Brown Recluse Spider bites

Factual Questions
1

My son-in-law had a sore spot develop on his back, and a trip to the doctor confirmed it was a brown recluse spider bite. So he is under a doctor’s care with medicine and salve.

When I mentioned this to my brother, he said that he had gotten bit on his hand, and his doctor gave him a nitroglycerin patch for treatment. Brother said within hours the swelling went down and within a week the sore was gone, with no scarring.

I googled a bit and these are some of the links I came up with …

PK1Slot Online Terpercaya: Situs slot online Terbaru 2023.

Anecdotal evidence suggests benefit can be gained with the application of nitroglycerin patches. [26] The brown recluse venom is a vasoconstrictor, and nitroglycerin causes vasodilation, allowing the venom to be diluted into the bloodstream, and fresh blood to flow to the wound. Theoretically this prevents necrosis, as vasoconstriction may contribute to necrosis. However, one scientific animal study found no benefit in preventing necrosis, with results showing it increased inflammation and it caused symptoms of systemic envenoming. The authors concluded the results of the study did not support the use of topical nitroglycerin in brown recluse envenoming. [27]
http://www.highway60.com/mark/brs/casestudy_photos.asp?Msg=2762 (warning: pictures)

I was writing to my doctor to get the prescription to buy nitroglycerin, as suggested by Dr. Burton.

After spraying the nitroglycerin I used to put also the charcoal and I have to say that finally things went OK, after a couple of more weeks. I DO believe that the charcoal helped a lot and it is the first real remedy that I found effective to fight against the bite. I would definitely suggest it to whom has the bad chance to experience the same problem.

http://www.highway60.com/mark/brs/bite.asp?Msg=679 (this one is by a RN with a 5y/o son who was bitten)

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 Yahoo | Mail, Weather, Search, Politics, News, Finance, Sports & Videos
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.
CS>Brown Recluse Bite

The etiology is the powerful, vasoconstricting properties of the venom,
as the mechanism of necrotic arachnidism, which causes the smail
arteries to spasm with resultant loss of blood supply to the bite area.
This sets up a cycle of ulceration and tissue loss through ischemia and
gangrene. Systemic medication alone is unable to penetrate the lesion
because of the barrier zone produced by the spastic occlusion of the
arteries.

However…a nitroglycerin patch can penetrate through the skin, into
the interstitial fluid and into the capillaries, rapidly dilating the
vessels. This is evidenced by the quick onset of a nitroglycerin
headache as circulation into the occluded area is re-established from
the edges inward. The pathologic process ceases and healing begins.
When a nitro patch is administered early, as in the first 48 hours, no
lesion ever develops! Delay treatment three to four weeks and a 5 cm ulcer
will develop, requiring three months of treatment with the
nitroglycerin patches. Even with delayed treatment, however, the degenerative process is reversed. The body heals itself.

According to anecdotal evidence, nitroglycerin patches have also found use as treatment for the bite of the brown recluse spider, which has a vasoconstricting venom. However, research has suggested that nitroglycerin has negligible benefits and might even increase inflammation of the bite wound.[citation needed]

Burton[61] described his 10 years of experience with applying nitroglycerin patches to the bite site area. His experiences indicate that necrosis and ulceration can be aborted if the nitroglycerin patch is applied within 48 hours of the time the patient was bitten. He promoted the use of a 0.1-mg/h patch and speculated that the nitroglycerin patches prevented necrosis through reversal of blood vessel spasm.
Brown recluse specific antivenin has been shown by Rees et al[31] to be most effective for limiting dermonecrosis secondary to brown recluse venom. Similar to antivenin use in the treatment of poisonous snakebite, brown recluse spider antivenin must be administered within the first 24 hours. It is most effective when administered as soon as possible after the bite, unfortunately at a time when the amount of venom injected by the spider is open to speculation. Consequently, it can only be guessed whether the patient received a sufficient quantity of venom to require treatment with antivenin.
From reading through many links, I surmise nitroglycerin for brown recluse spider bites is controversial. Some swear by it, my brother included, and yet the widipedia article says it could make things worse.

