EVIDENCE-BASED CLINICAL PRACTICE Management of Brown Recluse Spider Bites in Primary

Background: Treatment of brown recluse spider bites remains controversial; there are multiple options but little evidence of their effectiveness. Methods: Over a 5-year period, family physicians enrolled consecutive patients with suspected brown recluse spider bites. Usual care was provided based on physician preferences. Topical nitroglycerine patches and vitamin C tablets were provided at no cost for those who wished to use them. Baseline data were collected, and patients were followed-up weekly until healing occurred. Outcome measures in-cluded time to healing and occurrence of scarring. Regression methods were used to evaluate the im-pact of the 4 main treatment approaches (corticosteroids, dapsone, topical nitroglycerine, and high-dose vitamin C) after controlling for bite severity and other predictors. Results: Two hundred and sixty-two patients were enrolled; outcomes were available for 189. The median healing time was 17 days. Only 21 % had permanent scarring. One hundred seventy-four re-ceived a single treatment modality. Among this group, 12 different modalities were used. After control-ling for other variables, predictors of more rapid healing included lower severity level, less erythema, and less necrosis at time of presentation, younger age, no diabetes, and earlier medical attention. Sys-temic corticosteroids and dapsone were associated with slower healing. Predictors of scarring wer