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February 17, 1984

Management of Brown Recluse Spider Bite

Author Affiliations

University of Medicine and Dentistry— Rutgers Medical School Academic Health Science Center New Brunswick, NJ

JAMA. 1984;251(7):889. doi:10.1001/jama.1984.03340310011003

To the Editor.—  The dramatic event of severe cutaneous necrosis following brown recluse spider bites has prompted a variety of therapeutic trials. Unfortunately, single reports of successful prevention of necrotic arachnidism can be very misleading.1 As reported in The Journal,2 many of the documented bites produce only erythema and edema or mild hemorrhage and negligible necrosis. The unremarkable bites are most likely caused by small envenomations or protective immunity resulting from previous bites. In lesions destined to go on to significant necrosis, bullae and hemorrhage are usually evident by 24 hours, and a pale, demarcated area is often present at 48 hours. In severe reactions, systemic symptoms begin around 36 hours and include morbilliform rash, urticaria, fever, nausea and vomiting, and occasional hemolysis or diffuse intravascular coagulation. The description of the site at 48 hours in the case report entitled "Dapsone Treatment of a Brown Recluse Bite"3

Berger RS:  Necrotic arachnidism: A critical look at therapy .  Arch Dermatol 1973;107:288.
Berger RS:  The unremarkable brown recluse spider bite .  JAMA 1973;225:1109-1111.Crossref
King LE Jr, Rees RS:  Dapsone treatment of a brown recluse bite .  JAMA 1983;250:648.Crossref
Berger RS, Adelstein EH, Anderson PC:  Intravascular coagulation: The cause of necrotic arachnidism .  J Invest Dermatol 1973;61:142-150.Crossref
Smith CW, Micks DW:  The role of polymorphonuclear leukocytes in the lesion caused by the venom of the brown spider, Loxosceles reclusa .  Lab Invest 1970;22:90-93.