Dapsone Treatment of a Brown Recluse Bite

IN 1929, Schmaus1reported the treatment of the first documented case of cutaneous loxoscelism in North America with sedation, starch, and sodium bicarbonate, which was ineffective. Current therapies for brown spider bites, using corticosteroids, antibiotics, antihistaminics, and surgical excision, may not be much more effective management for the skin ulcer that the venom produces.2,3We have treated a documented bite from the brown recluse spiderLoxosceles reclusawith dapsone and produced a dramatic resolution of the skin lesion with no complications. Report of a Case A 27-year-old man killed a spider immediately after being bitten on the right leg while dressing. He went directly to the hospital emergency room, where no treatment was given because he was told that the spider was nonvenomous. He saw his private physician 24 hours later, after the bite site became larger (8×8 cm), swollen, and erythematous. He complained of itching and pain.