Comparison of hyperbaric oxygen and dapsone therapy for loxosceles envenomation

To determine whether hyperbaric O2 (HBO), dapsone, or HBO plus dapsone affects lesion size in a swine model of Loxosceles envenomation.

In a randomized controlled animal laboratory experiment, 32 piglets were assigned to 1 of 4 equal groups. Each piglet received 15 microliters, of purified venom intradermally on day zero. Group 1 received no treatment; group 2 received HBO at 2 atm for 2 hours on days 1-3; group 3 received 50 mg of dapsone orally on days 1-3; and group 4 received dapsone 50 mg orally and HBO at 2 atm for 2 hours on days 1-3. On days 1-7, 14, and 21, an investigator blinded to the treatment groups measured necrosis and induration. Mean necrosis and induration rates were compared using analysis of variance for repeated measures.

Comparing groups on any day, no significant difference was noted in necrosis, induration, reduction in necrosis from day 1, or rate of change in lesion size from days 1-7. A difference was seen in the reduction of induration between all 3 treatment groups and the control group on days 7 and 14 only. The sample size permitted a power of 0.8 to detect a 12-mm mean change in lesion size.

Compared with the control, neither dapsone, HBO, nor the combination of dapsone and HBO reduced necrosis from Loxosceles envenomation on days 3-21. An increase was seen in the rate of reduction in induration between all 3 treatment groups and the control group on days 7-21. However, the magnitude of this effect was clinically insignificant. In this animal model, treatment with either dapsone or HBO or a combination offers little clinical benefit in Loxosceles envenomation.