort AQ).  These are administered once daily (win), but they can be associated with nosebleeds if used incorrectly (boo), and honestly, many children don’t want something squirted up their noses.  There are also medications which can be prescribed, but that would best be discussed during a visit with one of our doctors.
Hay fever can be complicated by sinusitis and ear infections, so if you suspect your child has more than just allergies, it probably would be best to call and let us have a look.  
And there you have it: hay fever.  No hay, no fever, but lots of misery.