From the Guidelines
Brown recluse spider bites should be evaluated and treated with careful monitoring for complications, and patients should seek medical care if pain extends beyond the site of the bite, becomes severe, or if systemic symptoms develop, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The evaluation of a brown recluse spider bite involves assessing the severity of the bite and monitoring for potential complications. According to the 2024 American Heart Association and American Red Cross guidelines for first aid, patients should seek medical care if they experience symptoms throughout the body, such as difficulty breathing, muscle rigidity, dizziness, or confusion 1.
Initial Treatment
- Clean the bite with soap and water
- Apply ice to reduce pain and swelling
- Elevate the affected area
- Use over-the-counter pain relievers like acetaminophen or ibuprofen to manage discomfort, as suggested by the guidelines for scorpion stings, which may also be applicable to spider bites 1
Monitoring for Complications
- Watch for signs of infection, such as increasing redness, fever, or purulent discharge
- Monitor for systemic symptoms, such as hemolysis or rhabdomyolysis, which can occur with brown recluse spider bites 1
- Document the progression of the bite with photos, if possible, to help healthcare providers assess changes over time
Severe Cases
- May require antibiotics, such as doxycycline, or antihistamines for itching
- Tetanus prophylaxis may be necessary, depending on the patient's vaccination status
- In rare instances, surgical debridement of necrotic tissue might be necessary, although there is limited evidence to support this approach 1
From the Research
Evaluation of Brown Recluse Spider Bites
- The evaluation of brown recluse spider bites can be challenging due to the varying severity of symptoms, ranging from local reactions to necrotic ulcerations and systemic complications 2, 3.
- Most bites (90%) result in local reactions that are self-limiting and resolve spontaneously, while others may produce necrotic ulcerations with systemic sequelae such as fever, hemolysis, and kidney failure 2.
- The diagnosis of brown recluse spider bites is often delayed, and the actual spider bite may go unnoticed for several hours, making diagnosis and treatment difficult 4.
Treatment Options
- Current therapeutic options for brown recluse spider bites include local care, corticosteroids, dapsone, and hyperbaric oxygen (HBO) therapy, although their effectiveness is controversial 2, 3.
- Hyperbaric oxygen therapy has been shown to be effective in treating nonhealing wounds caused by brown spider bites, even in the late, chronic stage 5.
- Other treatment approaches, such as topical nitroglycerine patches and vitamin C tablets, have been used, but their effectiveness is unclear 3.
- Lumbar sympathetic block has been used to treat intractable pain and necrotic arachnidism from brown recluse spider bites, with significant improvement in symptoms 6.
- Dapsone and hyperbaric oxygen therapy have been used to bring adverse responses to brown recluse spider bites under control, although dapsone has been associated with slower healing and increased scarring 3, 4.
Treatment Considerations
- The treatment of brown recluse spider bites should be individualized based on the severity of symptoms and the presence of systemic complications 2, 3.
- Early medical attention and proper wound care are essential in preventing long-term complications and promoting healing 3.
- The use of antivenom is scarce, and capture of the offending spider appears to be most helpful in diagnosis and proper treatment 4.