From the Guidelines
If you suspect a brown recluse spider bite, clean the area immediately with soap and water, then apply an ice pack to reduce pain and swelling, and seek medical attention promptly if severe symptoms develop. The treatment of brown recluse spider bites prioritizes wound care, pain management, and monitoring for systemic reactions. According to the 2024 American Heart Association and American Red Cross guidelines for first aid 1, bites from brown recluse spiders can cause painful ulcerated wounds that progress over days to weeks, sometimes associated with hemolysis and rhabdomyolysis.
The guidelines recommend that emergency services should be called if a person bitten by a spider develops symptoms throughout the body such as difficulty breathing, muscle rigidity, dizziness, or confusion 1. Additionally, a person bitten by a spider should seek medical care if pain extends beyond the site of the bite, 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.
Some key considerations for treatment include:
- Cleaning the area immediately 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) for discomfort
- Elevating the affected area if possible and applying antibiotic ointment to prevent infection
- Avoiding the application of heat, as this can accelerate tissue damage
- Not cutting the wound, attempting to suck out venom, or applying tourniquets, as these methods are ineffective and potentially harmful.
It is essential to seek medical attention promptly, especially if severe symptoms develop, such as severe pain, spreading redness, fever, chills, nausea, or a growing ulcer at the bite site, as medical professionals can provide appropriate wound care, stronger pain management, and monitor for rare but serious systemic reactions that might require antibiotics or other interventions 1.
From the Research
Treatment Options for Brown Recluse Spider Bites
- The current standard of care for brown spider bites includes analgesics, ice, compression, elevation, antihistamines, and surgical debridement 2.
- Hyperbaric oxygen therapy (HBOT) has been used in the treatment of brown spider bites, particularly in the late, chronic, nonhealing stage, with positive results 2.
- Topical nitroglycerine patches and vitamin C tablets have been provided to patients with suspected brown recluse spider bites, but their effectiveness is unclear 3.
- Systemic corticosteroids and dapsone have been associated with slower healing and an increased probability of scarring 3.
- Dapsone and hyperbaric oxygen therapy have been used together to bring the adverse response to the bite under control in some cases 4.
Considerations for Treatment
- The diagnosis of spider bite-related ulcers is often delayed, which can make treatment more challenging 2.
- The severity of the bite, presence of necrosis, and patient's age and medical history can affect the outcome of treatment 3.
- Efforts are underway to develop an assay to provide a definitive diagnosis for the brown recluse spider bite, but none is yet commercially available 4.
- Capture of the offending spider appears to be most helpful in the diagnosis and proper treatment of spider bites 4.
Hyperbaric Oxygen Therapy
- HBOT has been administered in the early stage of ulceration, or 2 to 6 days after the bite, with positive results 2.
- HBOT should be considered as a valuable therapeutic tool even months after the bite 2.
- Daily HBOT sessions with 100% oxygen at 2 ATA (atmospheres absolute) have been used to treat nonhealing wounds caused by brown spider bites 2.