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Images in Dermatology
November 13, 2019

Cutaneous Loxoscelism

Author Affiliations
  • 1Section of Dermatology, Di.S.Sal. Department of Health Science, University of Genoa, San Martino Polyclinic Hospital, Genoa, Italy
JAMA Dermatol. 2020;156(2):203. doi:10.1001/jamadermatol.2019.3252

A woman in her 40s was bitten on her right leg by a brown spider during yardwork. Her husband captured and locked the spider in a glass (Figure 1). Twenty-four hours later, she developed local burning, blistering, and cyanosis at the site of the bite. Thirty-six hours later, she was evaluated in the emergency department and oral amoxicillin-clavulanate treatment was initiated. No fever or signs of systemic involvement were reported. A physical examination at 72 hours revealed an ulcer characterized by central necrosis and surrounding erythema on her right leg (Figure 2). The spider was recognized by an arachnologist as Loxosceles rufescens, confirming the diagnosis of cutaneous loxoscelism. Topical collagenase ointment for the necrotic center and topical methylprednisolone for the inflammatory edge were applied every 24 hours until the ulcer was well healed. There was minimal scarring at 12 weeks.

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