I emailed the above links to my daughter to share with her husband and his doctor if the regimen he is on does not improve the bite. They live too far away for my S-I-L to visit my brother’s doctor.

Have you, or anyone you know, been bitten by a brown recluse? What regimen did the doctor use?

Thanks in advance for any anecdotes you have to share.

2

A friend of mine encountered a brown recluse while putting on his boot at an Army training activity (I want to say it was at Ft. Benning for Ranger school, but I could be mistaken). Seems the bugger was hiding out in there (are spiders afraid of inane chanting and gunfire?). Upon discovery, it got the frig out of there, leaving a grown-ass man with advanced military training freaking out over a button-sized bug.

And now, for the next several days, I will be shaking down bedsheets and looking into my shoes before I put them on, even though I’m not in an area in which the brown recluse resides.

More importantly, I wish the best for your son. My (uneducated) guess would be that using standard, common-sense treatment will leave him relatively unharmed; with the additional treatment from his physician, all should be well.

3

Best wishes to a good recovery to your SIL. The dad of a good friend of mine growing up, was bit on his foot by a brown recluse, while putting on his loafers to go to work. He ultimately lost two of his toes.

4

Just in the name of fighting ignorance and all

Brown recluse bites are one of the most overblamed things in the world. Without the spider, you cannot decisively tell if it was a recluse or not even if “the doctor said so”, most doctors don’t know any more about spiders than I know about brain surgery (which as an ex-EMT is pretty much nothing beyond they cut a hole in your head).

In many cases, the simple fact that it took place in an inhabited structure leans toward it not being a recluse. They call them recluses for a reason, you will find them in areas that are rarely disturbed. Old woodpiles, storage sheds that see little or no activity, things like that. In something like an army barracks that gets cleaned and turned over weekly would be one of the last places you would find one.

Here in CA there are no more than a handful of real brown recluses if any, they do have a far less dangerous relative in CA.

A wide range of other spiders and biting insects can inflict similar looking wounds, that overall are far less serious, but can still become infected and require treatment.

5

A friend got bit over 10 years ago. He had necrosis and it was ugly. Every now and then it flares up but while it looks similar to the original bite, it is not as bad. Still ugly though. It can be a gift that keeps on giving.

6

funny you used that term, one of the poison control sites I was reading, giving examples of things misdiagnosed as brown recluse bites was inflamed herpes leisons.

7

drachillix, true, without the spider itself it is nearly impossible to know for sure if it was a brown recluse. When you add in the fact that BR bites are usually painless, one doesn’t even know to look for evidence until hours after the deed. He had been working in the yard and going in and out of the tool-shed. When he sat down and leaned back on the couch, he *thinks *he may have felt a small prick in the area where the sore came up, so small that he thought nothing of it at the time.
I believe it is the necrosis that lead the doctor to such a diagnosis. They do live in the green area of this map.

Yes, GiantRat, they are shaking out sheets, and clothes, doing a thorough cleaning, and SIL is spraying pesticide today while the kids are in school.

**Wilbo523 **and gonzomax, that is why I am interested in anecdotes, what has worked and what has not. I am very interested in if anyone has tried the nitroglycerin patch or heard of it, and how well that did or did not work.

8

That map shows brown recluses living in California.

And yet, according to the Department of Entomology at UC Riverside:

Emphasis in original.

This is a university department of entomology, located in California, and offering advice on a website specifically dedicated to spiders. The conclusions reached are those of Rick Vetter, who is not only an expert himself, but reached his conclusions in consultation with multiple California arachnologists, the California Department of Food and Agriculture, agricultural entomologists all over the state, and THE expert on American recluse spiders. As he says on that site:

9

This map is not one of the links I sent my daughter. I think I need to, as about mid-page when speaking of control, it says traps work better than pesticides.

10

I’m shocked!

A website run by a company that sells spider traps concludes that traps work better than pesticides. In other news, the people who sell Pepsi say it tastes better than Coke.

