A Critical Look at Therapy for the Brown Recluse Spider Bite

To the Editor.—  Necrotic arachnidism caused by Loxosceles reclusa is now recognized to be a prevalent medical problem in mid-United States and especially in Missouri. Other species of poisonous Loxosceles have been more recently identified in the western areas of this country.¹ Venom of this common house spider may cause diffuse intravascular coagulation,² thrombocytopenia, hemolytic anemia, hemoglobinuria, and death, as well as the more familiar cutaneous necrosis.³Although several other modes of therapy have been used in necrotic arachnidism, steroids given systemically or intralesionally have emerged as the treatment of choice.^3,4 Experiments in animals have not provided evidence to support clinical impressions that these medications are efficacious in preventing necrosis and human studies are not feasible.^5,6In attempting to affirm the benefit of systemic steroids, 20 New Zealand white female rabbits weighing about 4 kg were injected intradermally with venom that was obtained directly from