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Richard S. Berger, MD
University of Medicine and Dentistry— Rutgers Medical School Academic Health Science Center New Brunswick, NJ

JAMA. 1984;251(7):889.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The dramatic event of severe cutaneous necrosis following brown recluse spider bites has prompted a variety of therapeutic trials. Unfortunately, single reports of successful prevention of necrotic arachnidism can be very misleading.¹ As reported in THE JOURNAL,² many of the documented bites produce only erythema and edema or mild hemorrhage and negligible necrosis. The unremarkable bites are most likely caused by small envenomations or protective immunity resulting from previous bites. In lesions destined to go on to significant necrosis, bullae and hemorrhage are usually evident by 24 hours, and a pale, demarcated area is often present at 48 hours. In severe reactions, systemic symptoms begin around 36 hours and include morbilliform rash, urticaria, fever, nausea and vomiting, and occasional hemolysis or diffuse intravascular coagulation. The description of the site at 48 hours in the case report entitled "Dapsone Treatment of a Brown Recluse Bite"³ . . . [Full Text PDF of this Article]

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