From the Guidelines
For most spider bites, treatment involves cleaning the bite with soap and water, applying an ice pack to reduce pain and swelling, taking over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) as needed, and elevating the affected area if possible. According to the 2024 American Heart Association and American Red Cross guidelines for first aid 1, spider bites and scorpion stings are common occurrences in the United States, and while many are benign, some species of spider can cause more severe localized and systemic symptoms.
Key Considerations for Treatment
- Apply an antibiotic ointment like Neosporin to prevent infection and cover with a clean bandage
- For itching, try an antihistamine like diphenhydramine (Benadryl) or apply hydrocortisone cream directly to the bite
- Most spider bites heal on their own within a week
- However, if the bite is from a black widow or brown recluse spider, or if you develop severe symptoms like intense pain, spreading redness, difficulty breathing, severe swelling, or flu-like symptoms, seek immediate medical attention 1
Severe Symptoms and Medical Attention
The guidelines recommend that emergency services should be called if a person bitten by a spider or stung by a scorpion develops symptoms throughout the body such as difficulty breathing, muscle rigidity, dizziness, or confusion 1. Additionally, a person bitten by a spider or stung by a scorpion should seek medical care if pain extends beyond the site of the bite/sting, becomes severe, and is not controlled by over-the-counter pain medications; if an open wound develops; or if the person experiences symptoms throughout the body 1.
Pain Relief Options
Over-the-counter acetaminophen and nonsteroidal anti-inflammatory agents can be used to alleviate local pain from scorpion stings 1. Topical lidocaine can be useful to relieve local pain from scorpion stings if the skin is intact 1, and ice can be useful for local pain relief from scorpion stings 1. A randomized trial of 130 adults with scorpion stings occurring in Turkey showed pain improvement with application of topical 5% lidocaine, administration of intravenous acetaminophen, or topical application of ice; the greatest pain reduction was from lidocaine 1.
From the Research
Spider Bite Treatment Overview
- Most spider bites cause minimal or no effects, with only local irritation as a common symptom 2
- Some spider bites can cause significant morbidity and rarely, mortality, emphasizing the need for proper assessment and management 2
Assessment and Management
- Clinical assessment is crucial in determining the severity of the spider bite and the appropriate course of treatment 2
- Lay identification of the spider is not reliable, and medical professionals should not rely on patient identification of the spider 2
- Specific spider bites, such as latrodectism (red back spider envenomation), can be characterized by pain and systemic symptoms, while others like funnel web spider bites require immediate medical attention 2
Emergency Treatment
- Funnel web spider bites are considered a medical emergency, requiring the application of a pressure immobilisation bandage and immediate transfer to a hospital with available antivenom and resuscitation facilities 2
- Clinicians should consider spider bites in the differential diagnosis of unexplained autonomic and neurological dysfunction, particularly in children 2
Common Misconceptions
- Skin ulceration is more likely to be caused by infective, inflammatory, or traumatic factors rather than necrotising arachnidism in Australia 2