title: Management of brown recluse spider bites in primary care.
abstract: BACKGROUND
  Treatment of brown recluse spider bites remains controversial; there are multiple options but little evidence of their effectiveness.
  
  
  METHODS
  Over a 5-year period, family physicians enrolled consecutive patients with suspected brown recluse spider bites. Usual care was provided based on physician preferences. Topical nitroglycerine patches and vitamin C tablets were provided at no cost for those who wished to use them. Baseline data were collected, and patients were followed-up weekly until healing occurred. Outcome measures included time to healing and occurrence of scarring. Regression methods were used to evaluate the impact of the 4 main treatment approaches (corticosteroids, dapsone, topical nitroglycerine, and high-dose vitamin C) after controlling for bite severity and other predictors.
  
  
  RESULTS
  Two hundred and sixty-two patients were enrolled; outcomes were available for 189. The median healing time was 17 days. Only 21% had permanent scarring. One hundred seventy-four received a single treatment modality. Among this group, 12 different modalities were used. After controlling for other variables, predictors of more rapid healing included lower severity level, less erythema, and less necrosis at time of presentation, younger age, no diabetes, and earlier medical attention. Systemic corticosteroids and dapsone were associated with slower healing. Predictors of scarring were higher severity, presence of necrosis, and diabetes. Dapsone was associated with an increased probability of scarring.
  
  
  CONCLUSIONS
  We found no evidence that commonly used treatment approaches reduced healing time or the likelihood of scarring in suspected brown recluse spider bites.
authors.affiliation: Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA. james-mold@ouhsc.edu
authors.forename: James W
authors.initials: JW
authors.lastname: Mold
authors.forename: David M
authors.initials: DM
authors.lastname: Thompson
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D003622:Dapsone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use*; D011320:Primary Health Care; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D001098:Spider Bites / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D013112:Spiders / Q000145:classification*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D014665:Vasodilator Agents; D003622:Dapsone; D005996:Nitroglycerin; D001205:Ascorbic Acid