From the Guidelines
Treatment for a brown recluse spider bite requires immediate cleaning of the bite area with soap and water, followed by application of ice to reduce pain and swelling, and taking over-the-counter pain relievers like acetaminophen or ibuprofen as needed. 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.
Some key considerations for treatment include:
- Keeping the bite area elevated if possible to reduce swelling
- Applying an antibiotic ointment to prevent infection
- Monitoring the bite site for changes, as the venom of brown recluse spiders contains enzymes that can destroy skin tissue
- Seeking medical attention if severe pain, fever, rash, or a growing area of skin discoloration or ulceration around the bite develops, as recommended by the guidelines 1
It is essential to note that while most brown recluse bites heal on their own within a week or two without serious complications, certain individuals, such as children, elderly individuals, and those with compromised immune systems, should seek medical attention promptly regardless of symptom severity 1. In severe cases, doctors may prescribe antibiotics, corticosteroids to reduce inflammation, or in rare instances, surgical removal of dead tissue.
From the Research
Treatment Options for Brown Recluse Spider Bites
- The treatment for brown recluse spider bites remains controversial, with multiple options but little evidence of their effectiveness 2.
- Common treatment approaches include:
- Topical nitroglycerine patches
- Vitamin C tablets
- Corticosteroids
- Dapsone
- Surgical excision of skin lesions
- However, studies have found that these treatments may not reduce healing time or the likelihood of scarring 2, 3.
Specific Treatment Recommendations
- Thorough cleansing of the bite and updating tetanus status as needed is recommended 3.
- Surgical excision of skin lesions is indicated only for lesions that have stabilized and are no longer enlarging 3.
- Steroids are indicated in bites that are associated with severe skin lesions, loxoscelism, and in small children 3.
- Dapsone should be used only in adult patients who experience necrotic arachnidism and who have been screened for glucose-6-phosphate dehydrogenase deficiency 3.
- Topical nitroglycerin can be of value in decreasing the enlargement of necrotic skin ulcers 3.
Additional Treatment Considerations
- Resting, local cooling, systemic antibiotics to prevent infection, and mild anti-inflammatory drugs may be given 4.
- Oral corticosteroids may be added in the first 72 hours to the antibiotics, especially in massive bites with necrotic centers greater than 2 cm in diameter, or when there is systemic loxoscelism 4.
- Curettage of the subcutaneous tissue in the necrotic area of the lesion may be an effective treatment option 5.
- Operative debridement and wound closure may be necessary in cases of osteomyelitis or chronic wounds 6.