Quotes From A Missouri Physician Who Specialized In Brown Recluse Spider Bites


Below are quotes taken from an article by Dr. Phillip Anderson published in the journal, Missouri Medicine. Dr. Anderson was one of only a handful of practicing clinicians in the U.S. whose specialty was brown recluse spider bites, so his opinion is authoritative. He was a university physician specializing in dermatology, in particular on the effects of brown recluse spider bites from Missouri, which is in the heart of the range of the brown recluse, where they are very abundant.

The quotes from the review article below were generated from the experience of examining and studying over 1,000 probable recluse bites over 30 years time. If these quotes ruffle your feathers, then you really need to reconsider whether the source of your information has more experience that Phillip Anderson. That is very unlikely.

(No attempt is made to translate the medical terms in layman English. This would obscure valuable information for any medical person accessing the site. If you are truly interested in knowing all the terms, get Taber's Medical Dictionary for translation from Doctorese to English. One hint: Loxoscelism = necrotic wound attributed to brown recluse spider bite).

Anderson, Phillip, C. 1998. Missouri brown recluse spider: a review and update. Missouri Medicine 95: 318-322.

"The entire loxoscelism literature is deficient in failing to produce the evidence that the bite of the Loxosceles reclusa was the cause of the illness reported."

"The spider must be recovered on the site promptly and identified expertly. Clinical impression alone, without other physical evidence, is not sufficiently convincing."

" the early clinical literature about loxoscelism is almost useless."

". several deaths from loxoscelism were reported in medical journals, but none of the reports is convincing. We are not aware of any verifiable deaths caused by the bite of the North American brown recluse spider." [**** note: since this information was reported in the 1990's, a few deaths from brown recluse bite in children have been reported in the medical literature but they are still incredibly rare events.****]

"Almost all brown recluse spider bites heal nicely in two to three months without medical treatment at all. Also the long-term medical outcome is excellent without treatment."

"In my opinion, early debridement without closure or grafting also results in delayed healing, more scarring, and without relief of pain or reduction in risks."

"Systemic loxoscelism is uncommon, especially in adults."

"We estimate that we have seen or reviewed about 1,000 credible recluse spider bites, and we have seen about a dozen cases of impressive, sustained hemolysis."

"It would be fair to estimate that systemic loxoscelism occurs in much less than 1% of cases of focal necrosis of the skin due to loxosotoxin."

".the prime credo for the physician is to consider necrotizing cutaneous infection as the first diagnosis whenever you recognize focal necrosis in skin. Consider loxoscelism only after excluding infection."

"All medically significant recluse spider bites have central necrosis, that is, all of them are seen initially as central sinking blue-gray macules on the skin with a wide halo of mixed erythema and vasoconstriction (red-white-blue). If the central lesion is urticarial or nodular, another kind of injury is involved, not a recluse spider bite. Elderly people with diabetes, chronic liver disease, or alcoholism most often appear with spontaneous necrotizing fasciitis, while healthy children and young adults are the usual patients with loxoscelism."

"..cutaneous loxoscelism is a focal, single necrotic lesion without adenopathy or lymphangitis early, not exudative, not progressive after about 18-24 hours, and associated with only mild fever or toxicity in almost all cases. The patients do not seem very ill."

"Most recluse bites referred to us arrive already on high-dose antibiotics. We have never encountered an infected bite, even in unmedicated patients. Antibiotics are unnecessary, and may lend to a false sense of security or even induce errors in the proper diagnosis of cellulitis. It is best not to use antibiotics except for the credible diagnosis of infection, as against loxoscelism."

"Coagulopathy in adults from an ordinary spider bite is almost never seen."

"With no physician's care at all, most recluse spider bites show an excellent outcome."

"Healing may be slow, but all lesions heal and mostly with a minimum of scarring. Surgery can offer little or nothing more. No medications are required to treat brown recluse spider bites."


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