From the Guidelines
Management of a Loxosceles reclusa (brown recluse spider) bite involves localized wound care and over-the-counter analgesics for pain.
Key Considerations
- The bite can cause painful ulcerated wounds that progress over days to weeks, sometimes associated with hemolysis and rhabdomyolysis 1.
- First aid treatment involves localized wound care and over-the-counter analgesics for pain, with advanced medical care sometimes needed for severe symptoms 1.
- Patients 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.
Pain Management
- Over-the-counter acetaminophen and nonsteroidal anti-inflammatory agents can be used to alleviate local pain 1.
- Topical lidocaine can be useful to relieve local pain if the skin is intact, although its use is more established for scorpion stings 1.
- Ice can be useful for local pain relief, commonly recommended for scorpion stings and potentially applicable to spider bites 1.
From the Research
Management of Brown Recluse Spider Bites
The management of brown recluse spider bites involves various treatment options, including:
- Conservative wound management 2
- Systemic antibiotics 2
- Curettage of the subcutaneous tissue in the necrotic area of the lesion 3
- Aggressive, early debridement 4
- Systemic and intralesional corticosteroids 4
- Negative pressure wound therapy (vacuum-assisted closure) 5
Treatment Objectives
The primary objectives in the treatment of brown recluse spider bites are to:
- Prevent skin necrosis 3
- Prevent the need for reconstructive surgery 3
- Control symptoms and prevent further necrosis 3
Treatment Outcomes
Studies have shown that:
- Most brown recluse spider bites are not serious and can be treated with conservative management 2
- Curettage can be an effective treatment option, resulting in significant resolution of symptoms and minimal scarring 3
- Negative pressure wound therapy can accelerate healing time and promote wound closure 5
Considerations
It is essential to note that:
- The management of brown recluse spider bites can be complicated due to variable and unpredictable patient responses 4
- A conservative yet vigilant approach is necessary to manage these bites 4
- Further research is needed to develop diagnostic criteria and explore the effectiveness of various treatment options 2