BY DR. KENNETH BURTON
Introduction

The devastation caused by the bite of the Brown Recluse spider can be stopped in its tracks and reversed, even at  advanced stages of its degenerative effects.

The Recluse bite can cause a prolonged and expensive trail of suffering and disability to its victims. The frequency of bites to humans has increased at an alarming rate, as the spider moves indoors and into our garments, shoes and bedding. Treatment cost now run into the millions of dollars per year and are rising rapidly as incidences increase.While some spiders inject little venom, others may be expected to create serious management problems with resultant extensive tissue loss, pain. disability and chronic deterioration.

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. There is no need for surgery with its debilitating effects, potential complications and severe scarring.

The patch is cut to cover only the effected area, right up to and extending just over the edge of involvement. In the case of a youngchild, the patch should be cut down to cover the smallest area possible, with more frequent removal and reapplication necessary. Pictures of the recluse bites treated with these patches provide examples of some responses.

With few exceptions, regardless of the site of the bite or the age and health of the patient, the patch has stopped the progress of the tissue loss, thus allowing the area to begin recovery, usually without scarring and with only slightly darker pigmentation.

*3 wks. old untreated lesion near wrist
*After 7 weeks treatment on Nitro 0.2 patch - completely healed - no scar
Exceptions include a patient with a very old ulcer (10 months), one whose bite was at the posterior knee joint and who was not diligent in keeping the patch on in this difficult location, and a patient whose auto immunity was compromised by HIV. I have found the Deponit Nitroglycerinpatch to be the most effective patch of the several types tried because the nitroglycerin is dispersed throughout the matrix, the dosage is easily controlled, and the patch is very flexible (important for joint areas).  Nitroglycerin spray was also used, and found to be very effective when applied to a bite of no more than several days age. Under no circumstances will oral nitroglycerin be appropriate. With blood flow re-established to the bite site, systemic antibiotics are effective and patients are prescribed Ciproflaxin for the first five to seven days to counteract bacteria - possibly delivered by the spider’s fangs - and to prevent potential bone involvement. Patients should be instructed that in the event of a headache the patch should be removed for up to one hour and then replaced.

I have been using this procedure in my private practice since 1989 with amazing and conclusive results. In instances where I see the bite so early on as to be unable to positively identify as a Brown Recluse bite (most times the victim does not see the spider, or if they do the response is to pulverize it, thus allowing no method of identification other than an examination of the affected area), I will initiate treatment with the nitroglycerin patches as a precaution. There is no danger from its use on other bites, but to delay treatment from uncertainty only allows further degradation and necessitates a prolonged treatment period. The patch will also help scorpion and other bites anyway. Exception: Do not use on snake bite.

Introduction : Current Methodologies : Symptoms : Identifying The Bite : Wound Care : Treatment Procedure : About The Author : References
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