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Lloyd E. King, Jr, MD, PhD; Riley S. Rees, MD
Vanderbilt University Veterans Administration Medical Center Nashville, Tenn

JAMA. 1984;251(7):889-890.

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

In Reply.—

Based on previous experience in an endemic area and our report, Dr Berger questions whether dapsone is indicated for severe brown recluse spider "bites." We agree that (1) not all "bites" should be treated¹; (2) in experimental loxoscelism, blood vessels were the primary site of damage; and (3) polymorphonuclear leukocytes (PMNs) were required for extensive cutaneous necrosis.² We also point out that in humans, extensive PMN accumulation and perivasculitis are routinely noted 24 to 72 hours after the bite and before skin necrosis (personal observations³). These findings have diagnostic and prognostic implications. In humans, once skin necrosis occurs, lesions persist for weeks. The goal of dapsone therapy is to decrease the ulcerated bite size and speed resolution. In experimental animals, any therapy such as dapsone or specific antivenom that reduced inflammation and PMN infiltration proportionately reduced cutaneous morbidity. Persistent inflammation in bites has been studied . . . [Full Text PDF of this Article]

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