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February 1973

A Critical Look at Therapy for the Brown Recluse Spider Bite

Author Affiliations

Columbia, Mo

Arch Dermatol. 1973;107(2):298. doi:10.1001/archderm.1973.01620170100034

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

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