Brown recluse spider bites.
BACKGROUND
Brown recluse spider bites are a serious medical problem in the southeastern United States. Although most bites are asymptomatic, envenomation can result in a constellation of systemic symptoms referred to as loxoscelism. Patients can also develop necrotic skin ulcers (necrotic arachnidism). These ulcers are often difficult to heal and can require skin grafting or amputation of the bitten appendage.


METHODS
A search of the literature was performed using the search words "spider envenomation," "brown recluse spider bites," and "arachnid envenomation."


CONCLUSIONS
Most brown recluse spider bites are asymptomatic. All bites should be thoroughly cleansed and tetanus status updated as needed. Patients who develop systemic symptoms require hospitalization. Surgical excision of skin lesions is indicated only for lesions that have stabilized and are no longer enlarging. Steroids are indicated in bites that are associated with severe skin lesions, loxoscelism, and in small children. Dapsone should be used only in adult patients who experience necrotic arachnidism and who have been screened for glucose-6-phosphate dehydrogenase deficiency. Topical nitroglycerin can be of value in decreasing the enlargement of necrotic skin ulcers.
Forks
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Department of Family Medicine, The University of Mississippi Medical Center, Jackson 39216-4505, USA.
D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000997:Antivenins / Q000627:therapeutic use; D003622:Dapsone / Q000627:therapeutic use; D006801:Humans; D012883:Skin Ulcer / Q000209:etiology; D001098:Spider Bites / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D013111:Spider Venoms
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000997:Antivenins; D013111:Spider Venoms; D003622:Dapsone