Envenomation by Brown recluse spider bite – a case series of cutaneous loxocelism.

This article focuses on cutaneous loxoscelism caused by bites from the brown recluse spider (Loxosceles reclusa), a species primarily found in central and southern regions of the United States. It presents a case series of four patients who developed localized skin lesions, including haemorrhagic bullae, necrotic plaques, and vesicles, following confirmed or suspected spider bites, with no systemic complications observed. The brown recluse spider is characterized by a violin-shaped marking on its cephalothorax and venom containing enzymes such as sphingomyelinase D, which contribute to skin necrosis and, in severe cases, systemic effects like haemolysis and renal abnormalities. Treatment in these cases involved topical fusidic acid and oral doxycycline, resulting in complete lesion resolution. The article notes that diagnosis is straightforward when the spider is identified, but no standardized treatment protocol for loxoscelism currently exists, emphasizing supportive care for complications.