Treatment for Brown Recluse Spider Bites
Brown recluse spider bites should be treated with thorough wound cleansing, tetanus prophylaxis if needed, and close monitoring for systemic symptoms, with surgical excision reserved only for stabilized lesions that are no longer enlarging. 1
Initial Assessment and First Aid
- Thoroughly irrigate the bite wound with copious amounts of clean water to reduce venom load and prevent infection 2
- Most brown recluse spider bites are initially asymptomatic, with symptoms developing over several hours 1
- Remove rings and other constricting objects from the bitten extremity as swelling may occur 2
- Apply ice to the bite site for local pain relief, but place a thin barrier between the ice and skin to prevent tissue damage 2, 3
- Do not apply suction to the bite site as this is ineffective and potentially harmful 2
- Do not apply tourniquets or pressure immobilization bandages as these may worsen tissue injury 2
Clinical Presentation
- Local symptoms include pain, erythema, and potential development of a necrotic ulcer (necrotic arachnidism) 1
- Systemic symptoms (loxoscelism) may include fever, chills, nausea, vomiting, myalgias, and in severe cases, hemolysis 4
- The bite often goes unnoticed for 4-6 hours, making early diagnosis difficult 4
- Median healing time is approximately 17 days, with only about 21% of patients developing permanent scarring 5
Medical Management
- Update tetanus prophylaxis status as needed 1
- Over-the-counter acetaminophen and NSAIDs can be used for pain management 3
- Seek immediate medical attention if systemic symptoms develop, including difficulty breathing, muscle rigidity, dizziness, or confusion 6, 3
- Hospitalize patients who develop systemic symptoms (loxoscelism) for close monitoring 1
Pharmacological Interventions
- Systemic corticosteroids are indicated for severe skin lesions, loxoscelism, and in small children 1
- Dapsone should be used cautiously and only in adult patients with necrotic arachnidism who have been screened for glucose-6-phosphate dehydrogenase deficiency 1
- Evidence suggests that both systemic corticosteroids and dapsone may be associated with slower healing and increased scarring 5
- Topical nitroglycerin may help decrease the enlargement of necrotic skin ulcers 1
Wound Management
- Surgical excision is indicated only for lesions that have stabilized and are no longer enlarging 1
- Early surgical excision may lead to painful, recurrent wound breakdown and hand dysfunction 7
- Delayed surgical excision is preferable until wounds are free from active inflammation 7
- For non-healing wounds persisting for months after the bite, hyperbaric oxygen therapy (HBOT) may be beneficial 8
Special Considerations
- Bites to the hand and upper extremity can create severe functional deficits and long-term disability 7
- Patients with diabetes may experience slower healing and increased risk of scarring 5
- Younger patients and those seeking earlier medical attention typically experience more rapid healing 5