Zanfel : Poison Ivy, Oak and Sumac Wash

2 Allergy to Urushiol: What is it? §Poison ivy, oak and sumac belong to a family of plants that produce one of the most common allergic reactions in the United States. §Experts estimate that up to 70 percent of the population is allergic to urushiol, the oil found in the sap of these plants. §The reaction, known as “urushiol-induced allergic contact dermatitis,” occurs when urushiol attaches itself to the skin after a person’s direct or indirect exposure to the oil.

3 What does Poison Ivy look like? Poison Ivy, the most common of the three plants, is characterized by three or five serrated- edge, pointed leaflets. These leaves assume bright colors in the fall, turning yellow then red.

4 T. Radicans radicans demonstrating trifoliate leaves with three leaflets each. Brown aerial rootlets can also be seen emanating from the branches. These are clinging to the bark of the tree. Used with permission – Photo from Jere Guin, MD – University of Arkansas

5 Urushiol on leaf, oxidized to black. Urushiol self-melanizes on exposure to oxygen. The 'black-spot test' helps identify toxic Anacardiaceae, but it also increases one's likelihood of contracting a nasty dermatitis! Use a stone to thoroughly crush plant contents, especially the leaf stalks, between the folds of white paper. Urushiol turns dark brown within 10 minutes and black

6 White fruit on poison ivy in the winter. Used with permission – Photo from Jere Guin, MD – University of Arkansas

Figure 1: Early shrub version of T. radicans. Figure 2: T. radicans ssp. radicans growing at least 20 feet up an alanthus tree. Fort Detrick, MD. All the leaves on the lower half of the tree are poison ivy. Note the rear end of a truck in the lower left hand corner for comparison.

8 Western poison ivy (T. rydbergii ) growing just west of Denver in the foothills of the Rocky mountains. Contrary to what many sources say, poison ivy can grow above an altitude of 4000 feet. The lowest elevation in the park is 7600 feet. If you look closely, you can see black dots of self-melanizing sap on the leaflets. This picture has been published in Cutis 61: May Used with permission.

9 What does Poison Oak look like? Poison Oak has three oak- like leaves and grows as a low shrub in the eastern U.S. and as both low and high shrubs in the western U.S., where it is most prevalent. Poison oak produces whitish flowers from August to November that dry but may remain on the plant for many months.

10 Western poison oak (T. diversilobum) Used with permission – Photo from Jere Guin, MD – University of Arkansas

11 What does Poison Sumac look like? Poison Sumac has seven to 13 leaflets per leaf. Mainly found in the eastern U.S., poison sumac grows in peat bogs and swamps as a shrub or a small tree. The large allergen-containing fruit is white and grows between the leaf and the branch.

12 Poison sumach (T. vernix). Note flowers growing from an axillary position. Used with permission – Photo from Jere Guin, MD – University of Arkansas

13 Non-allergenic Rhus glabra (Common sumac) growing on the campus of Kansas State University in Manhattan, KS. Note the terminal, red fruiting structure (inset).

14 Other plants that contain urushiol §Brazilian Pepper Plant §Cashew Nut Tree §Japanese Laquer Tree §Mango Plant §Poisonwood Plant

15 Anacardium Occidentale Cashew Nut Tree Cashew apples and cashew nuts. Used with permission.

16 Toxicodendron Vernififlua Japanese Lacquer Tree Branch from Japanese lacquer tree (T. verniciflua).

17 Mangifera indica Mango Tree The mango tree (Mangifera indica) Used with permission. (Photo courtesy of Richard Gentry, MD)

18 Symptoms of urushiol induced contact dermatitis Symptoms include: §rashes §oozing blisters §itching §swelling §red leathery skin

19 Figure 1: Acute reaction to poison ivy from hand transfer of allergen to face. Note significant periorbital edema. Used with permission. Bolognia Figure 2: Acute poison ivy dermatitis with vesicles and bullae. Used with permission. Bolognia

20 Note pattern of transfer from this photo to the next in a young women with poison ivy dermatitis. Used with permission – Photos from Jere Guin, MD – University of Arkansas

21 Hand transfer pattern of urushiol to forearm. Used with permission – Photos from Jere Guin, MD – University of Arkansas

22 Incidence of Poison Ivy Peak poison ivy season is between Memorial Day and Labor Day, yet people suffer from poison ivy exposure throughout the year. Even in winter, the dormant plants are still toxic.

23 Myths and Facts Myth: Poison ivy rash is contagious. Fact: Since poison ivy rash is an allergic reaction to urushiol (the toxin found in poison ivy, oak and sumac plants), the only ways to contract poison ivy is through direct contact with the plant; indirect contact by touching something that has urushiol on it (like a family pet or garden tool); or through airborne exposure to burning plants.

