Utilization of dapsone and hemoglobin in the epithelial skin regeneration therapy of cutaneous loxoscelism: a case report and integrative literature review
Keywords:
Loxosceles venom, Spider bites, Case reports, Dapsone, Hemoglobins, Cutaneous loxoscelism, Loxosceles spider, Necrotic arachnidismAbstract
BACKGROUND: Loxosceles spp are arthropods found worldwide. Its bite may produce cutaneous loxoscelism (necrotic or edematous) or cutaneous-visceral loxoscelism. Depending on their severity and location, cutaneous forms are managed with local cold application and systemic administration of antihistamines, corticosteroids, antibiotics, polymorphonuclear inhibitors, and analgesics.
OBJECTIVE: This study aimed to report a case of cutaneous loxoscelism and to identify the main dermatological manifestations associated with the Loxosceles spp bite.
DESIGN AND SETTING: This case report and literature review was conducted in a Mexican university.
METHODS: A detailed report on the medical management of a patient with cutaneous loxoscelism treated at the emergency department of a public hospital was published. Scopus, PubMed, Web of Science, and Google Scholar databases were searched to identify articles reporting cutaneous loxoscelism. The following keywords were used during the database search: “loxoscelism” OR “spider bite,” OR “loxosceles” OR “loxosceles species” OR “loxosceles venom” OR “loxoscelism case report” AND “cutaneous” OR “dermonecrotic arachnidism.”
RESULTS: A 62-year-old female patient with cutaneous loxoscelism was treated with systemic dapsone and local heparin spray. Eighteen studies with 22 clinical cases were included in this systematic review. Of the 22 patients, 12 (54.5%) were men. L. rufescens was the predominant spider species.
CONCLUSIONS: The administration of dapsone and heparin for the management of cutaneous loxoscelism demonstrated success in this case, with no sequelae observed. In general, the literature review indicated favorable outcomes in patients treated with antimicrobials and corticosteroids, with continuous healing of skin lesions.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID CRD42023422424 (https://www.crd.york.ac.uk/pros-
pero/display_record.php?ID=CRD42023422424).
Downloads
References
Isbister GK, Fan HW. Spider bite. Lancet. 2011;378(9808):2039-47. PMID: 21762981; https://doi.org/10.1016/s0140-6736(10)62230-1.
Orozco-Gil M, Desales-Lara MA. Las arañas (Arachnida: Araneae) del estado de Hidalgo, México: contribución al conocimiento de su biodiversidad. Acta Zool Mex. 2021;37:e3712362. https://doi. org/10.21829/azm.2021.3712362.
Vetter RS. Spiders of the genus Loxosceles (Araneae, Sicariidae): a review of biological, medical and psychological aspects regarding envenomations. J Arachnology. 2008;36(1):150-63. https://doi. org/10.1636/RSt08-06.1.
Manríquez JJ, Silva S. Loxoscelismo cutáneo y cutáneo-visceral: Revisión sistemática. Rev Chilena Infectol. 2009;26(5):420-32. PMID: 19915750; http://dx.doi.org/10.4067/s0716-10182009000600004.
Lopes PH, Squaiella-Baptistão CC, Marques MOT, Tambourgi DV. Clinical aspects, diagnosis and management of Loxosceles spider envenomation: literature and case review. Arch Toxicol. 2020;94(5):1461-77. PMID: 32232511; https://doi.org/10.1007/s00204020-02719-0.
Loh C, Tan QY, Eng DLK, et al. Granulox-the use of topical hemoglobin to aid wound healing: a literature review and case series from Singapore. Int J Low Extrem Wounds. 2021;20(2):88-97. PMID: 32349571; https:// doi.org/10.1177/1534734620910318.
de Oliveira KC, Gonçalves de Andrade RM, Piazza RM, et al. Variations in Loxosceles spider venom composition and toxicity contribute to the severity of envenomation. Toxicon. 2005;45(4):421-9. PMID: 15733563; https://doi.org/10.1016/j.toxicon.2004.08.022.
Vetter RS. Clinical consequences of toxic envenomation by spiders.Toxicon. 2018;152:65-70. PMID: 30053439; https://doi.org/10.1016/j.
toxicon.2018.07.021.
Puerto CD, Saldías-Fuentes C, Curi M, Downey C, Andino-Navarrete R. Experience in visceral cutaneous and cutaneous loxoscelism of hospital management: clinical, evolution and therapeutic proposal. Rev Chilena Infectol. 2018;35(3):266-75. PMID: 30534906; https://doi.org/10.4067/ s0716-10182018000300266.
Droppelmann K, Majluf-Cáceres P, Sabatini-Ugarte N, et al. Caracterización clínica y epidemiológica de 200 pacientes con loxoscelismo cutáneo y cutáneo visceral. Rev Méd Chil. 2021;149(5):682-8. PMID: 34751320; https://doi.org/10.4067/s0034-98872021000500682.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. J Clin Epidemiol. 2021;134:178-89. PMID: 33789819; https://doi.org/10.1016/j. jclinepi.2021.03.001.
