Wui-Leong Koh, M.D.

Spider Bites/Vol 103/No 4/ April 1998/Postgraduate Medicine - "When to worry about spider bites" by Wui-Leong Koh, MD.

Treatment regimens vary, but the supportive treatment with rest, local applications of ice, immobilization, and elevation is adequate for most mild to moderate bites.   Early surgical excision of the wound has been suggested in severe bites, although it is controversial.  Corrective surgery with skin grafting after eschar formation has been generally accepted.

Dapsone, which inhibits polymorphonuclear leukocytes (a major component of skin necrosis), has been shown to be effective in treatment of cutaneous loxoscelism.   Patients are given 50 to 100 mg orally twice a day until necrosis subsides.   Clinical studies have shown the need for few surgical interventions in dapsone-treated patients.

Systemic corticosteroid therapy is controversial and has failed to show consistent efficacy in treatment of localized envenomation and systemic loxoscelism.  Other, less commonly used treatments (e.g., dextran, heparin, hyperbaric oxygen, phentolamin[Regitine]) require further investigation.  An antivenin is available in South America, but it is not currently available in the United States.

Note from Mark:  At the time of this writing Dr. Koh was a staff physician at the Kaiser-Fontana Medical Center in Fontana, CA.  His e-mail is listed as wui.l.koh@kp.org .