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Journal of the American Academy of Dermatology
Volume 44, n° 4
pages 603-608 (avril 2001)
Doi : 10.1067/mjd.2001.112380
accepted : 16 August 2000
Nineteen documented cases of Loxosceles reclusa envenomation

Hunter H. Sams, MD a, Scott B. Hearth, MD a, Lana L. Long, MD a, David C. Wilson, MD a, Dian H. Sanders a, Lloyd E. King, MD, PhD b
a Department of Medicine, Division of Dermatology, Vanderbilt University Nashville, Tennessee 
b Nashville Veterans Administration Medical Center. Nashville, Tennessee 


Objective: Our purpose was to review documented Loxosceles reclusa (brown recluse spider) envenomations and to describe the natural history. Methods: This article is a retrospective review of 19 documented cases seen in a university dermatology clinic. The study included the cases of 11 female and 8 male patients between the ages of 15 and 54 years with documented cases of brown recluse spider bite between 1987 and 1993. Rest, ice compresses, elevation, and prophylactic antibiotics were used in all cases. Fourteen patients received dapsone and 11 received nonsteroidal anti-inflammatory drugs. Two patients were hospitalized. A 3-point scale of cutaneous lesion severity was developed. Analysis of the association between maximum lesion severity (mild, moderate, severe) and time to complete healing or final evaluation was statistically significant (P < .001). Results: All patients presented with localized erythema. Most bites were on the extremities (18/19; 95%). The most common presenting symptom was pain at the bite site (10/19; 53%). Eleven patients (58%) had skin necrosis; 32% of them had areas of necrosis larger than 1 cm2. Time to healing ranged from 5 days to more than 17 weeks (mean, 5.6 weeks). Average time to healing for grade 3 (severe) lesions was 74 days, for grade 2 (moderate) lesions 22 days, and for grade 1 (mild) lesions 8 days (in patients seen more than once). Conclusions: Brown recluse spider bites frequently induce necrotic, slowly healing lesions. Maximum lesion severity is a predictor of time to complete healing. (J Am Acad Dermatol 2001;44:603-8.)

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Abbreviations : BRS:, CBC:, NSAID:, RICE:, SMD:

 Reprint requests: Lloyd E. King, MD, PhD, Division of Dermatology, 3900 The Vanderbilt Clinic, Nashville, TN 37232-5227. E-mail:
 J Am Acad Dermatol 2001;44:603-8

© 2001  American Academy of Dermatology, Inc. Published by Elsevier Masson SAS@@#104157@@
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