Hong QN, Pluye P, Fàbregues S, et al. Improving the content validity of the mixed methods appraisal tool: a modified e-Delphi study. J Clin Epidemiol. 2019;111:49-59.e1. PMID: 30905698; https://doi. org/10.1016/j.jclinepi.2019.03.008.
Farace F, Lissia M, Mele A, Masia DR, Rubino C. Local cutaneous arachnidism: a report of three cases and their management. J Plast Reconstr Aesthet Surg. 2006;59(2):197-201. PMID: 16703866; https:// doi.org/10.1016/j.bjps.2005.05.018.
Hadanny A, Fishlev G, Bechor Y, Meir O, Efrati S. Nonhealing Wounds Caused by Brown Spider Bites: Application of Hyperbaric Oxygen Therapy. Adv. Skin Wound Care. 2016;29(12):560-6. PMID: 27846029; https://doi.org/10.1097/01.asw.0000504578.06579.20.
Hillis TJ, Grant-Kels JM, Jacoby LM. Presumed arachnidism. A case report (in Connecticut). Int J Dermatol. 1986;25(1):44-8. PMID: 3949429; https:// doi.org/10.1111/j.1365-4362.1986.tb03402.x.
Miller MS, Ortegon M, McDaniel C. Negative pressure wound therapy: treating a venomous insect bite. Int Wound J. 2007;4(1):88-92. PMID: 17425551; https://doi.org/10.1111/j.1742-481x.2006.00231.x.
Laack TA, Stead LG, Wolfe ME. Images in emergency medicine. Loxosceles reclusa bite. Ann Emerg Med. 2007;50(4):368-70. PMID: 17881314; https://doi.org/10.1016/j.annemergmed.2007.02.021.
de Entrambasaguas M, Plaza-Costa A, Casal J, Parra S. Labial dystonia after facial and trigeminal neuropathy controlled with a maxillary splint. Mov Disord. 2007;22(9):1355-8. PMID: 17486646; https://doi. org/10.1002/mds.21488.
Bajin MS, Arikan G, Parlak M, et al. Necrotic arachnidism of the eyelid due to Loxosceles rufescens spider bite. Cutan Ocul Toxicol. 2011;30(4):302-5. PMID: 21554159; https://doi.org/10.3109/15569527.2011.577494.
Yi X, AuBuchon J, Zeltwanger S, Kirby JP. Necrotic arachnidism and intractable pain from recluse spider bites treated with lumbar sympathetic block: a case report and review of literature. Clin J Pain. 2011;27(5):457-60. PMID: 21317774; https://doi.org/10.1097/ ajp.0b013e31820b6424.
Hubiche T, Delaunay P, Del Giudice P. A case of loxoscelism in southern France. Am J Trop Med Hyg. 2013;88(5):807-8. PMID: 23636613; https:// doi.org/10.4269/ajtmh.12-0339.
Molgó MN, Arriagada CE, Salomone CB, et al. Skin necrosis: report of eleven cases. Rev Med Chil. 2014;142(1):118-24. PMID: 24861125; https://doi.org/10.4067/s0034-98872014000100019.
Morales-Moreno HJ, Carranza-Rodriguez C, Borrego L. Loxoscelismo cutáneo por Loxosceles rufescens. J Eur Acad Dermatol Venereol. 2016;30(8):1431-2. PMID: 26333780; https://doi.org/10.1111/jdv.13274.
Guglielmetti A, Jahr C, Gompertz-Mattar M. Autologous fibroblasts for the treatment of cutaneous loxoscelism: First experience. Int Wound J. 2019;16(6):1503-5. PMID: 31531944; https://doi.org/10.1111/iwj.13222.
Trave I, Barabino G, Parodi A. Cutaneous Loxoscelism. JAMA Dermatol. 2020;156(2):203. PMID: 31721992; https://doi.org/10.1001/ jamadermatol.2019.3252.
Esteban Vazquez A, Malmierca Corral E. Case report: Autochthonous cutaneous loxoscelism with oedematous predominance (CLEP) in Madrid, Spain. Enferm Infecc Microbiol Clin. 2020;38(6):296-7. PMID: 31767221; https://doi.org/10.1016/j.eimc.2019.10.005.
Combi F, Papi S, Marchesini D, et al. Uncommon differential diagnosis of a breast ulcer: a case study. J Wound Care. 2021;30(Sup9a):XIIi-XIIiv. PMID: 34597171; https://doi.org/10.12968/jowc.2021.30.sup9a.xii.
Simões GCS, Paladino Júnior JR, Simões AGS. Loxoscelism leading to penile necrosis. Rev Soc Bras Med Trop. 2021;54:e05162021. PMID: 34932769; https://doi.org/10.1590/0037-8682-0516-2021.
Luna-Muñoz C, Reyes-Florián G, Seminario-Aliaga M, Vinelli-Arzubiaga D. Cutaneous loxoscelism predominantly edematous. Case report.