24 Myths and Facts Myth: Scratching poison ivy blisters will spread the rash. Fact: The fluid in the blisters will not spread the rash. After the first five minutes to two hours following exposure, neither scratching nor skin-to-skin contact can spread the reaction. However, excessive scratching may cause infection because it allows bacteria from dirt on the hands to enter the skin.

25 Myths and Facts Myth: Dead poison ivy plants are no longer toxic. Fact: Urushiol stays active on any surface, including dead plants, for up to five years in wet climates and up to nine years in dry climates.

26 Myths and Facts Myth: Once allergic, always allergic to poison ivy. Fact: A person’s sensitivity changes over time, even from season to season. Sensitivity to poison ivy tends to decline with age, as the body’s immune system slows down.

27 Effective Date: June 13, 2005

28 Exposure Sales by Region Source: IRI Drug COT 52 week ending December 31 st, RegionShare of Exposure Northeast25.4%25.9%26.8 Mid South18.4%16.9%16.1 Great Lakes15.4%16.4%15.7 Southeast12.7%12.8%12.2 California10.6%9.9%9.4 South Central9.8%9.4%11.0 Plains5.0%5.2%5.6 West2.7%3.5%3.3

29 Poison Ivy Toxin Quickly Binds to Skin Once urushiol touches the skin, it begins to penetrate in minutes. It is completely bound to the skin within 8 hours. Source: Godfrey HP, Baer H, Watkins RC. Delayed hypersensitivity to catechols V. Absorption and distribution of substances related to poison ivy extracts and their relation to the induction of sensitization and tolerance. J Immunol 1971; 106:

30 How to Prevent a Scratchy Situation §Know what to look for and educate your family. Before you head outside, make sure your family knows how to identify these plants so they can avoid them. §Wear protective clothing. Clothing, including long pants, long-sleeved shirts, hats and gloves, can help protect you from exposure. §Wash outdoor items frequently. Be sure to wash all clothing, shoes, tools or pets that may have been exposed. §Do not burn any suspicious plants. Burning the problematic plant and inhaling its smoke can cause a systemic reaction, which can be deadly. §Stop the symptoms before they start. If you know you’ve been exposed to poison ivy, cleanse the area immediately with plain soap and water to remove urushiol before it has a chance to bind to the skin.

31 Prevention of Poison Ivy Rash by Cleaning with Soap and Water Time of Washing After Exposure Extent of Removal of Poison Ivy Oil (%) Immediately min50 15 min25 30 min10 60 minNone Source: Fisher AA. Poison Ivy/Oak/Sumac Dermatitis. Part 1: Prevention – Soap and water, topical barriers, hyposensitization. Cutis 1996; 57:

32 Zanfel – How It Works Dual-action Zanfel is the only product clinically shown to remove “urushiol,” the toxin found in poison ivy, oak and sumac, from the skin anytime after breakout, while relieving itching within 30 seconds. Evidence Based – A double-blind study (presented in 2003) has clinically shown the effectiveness of Zanfel Poison Ivy, Oak and Sumac Wash’s patented formula. Source: Anals of Emergency Medicine, V42 (4suppl 1), Davila A,et al, “A New Topical Agent, Zanfel, Ameliorates Urushiol- Induced Toxicodendron Allergic Contact Dermatitis,” Abstract 364, © 2003, with permission from American College of Emergency Physicians.

33 Zanfel Poison Ivy, Oak & Sumac Wash Zanfel is a safer, more effective option than the steroids or antihistamines commonly prescribed for poison ivy, oak and sumac. Hydrocortisones, prescription steroids and antihistamines only treat the symptoms, Zanfel goes after the cause of the allergic reaction and completely removes urushiol from the skin.

34 Zanfel Facts Zanfel is effective at any stage of the outbreak. In many cases, one washing is adequate for each affected area (For mild to moderate reactions). Zanfel is safe for the face and genitals, and can be used by children and pregnant or nursing women. Zanfel is sold in 1 oz. tubes. The product has a 10- year shelf life and provides approximately applications the size of an adult hand or face.

35 Zanfel Results 24 hours prior to using Zanfel 5 hours after using Zanfel 2 days after using Zanfel

36 Zanfel Directions Zanfel is easy to use: (The following directions are for an area the size of an adult hand or face.) For best results, use Zanfel in a shower or sink where it is easy to thoroughly rinse off the product. This tube contains enough Zanfel to wash approximately 15 patches the size of an adult hand or face. Note: Severe reactions (that typically look like thick leathery burns) will probably require additional washings. If symptoms persist, reread the Q&A insert and see a physician.

37 Got Poison Ivy? Get Zanfel! It Works!