Brown Recluse Spider Bite Treatment
Brown recluse spider bites should be treated with thorough wound cleaning using soap and water, application of ice for pain relief, and over-the-counter pain medications, with immediate medical attention if systemic symptoms develop. 1
Initial Management
- Clean the wound thoroughly with soap and water to prevent infection 1
- Apply ice to reduce pain and swelling (place a barrier between ice and skin) 1
- Use over-the-counter pain medications such as acetaminophen or NSAIDs (ibuprofen, naproxen) 1
- Update tetanus immunization if needed 1
When to Seek Immediate Medical Care
Seek emergency medical attention if any of the following develop:
- Difficulty breathing
- Muscle rigidity
- Dizziness or confusion
- Pain extending beyond the bite site
- Severe pain uncontrolled by OTC medications
- Development of an open wound
- Any systemic symptoms (fever, chills, nausea, vomiting) 1
Medical Treatment Options
For Local Wound Management:
- Topical 5% lidocaine can be applied for pain relief if skin is intact 1
- Wound cleaning and sterile dressing to prevent secondary infection 1
- Delayed surgical excision is preferable until wounds are free from active inflammation 2
- Early surgical excision may lead to painful recurrent wound breakdown and hand dysfunction
- Surgical intervention should only be considered for lesions that have stabilized and are no longer enlarging 3
For Systemic Symptoms (Loxoscelism):
- Hospitalization is required for patients with systemic symptoms 3
- Steroids (methylprednisolone) are indicated for:
- Severe skin lesions
- Systemic loxoscelism
- Small children 3
- Dapsone should be used only in:
- Adult patients with necrotic arachnidism
- Patients who have been screened for glucose-6-phosphate dehydrogenase deficiency 3
- Topical nitroglycerin may decrease the enlargement of necrotic skin ulcers 3
For Severe Cases with Hemolysis:
- Therapeutic plasma exchange (TPE) should be considered for severe hemolytic anemia not responding to usual treatment modalities and RBC transfusion 4
- Close monitoring of hemoglobin levels during the first week after bite in patients with systemic loxoscelism 4
Special Considerations for Bites on Extremities
- Bites on the hand and upper extremity require special attention due to potential for functional deficits 2
- Conservative wound management with dapsone and antibiotics may reduce functional complications 2
- For painful, recurrent wound breakdown and hand dysfunction, consider:
- Steroids
- Sympathetic blockade
- Early aggressive physical therapy 2
Common Pitfalls to Avoid
- Do not perform early surgical excision of the wound as this may worsen outcomes 2
- Do not apply suction to the bite (ineffective and potentially harmful) 5
- Do not delay seeking medical attention if systemic symptoms develop, as hemolysis can be life-threatening 4
- Do not apply direct pressure immobilization bandages as this technique is only recommended for snakebites, not spider bites 5
- Do not apply ice directly to the skin without a barrier as it can cause tissue ischemia 5
Most brown recluse spider bites (90%) resolve spontaneously without significant complications, but close monitoring is essential to identify the minority that may develop severe reactions requiring more aggressive intervention 4.