Rev Fac Med Hum. 2022;22(3):642-5. https://doi.org/10.25176/RFMH. v22i3.5040.
Morales-Avalos JM, Torres-Moreno AJ, Zamora-Gómez R, Arce-Sanchez HJ. Loxoscelismo necrótico palpebral y reconstrucción con autoinjerto cutáneo: reporte de un caso. Rev Mex Oftalmol. 2022;96(1):37-40. https://doi.org/10.24875/rmo.m21000161.
Sams HH, Dunnick CA, Smith ML, King Jr LE. Necrotic arachnidism. J Am Acad Dermatol. 2001;44(4):561-73. PMID: 11260528; https://doi. org/10.1067/mjd.2001.112385.
Ghaoui N, Hanna E, Abbas O, Kibbi AG, Kurban M. Update on the use of dapsone in dermatology. Int J Dermatol. 2020;59(7):787-95. PMID: 31909480; https://doi.org/10.1111/ijd.14761.
Staneff J, Alarcón Acosta SV, Haedo Pitteri F, et al. Presentation of an eff ective protocol for the treatment of miodermonecrolisis by cutaneous loxoscelism. Rev Argent Cir Plást. 2017;23(3):100-2. Available from: https://www.sacper.org.ar/revista/2017-003.pdf. Accessed in 2023 (May 12).
Gremski LH, da Justa HC, Polli NLC, et al. Systemic Loxoscelism, less frequent but more deadly: the involvement of phospholipases d in the pathophysiology of envenomation. Toxins. 2022;15(1):17. PMID: 36668837; https://doi.org/10.3390/toxins15010017.
Zúñiga-Carrasco IR, Caro-Lozano J. Aspectos clínicos y epidemiológicos de la mordedura de arañas en México. Rev Hosp Med Clin Manag. 2019;11:191-203. https://doi.org/10.24875/HMCM.18000161.
Moranchel-García L, Pineda-Galindo LF, Casarrubias-Ramírez M, et al. Evolución clínica de pacientes con loxoscelismo sistémico y dermonecrótico en un hospital de tercer nivel. Med Interna Méx. 2017;33(1):18-27. Available from: https://www.scielo.org.mx/scielo. php?script=sci_arttext&pid=S0186-48662017000100018. Accessed in 2023 (May 12).
World Spider Catalog. Version 23.5. Natural History Museum Bern. Available from: http://wsc.nmbe.ch. Accessed in 2023 (April 21).
Vetter RS, Cushing PE, Crawford RL, Royce LA. Diagnoses of brown recluse spider bites (loxoscelism) greatly outnumber actual verifications of the spider in four western American states. Toxicon. 2003;42(4):413-8. PMID: 14505942; https://doi.org/10.1016/s00410101(03)00173-9.
Oliveira-Mendes BBR, Chatzaki M, Sales-Medina DF, et al. From taxonomy to molecular characterization of brown spider venom: an overview focused on Loxosceles similis. Toxicon. 2020;173:5-19. PMID: 31726080; https://doi.org/10.1016/j.toxicon.2019.11.002.
Hogan CJ, Barbaro KC, Winkel K. Loxoscelism: old obstacles, new directions. Ann Emerg Med. 2004; 44:608-24. PMID: 15573037; https:// doi.org/10.1016/j.annemergmed.2004.08.028.
Diaz HJ, Leblanc KE. Common spider bites. Am Fam Physician. 2007;75(6):869-73. PMID: 17390599.
Valdez-Mondragón A, Cortez-Roldán MR, Juárez-Sánchez AR, SolísCatalán KP, Navarro-Rodríguez CI. Arañas de importancia médica: arañas violinistas del género Loxosceles en México, ¿qué sabemos de su distribución y biología hasta ahora? Boletín AMXSA. 2018;2(1):1424. Available from: https://amxsa.org/wp-content/uploads/2021/01/ boletin-amxsa-21-2018.pdf. Accessed in 2023 (May 12).
Málaque CMS, Castro-Valencia JE, Cardoso JLC, et al. Clinical and epidemiological features of definitive and presumed loxoscelism in São Paulo, Brazil. Rev Inst Med Trop Sao Paulo. 2002;44(3):139-43. PMID: 12163906; https://doi.org/10.1590/s003646652002000300005.
Malaque CMS, Novaes CTG, Piorelli RO, et al. Impact of antivenom administration on the evolution of cutaneous lesions in loxoscelism: A prospective observational study. PLoS Negl Trop Dis. 2022;16(10):e0010842. PMID: 36240248; https://doi.org/10.1371/journal. pntd.0010842.
Sezerino UM, Zannin M, Coelho LK, et al. A clinical and epidemiological study of Loxosceles spider envenoming in Santa Catarina, Brazil. Trans R Soc Trop Med Hyg. 1998;92(5):546-8. PMID: 9861376; https://doi. org/10.1016/s0035-9203(98)90909-9.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 São Paulo Medical Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.
