From the Guidelines
Treatment for a brown recluse spider bite requires immediate attention, with a focus on wound care, pain management, and monitoring for severe symptoms, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The primary goal is to reduce pain and swelling, and prevent infection.
- Clean the bite area with mild soap and water
- Apply a cold compress to reduce pain and swelling
- Elevate the affected limb if possible
- Take over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for discomfort, as suggested by the guidelines 1. It is essential to seek medical attention promptly, especially if severe symptoms develop, such as difficulty breathing, muscle rigidity, dizziness, or confusion, as outlined in the guidelines 1. A healthcare provider may prescribe antibiotics, like doxycycline, to prevent infection, or corticosteroids to reduce inflammation, in severe cases. Never attempt to remove venom by cutting the wound or using suction, as this can cause further damage. Most brown recluse bites heal without serious complications, but medical evaluation is crucial because the venom contains enzymes that can cause tissue death (necrosis) in some cases, and early intervention can prevent complications, as noted in the guidelines 1.
From the Research
Treatment Options for Brown Recluse Spider Bites
- The majority of brown recluse spider bites (90%) result in local reactions that are self-limiting and require little to no attention 2
- For more severe bites, treatment options include:
- Local care, such as wound cleansing and tetanus shots 3
- Corticosteroids, which may be indicated for severe skin lesions, loxoscelism, and in small children 3
- Dapsone, which should be used only in adult patients with necrotic arachnidism and who have been screened for glucose-6-phosphate dehydrogenase deficiency 3
- Topical nitroglycerin, which may be of value in decreasing the enlargement of necrotic skin ulcers 3
- Hyperbaric oxygen therapy (HBOT), which has been shown to be effective in treating nonhealing wounds caused by brown spider bites, even in the late, chronic stage 4
- Surgical debridement, which may be necessary for lesions that have stabilized and are no longer enlarging 3
- Systemic antibiotics and topical antimicrobials may also be valuable adjuncts of treatment, as indicated, based on the clinical course 5
Effectiveness of Treatment Options
- A study found that systemic corticosteroids and dapsone were associated with slower healing, and dapsone was associated with an increased probability of scarring 6
- Another study found that HBOT was effective in treating nonhealing wounds caused by brown spider bites, with all three patients in the study experiencing complete healing of their wounds 4
- A case report found that operative debridement and wound closure resulted in successful treatment of osteomyelitis of the mandible caused by a brown recluse spider bite 5