ts and medical practitioners. Despite significant advances in the biomedical sciences and increasing focus on evidence-based medicine, the diagnosis of a spider bite continues to be based mainly on suspicion and fear of spiders, and diagnosis of a chronic ulcer on stories of suspected spider bites causing devastating necrotic fasciitis (flesh-eating skin disease)."

An accompanying commentary (p 484) by Richard Vetter (University of California, USA) agrees that the medical community has helped weave a web of misinformation about the alleged dangers of spiders. He concludes: "Instead of using the presumptive diagnosis of spider bite when the causative agent is unknown, physicians should diagnose idiopathic [of unknown cause] necrotic ulcer, which accurately describes the clinical presentation of the lesion. Some medical conditions confused with necrotic spider envenomation can result in far worse outcome than most spider bites. The worldwide medical community would do well to relegate spider bite to the bottom of the list of differential diagnoses and consider the plethora of other conditions that manifest in dermonecrosis which have higher probability of occurrence than the rare necrotic spider envenomation".

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Contact: Geoffrey K Isbister
gsbite@ferntree.com
61-24-921-1211
Lancet
5-Aug-2004

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