Treatment for Brown Recluse Spider Bites
The treatment for brown recluse spider bites should focus on supportive care with wound irrigation, ice application with a barrier, pain management with acetaminophen or NSAIDs, and avoidance of harmful interventions like suction, tourniquets, or early surgical excision—while systemic corticosteroids and dapsone should be avoided as they are associated with slower healing and increased scarring.
Immediate First Aid Management
- Thoroughly irrigate the bite wound with copious amounts of clean water to reduce venom load and prevent infection 1, 2.
- Remove rings and constricting objects from the affected extremity immediately, as swelling may develop 2.
- Apply ice to the bite site for local pain relief, but always place a thin barrier (such as a towel) between the ice and skin to prevent tissue ischemia 1, 2.
- Do not apply suction to the bite site, as this intervention is ineffective and potentially harmful 1, 2.
- Do not apply tourniquets or pressure immobilization bandages, as these may worsen tissue injury in brown recluse bites 2.
Pain Management
- Use over-the-counter acetaminophen or NSAIDs for pain control 2.
- These medications are effective for managing the local discomfort associated with most brown recluse bites 2.
What NOT to Do: Critical Pitfalls
The evidence strongly contradicts several commonly used treatments:
- Avoid systemic corticosteroids, as they are associated with significantly slower healing times in a large prospective study of 189 patients 3.
- Avoid dapsone, which was associated with both slower healing and increased probability of scarring in the same study 3.
- Do not perform early surgical excision of the bite site, as surgery is indicated only for lesions that have stabilized and are no longer enlarging 4.
This is particularly important because despite widespread historical use of steroids and dapsone, the highest quality prospective study found no evidence these treatments reduced healing time or scarring—in fact, they worsened outcomes 3.
When to Seek Immediate Medical Attention
- Seek emergency care if systemic symptoms develop, including difficulty breathing, muscle rigidity, dizziness, or confusion 2.
- Medical evaluation is warranted if pain extends beyond the bite site, becomes severe, is not controlled by over-the-counter medications, or if an open wound develops 2.
- Most brown recluse bites heal within 2-3 weeks, with only 21% resulting in permanent scarring and only 40% developing necrosis 3, 5.
Wound Care and Follow-up
- Conservative wound management is appropriate for most bites 5.
- Cover wounds with antibiotic ointment or cream and a clean occlusive dressing, as wounds heal better with less infection when properly covered 1.
- Predictors of slower healing include higher severity at presentation, more erythema, presence of necrosis, older age, diabetes, and delayed medical attention 3.
- Antibiotics are not routinely indicated unless signs of secondary bacterial infection develop (progressive erythema, purulent discharge, fever) 6.
Clinical Context
The median healing time for brown recluse bites is 17 days, with 43% healing within 2 weeks 3, 5. Most bites are not serious, with only 1 hospitalization reported in a series of 149 cases 5. The key to management is supportive care while avoiding interventions that have been shown to worsen outcomes.