11

txobbin, I note that many recluse bites produce little or no symptoms, therefore it can be assumed that a number of people who saw the recluse, applied a nitro patch, and got better, would have done just as well without the patch.

12

In 25 years of nursing in a part of the country where they’re found, the only ‘brown recluse’ bites I ever saw that caused any significant damage were in people who had other risk factors - namely, diabetes, PAD, and other conditions that would make them more susceptible to developing nasty ulcers anyhow, from almost any kind of insect bite.

My brother was once bitten by a verified brown recluse. His idea of treatment was to apply a drop of liquid nitrogen to the bite site on the theory the cold would break down the venom. (He worked in a lab and had access to the stuff). It worked in the sense the bite never developed any kind of ulceration, but I still wouldn’t recommend it or proclaim it as a treatment.

13

mhendo, I suppose the whoosh is on me (lol??), I did not look on the left of the page, never even noticed it was an advert for traps, I was too focused on what it had to say about the spiders. He says he is going to use Demon wp.
I’m a Dr Pepper girl myself, my sister would argue with the Pepsi folks.

**outlierrn **and GythaOgg, thanks for the input. SIL said yesterday it seemed to already be getting better. Having heard horror stories about BR bites, I wanted to help find as much information about treatment as I could.

My brother is sold on the idea of using the nitroglycerin. He maintains his bite (or ulcer) did not begin to get better until he used the patch, and that then within hours the swelling and redness had begun to recede.

Thanks again to all.

14

This bit is important and may suggest a good reason to be cautious using the nitro, basically it suggests the possibility of helping with the local effects (or not) but spreading the venom further afield to cause other damage such as (from the OP’s first link).

I had a quick look at the abstract for the nitro study and it hardly presented strong evidence for major danger to humans, but the mechanism for potential risk seems plausible.

(Not a medical doctor)

15

I have also heard (probably on this board) that actual Brown Recluse bites are very rare. I can accept that, but I wonder what bites are causing these cases of infection then? Some other spider?

I was diagnosed as having a Brown Recluse bite when I was young, but the area I got it in (rural Montana) does not appear to have a Brown Recluse population based on the map. So what gave me a very nasty infection and swelled up my skin the size of a baseball?

16

My Mom was diagnosed with a BR bite and had to have surgery to ‘core’ the dead skin. I had thought that I have had BR bites too. But I think they where Hobo spiders. The few I have caught really look like a Hobo. And the simptoms are similar, but from what I have read, not as bad. I’m in Colorado FWIW.

17

My dad was bitten by a black widow spider (abundant where we lived), which left a necrotic/ulcerated sore that took three weeks to heal. If your son-in-law had been going in and out of a tool shed, perhaps he found a black widow? They like places like tool sheds.

18

While BRs have a limited range, I was talking with a spider guy who works at NMSU and he told me that there are related species (like the desert recluse) that live elsewhere and that can also cause necrosis if they bite you.

19

Yes, enigmatic, the treatment is controversial, that is why I included links both pro and con. IIRC, I found that same link, too. There were many to choose from.

They do not have home internet so I was trying to find out as much as possible for them. He asked, “Why is she sending me this stuff?” Turns out their Blackberrys do almost as good a job as my pc, so he has already found many of the sites I did. (Boo, my cheapo cell phone doesn’t do internet that well. Anyone got any cheese to go with my whine? On the plus side, maybe I have scored some mother-in-law points!)

I just spoke with my daughter, and he is improving. He knows not to ‘mess’ with it, but the ulcer/sore opened up on its own while he was in the shower, and some of the dead skin sloughed off. They peroxided it and applied the steroid cream. He is also taking an antibiotic and an oral steroid.

He said while clearing and moving things to apply the pesticide, he found a few more spiders he is certain are brown recluse.

20

Well yes, it’s just that there is something of a gulf between “controversial as to whether treatment helps symptoms” and “controversial as to whether this treatment may increase the chances of you dropping dead” that I thought was worth highlighting.