Brown recluse spider envenomation: dermatologic application of hyperbaric oxygen therapy

Envenomation from the brown recluse (Loxosceles recluse) spider commonly proceed on one of three clinical pathways. The majority of bites (90%) result in nothing more than a local reaction. They are essentially self-limiting, require little if any attention, and resolve spontaneously. A great majority of the remaining bites will produce necrotic ulcerations of various sizes and dimensions, with systemic sequela ranging from fever to hemolysis and kidney failure. Finally, and in the most rare cases, the patient will succumb a fatal systemic reaction. Current therapeutic options for these wounds remain controversial and include the following: local care, corticosteroids, dapsone, and hyperbaric oxygen (HBO) therapy. This article will review the application of HBO therapy for patients who are envenomated by brown recluse spiders. Information for this manuscript was derived from multiple MEDLINE searches as well as searches of the National Baromedical Service's hyperbaric specialty literature collection.