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Letter to the Editor

Letter to the Editor

How Do You Apply Trichloroacetic Acid?

doi: 10.1097/01.EEM.0000666376.73175.a0

    Editor:

    Thanks to Chris Schulze, MD, for this exciting clinical information. (“A New Therapy for Brown Recluse Spider Bites,” EMN. 2020;42[3]:28; http://bit.ly/32J2qJx.)

    Do you apply trichloroacetic acid over the entire area of inflammation? Is the process repeated? Thank you again.

    Terry Perkins, MD

    Grandview, IN

    Dr. Schulze responds: Thank you for your interest. I have only used this technique on myself, and can provide limited guidance. I used two parameters (progression and relief of itching) to determine where to apply and whether to reapply a few days later. Initially, I painted only the edge of the lesion, which successfully relieved the itching in the middle of the night. I painted the entire lesion only after I noticed that the ulceration had stopped progressing, which led to faster resolution. I repainted any part of the ulceration not responding or where the itching or pain returned.

    I painted subsequent envenomations rather liberally from the onset, which either halted or prevented further ulceration. Of course, I knew that a more liberal use would cause a greater skin peel, but I found that rather trivial, especially in relation to the relief and final effect. I used only a single application to treat bumblebee stings and black spider and mosquito bites.

    I noted several other effects from the envenomation not reported in the article (nor in my literature search), such as a delayed distal venom effect on new injuries, but I treated those the same way. As far as I can see, this is a completely new way of management, and there is a lot of investigation and experimentation yet to be done.

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