Nonhealing Wounds Caused by Brown Spider Bites: Application of Hyperbaric Oxygen Therapy

ABSTRACTBACKGROUND: Bites by Loxosceles spiders (also known asrecluse spiders or brown spiders) can cause necrotic ulcerationsof various sizes and dimensions. The current standard of carefor brown spider bites includes analgesics, ice, compression,elevation, antihistamines, and surgical debridement. Hyperbaricoxygen therapy (HBOT) in the treatment of brown spider biteshas been administered in the early stage of ulceration, or 2 to6 days after the bite. Unfortunately, the diagnosis of spiderbiteYrelated ulcers is often delayed and weeks or months mayelapse before HBOT is considered.OBJECTIVE: To evaluate the effect of HBOT on nonhealingwounds caused by brown spider bites in the late, chronic,nonhealing stage.METHODS: Analysis of 3 patients with brown spider-bite healingwounds treated at The Sagol Center for Hyperbaric Medicineand Research in Israel. Patients presented 2 to 3 months afterfailure of other therapies including topical dressings, antibiotics,and corticosteroids. All patients were treated with daily 2 ATA(atmospheres absolute) with 100% oxygen HBOT sessions.RESULTS: All 3 patients were previously healthy without anychronic disease. Their ages were 30, 42, and 73 years. They weretreated once daily for 13, 17, and 31 sessions, respectively. Thewounds of all 3 patients healed, and there was no need foradditional surgical intervention. There were no significant adverseevents in any of the patients.CONCLUSIONS: Microvascular injury related to brown spider bitesmay culminate in ischemic nonhealing wounds even in arelatively young, healthy population. Hyperbaric oxygen therapyshould be considered as a valuable therapeutic tool even monthsafter the bite.