What to Do in the Middle of the Night
when You are Stricken 

Recognition

The sudden onset of intense localized itching, one to three days after an outdoor activity is characteristic. If the effected skin is finely bumpy, pinkish and slightly swollen, begin treatment at once.
 

First Aid

If you have had trouble before, you should stock the following in advance:

1. Fingernail clippers.

2. Tecnu or Zanfel.

a. Tecnu Outdoor Skin Cleanser comes as individual-use packets, 6 ounce bottles and 12 ounce bottles, the last for about ten dollars at local pharmacies. (Tecnu can also be used to decontaminate equipment.)

b. Zanfel comes in 6 ounce tubes that cost about forty dollars.

3. A prescription from your family doctor of Clobetasol cream 0.05%.

First, trim the free edges of your fingernails. Poison-oak can be spread by your fingers.

Then rub Tecnu on thoroughly. Rinse with cold water, and towel dry. Repeat once if itching recurs. OR use Zanfel according to package directions.

If itching recurs again, begin Clobetasol at least twice a day; it will stop the symptoms.

More Advanced Cases

In untreated cases the fine bumps (vesicles) get bigger and merge with each other into large blisters (bullae). The itching remains intense. Discontinue the Clobetasol (it stops working), and try brief dips in hot water. Protect the bullae from breaking with roller gauze, triangular and/or other bandages. Sleeping medication may help.

After a while the bullae begin to leak large amounts of clear yellow fluid. Cleanliness at this stage helps prevent infection. Clean with tap water, and air dry. Sunlight helps additionally. You may bandage with absorbent materials (Tampax, Depends, etc.) to contain the mess.

As pink new skin forms underneath the bullae the crusting phase is reached. Bandaging becomes less important, and air drying works better. At this stage ointments improve comfort; they decrease cracking and bleeding by softening the scabs.

Written in collaboration with R. Jeffrey Herten, M.D., by Curt Beebe, M.D., 500 Fresno Avenue, Morro Bay, CA 93442, curtbeebe@charter.net.