My 5 yo son was bitten 96 hrs ago. I recognized it immediately as I am an RN of 25+ years, an Adult Nurse Practitioner of 20+ years and the director of a county health department. The wound started with a "mosquito bite" looking lesion on the ankle. 24 hrs later at bedtime it was 2 inches across with a classic bullseye appearance. The next morning we instituted steroids ( Prednisone ) 1 mg per kilogram of body weight orally and applied the Nitroglycerin patch to the wound. So far, the redness is rapidly receding and there has been no pain or itching. The swelling is gone. There was a 1 cm blister over the center of the bite after approximately 36 hrs which burst within 12 hrs, containing a clear serous fluid. Having reviewed as much of the literature I can find, I am convinced that the necrosis ( rotting) and subsequent infections and tissue loss are a result of the envenomation which causes the blood vessels to constrict so tight that blood essentially does not get to the wound and the tissue dies. This is why the nitroglycerin patches ( oral will not work) work as it dilates the blood vessels locally and allows oxygen and nutrients and white blood cells into the area. The web site you want to visit is http://www.geocities.com/Yosemite/Forest/2021/recluse/intro.html The author is a physician of 50 years of practice who treats these with nitroglycerin patches since 1989 with 100% success. The key is early treatment. This works. As soon as you diagnose the bite as BRS, run do not walk to a physician, PA or NP who will listen to you and get the Rx. Follow the instructions on Dr Burton's Web Site. He knows what he is talking about. I have spoken to him and he is the real deal not some quack. Save yourself grief. Use the nitroglycerin patches exactly as he says on the web site.I am certain that between the prednisone and the nitro, this is why we are doing so well so far.
16 Sep 02 What a tumultuous 2 weeks ! We kept my son on Prednisone ( 30 mg ) (He weighs 50 lbs) for 7 days. He continues on a nitro patch changed daily. The wound healed just like Dr Burton said it would at http://www.geocities.com/Yosemite/Forest/2021/recluse/intro.html It continued to be less red and the central core lesion never necrosed due to the nitroglycerin patch. The top of the central ( coin sized) lesion got a thin yellowish dead skin covering which peeled off like a mild sunburn, leaving dry mildly red tissue that is clearly trying to turn to scar. The 2 inch lesion has shrunk to the size of a dime and does not appear to be progressing as all the other pictures on the net look like. This is again exactly what Dr Burton predicted. Again: if you have a brown recluse bite, run do not walk to the nearest prescriber and start the nitroglycerin ASAP as catching it early is the key to avoiding a long drawn out convalesence/surgery/grief etc. I am going to keep the nitro going for at least another week to avoid relapse.
1Oct02 We went a total of 2 weeks, 4 days on the nitro patches. The tissue began looking macerated ( a little wet and gooey) from the constant adhesive and we had done over a week past closure so we held our breaths and quit the nitro. We bandaged it with Kling wrapa nd dry gauze ( telfa for a whiel jsut to be sure). The now dime sized lesion became tan/brown and slightly leathery in appearance and in texture. It was a tad swollen but there was no fluid detectable under it and no erythema ( sorry - redness) around the lesion. The area around the central dime sized lesion was pinkish scar like tissue. At week three, a good friend of the family and a long time Army Trauma Nurse advised lotion to soften it up 2-3 times a day. We gingerly applied Eucerin cream to it twice a day and wrap it in gauze to protect it from trauma ( my son is 5 yrs old). At 4 weeks, we wrapped his leg in plastic cling wrap and threw him in the shower and gave him his first shower in a month (sponge baths have their limits). After 2 of these, a little water leaked in the cling wrap and when we peeled it off after the shower, the brown central lesion literally had disintegrated. The tissue underneath was pink and healthy and didn't even look like scar tissue. There was a continuation of the normal surface of the skin of his leg right across where the lesion had been. It was gone. We were astounded and opened champagne to celebrate. It had been 4 weeks to the day fromthe original bite. 24 hrs later the pink centrallesion started to fade to surrounding skin tone. I do not believe my own eyes but I am already having trouble finding where it was. IF I didn't know where to look, I would have trouble identifying it. Dr Burton was/is right/. If this happened to us again, I would do everything the same except I would go to the nearest ER and talk someone into nitroglycerin patches immediately. I would not take no for an answer. We remain very grateful to Dr Kenneth G. Burton the web site originator as well as Dr Ingrid Goldenstein, our pediatrician who went along with us, Dr David Waddell for suggesting the prednisone, and Colonel Michael Calder, US Army for the lotion advice.
Postscript 26 Aug 05 Since that time, Dr Waddell (above) contacted me as he had a diabetic patient who clearly had a brown recluse bite on her foot. He had already hospitalized her and the pictures were those of a bad bite. I advised to go forward with nitro patches. He did and reported a complete recovery later. Since then I have provided endorsement of this treatment upon request for submission to the FDA for approval of this treatment. I still agree with my statements above. This works. I don't know of anything that works like this and I would try it again in a heartbeat.