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February 17, 1984

Management of Brown Recluse Spider Bite-Reply

Author Affiliations

Vanderbilt University Veterans Administration Medical Center Nashville, Tenn

JAMA. 1984;251(7):889-890. doi:10.1001/jama.1984.03340310011004

In Reply.—  Based on previous experience in an endemic area and our report, Dr Berger questions whether dapsone is indicated for severe brown recluse spider "bites." We agree that (1) not all "bites" should be treated1; (2) in experimental loxoscelism, blood vessels were the primary site of damage; and (3) polymorphonuclear leukocytes (PMNs) were required for extensive cutaneous necrosis.2 We also point out that in humans, extensive PMN accumulation and perivasculitis are routinely noted 24 to 72 hours after the bite and before skin necrosis (personal observations3). These findings have diagnostic and prognostic implications. In humans, once skin necrosis occurs, lesions persist for weeks. The goal of dapsone therapy is to decrease the ulcerated bite size and speed resolution. In experimental animals, any therapy such as dapsone or specific antivenom that reduced inflammation and PMN infiltration proportionately reduced cutaneous morbidity. Persistent inflammation in bites has been studied