Thanks to Chris Schulze, MD, for this exciting clinical information. (“A New Therapy for Brown Recluse Spider Bites,” EMN. 2020;42:28; 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
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.