The distribution of brown recluse spiders in the southeastern quadrant of the United States in relation to loxoscelism diagnoses.

The southern and eastern margins of the range of the brown recluse spider run through the southeastern quadrant of the United States. Populations vary from abundant in states such as Arkansas and west and central Kentucky and Tennessee to absent in the Atlantic seaboard states. The diagnosis of loxoscelism should be restricted to areas of the southeastern United States where brown recluse spiders are both common and widespread. Better knowledge of the local presence of recluse spiders in one's area, along with the list of differential diagnoses for dermonecrosis, will allow medical personnel in the south to better assess the probability of spider involvement in a necrotic skin lesion. In North America, there are two groups of spiders proven to be medically important: the widow spiders (genus Latrodectus) and the recluse spiders (genus Loxosceles). The widow spiders are a known entity, because their distinctive coloration makes them readily identifiable by nonarachnologists. Also, the physiological mechanism of the venom, the antivenom to counter it, and the symptoms are known, causing misdiagnosis to rarely occur. In contrast, recluse spiders are almost at the other end of the spectrum. They are readily misidentified or confused with harmless spiders, and the physiological mechanism of the venom is still being elucidated. Furthermore, no antivenom is commercially available, and the brown recluse's infamy causes many skin lesions of nonarachnid origin to be misdiagnosed as brown recluse spider bites.