Oral corticosteroids for poison ivy dermatitis

As John Goodall has noted, dermatology is not our area of expertise. However, we would make the following points.

First, none of the patients in our series had severe poison ivy dermatitis; they had been prescribed the medication after only a few days or at most a week of symptoms. Second, it is our understanding that there are very few prospective or randomized trials that support the use of corticosteroid medication to treat poison ivy dermatitis. Third, none of our patients remembered being warned about the potential side effect of osteonecrosis with the use of corticosteroid medication. Fourth, our patients told us emphatically that, had they known of such a risk, they would not have taken the medication.

Unfortunately, because our study was essentially a case series,¹ there is no way of knowing the denominator (the size of the pool of patients from which our cases were drawn). In addition, it is our impression that a number of risk factors for osteonecrosis, such as alcoholism, steroid use and trauma, may be additive in terms of causation, but this is extremely difficult to prove statistically.

The preponderance of young people in our series is explained by the fact that our patients were drawn from a referral population of younger people sent specifically for femoral head salvage rather than total hip arthroplasty. However, anecdotally, we are aware of similar cases in older patients. The preponderance of male patients remains unexplained.

Unfortunately, we are unable to provide any specific risk factors for the development of this condition following corticosteroid administration. We agree with Goodall that corticosteroid therapy should be reserved for use in patients with the severe form of poison ivy dermatitis and that patients should be appropriately warned about potential side effects. We look forward to the results of prospective trials regarding the use of corticosteroids to treat poison ivy dermatitis.

Signatures

Michael D. McKee
Division of Orthopaedics Department of Surgery St. Michael's Hospital Toronto, Ont.

Emil H. Schemitsch
Division of Orthopaedics Department of Surgery St. Michael's Hospital Toronto, Ont.

James P. Waddell
Division of Orthopaedics Department of Surgery St. Michael's Hospital Toronto, Ont.

Robin R. Richards
Division of Orthopaedics Department of Surgery St. Michael's Hospital Toronto, Ont.

Patricia A. Kudo
Division of Orthopaedics Department of Surgery St. Michael's Hospital Toronto, Ont.