Management of Brown Recluse Spider Bites in Primary Care

Abstract

Background: Treatment of brown recluse spider bites remains controversial; there are multiple options but little evidence of their effectiveness.Methods: Over a 5-year period, family physicians enrolled consecutive patients with suspected brown recluse spider bites. Usual care was provided based on physician preferences. Topical nitroglycerine patches and vitamin C tablets were provided at no cost for those who wished to use them. Baseline data were collected, and patients were followed-up weekly until healing occurred. Outcome measures included time to healing and occurrence of scarring. Regression methods were used to evaluate the impact of the 4 main treatment approaches (corticosteroids, dapsone, topical nitroglycerine, and highdose vitamin C) after controlling for bite severity and other predictors.Results: Two hundred and sixty-two patients were enrolled; outcomes were available for 189. The median healing time was 17 days. Only 21% had permanent scarring. One hundred seventy-four received a single treatment modality. Among this group, 12 different modalities were used. After controlling for other variables, predictors of more rapid healing included lower severity level, less erythema, and less necrosis at time of presentation, younger age, no diabetes, and earlier medical attention. Systemic corticosteroids and dapsone were associated with slower healing. Predictors of scarring were higher severity, presence of necrosis, and diabetes. Dapsone was associated with an increased probability of scarring.

Two Successive Necrotic Lesions Secondary to Presumed Loxosceles Envenomation

“…Other therapies including steroids, dapsone, and hyperbaric oxygen have not shown definitive benefit and are not recommended. 12,13 In conclusion, brown recluse envenomation can rarely result in multiple, successive cutaneous necrotic lesions. Within endemic areas, the diagnosis of cutaneous loxoscelism should be considered in such cases after excluding other etiologies.…”

Brown Recluse Spider Bites: A Case Report

“…Dapsone (avlosulfon, a sulfone used for leprosy) may be recommended but is not universally used, 4,5,9 and if so, it must be used within hours of the bite. Reactions to dapsone include dose-related hemolysis, agranulocytosis, and aplastic ane- BROWN RECLUSE SPIDER BITES mia.…”

“…3 Diabetic patients heal more slowly than nondiabetics. 4 Severe reactions occur in less than 10% of bites, affecting primarily the very young or old. There is no correlation between the severity of the bite reaction and systemic responses.…”

Brown recluse spider (Loxosceles reclusa) envenomation in small animals

“…To date, none of these have been consistently effective and in some cases have proven to be detrimental. 1,8,46,[51][52][53] Surgical excision, once widely recommended, has also fallen out of favor. 8,46 Treatment of secondary manifestations such as demonstrated coagulopathies or bacterial infections should be considered when appropriate.…”