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Brown Recluse Spider Bites: Stay Cool

Lloyd E. King
JAMA. 1985;254(20):2895-2896. doi:10.1001/jama.1985.03360200045024.
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To the Editor.—  The recommended therapy for brown recluse (BR) spider bites in the southeastern United States remains controversial.1 Because many bites are unremarkable,2 some authors recommend no treatment. Intralesional or systemic corticosteroids with or without concurrent antibiotics have been used to treat BR bites.2,3 Many surgeons prefer early surgical excision of "serious" bites.3 We also found that BR bites are often unremarkable and heal without incident. Our findings in 31 patients with severe BR bites treated with either immediate surgical excision or dapsone1 and delayed surgical excision, if required, were unequivocal. Immediate surgical excision of BR bite sites resulted in more complications than did the use of dapsone with or without delayed excision or repair.When the historical and clinical data from these patients with BR bites1,4 were collected, we found the following: (1) Heat was commonly being recommended as adjunctive therapy for


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