image by: Center for Wilderness Safety

HWN Suggests

Meet the Brown Recluse Spider

For recluse spider envenomations, we treat the local damage by leaving it the hell alone. Keep it clean. Don’t cut into it. We don’t use dapsone anymore. These don’t require antibiotics. We don’t use nitroglycerin. We don’t use corticosteroids. The benefits of hyperbaric oxygen are unclear. As I mentioned earlier, almost all of these will eventually heal on their own, so we definitely want to avoid premature surgical intervention. A small percentage will require skin grafts, but these should not even be considered for at least six weeks after the bite.

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 Brown recluse bites

So what to do if someone comes in and says they have a brown recluse bite? If you live in an endemic area, 99 times out of 100 it’s still MRSA. If you live somewhere they don’t live, which is anywhere east of Tennessee, north of Missouri, or the small region near the Mexican border from Texas to California, it’s always MRSA. In the off chance you do have an identified spider and a small red lesion, rest assured that it will become necrotic less than 10% of the time. However, you may want to check a urine as it’s an easy and non-invasive way to check for hemolysis. While you’re at it, put a cold pack on the area. And by cold pack I mean ice pack, not the chemical variety. Beyond that, the evidence for anything is lacking. Just supportive care.

Articles of Interest

A Case of Severe Brown Recluse Envenomation

Because the majority of bites are minimally symptomatic, most can be treated with little medical intervention. Treatment of more severe manifestations of envenomation is more challenging.

Acute Hemolytic Anemia Caused by Loxoscelism Treated With Plasmapheresis: A Case Report

The bite of a brown recluse spider (Loxosceles reclusa) is usually associated with skin necrosis; however, it can lead to more significant morbidity including acute hemolytic anemia, rhabdomyolysis, disseminated intravascular coagulopathy and death.

Brown Recluse Spider

One spider found in Kentucky and much of the Midwest that is potentially dangerous is the brown recluse. It is sometimes referred to as the ‘violin’ or ‘fiddleback’ spider because of the violin-shaped marking on its dorsum. Although brown recluse spider bites are rare, the venom can sometimes cause serious wounds and infestations should be taken seriously.

Brown Recluse Spider Bite

The spider venom contains sphingomyelinase, which causes local ischemia and destruction of the capillary bed and results in an initial central area of pallor that becomes necrotic in one to two weeks. Loxoscelism, the effect of the spider venom, can present as a local cutaneous lesion, or develop into systemic symptoms, which are broad and can include weakness, fatigue, hemolytic anemia, thrombocytopenia, and coagulopathy. In severe systemic cases, patients can develop a coagulopathy and maculopapular rash, which typically respond to steroids. Wounds may take up to three months to heal,

Brown Recluse Spider Bite: A Rare Cause of Necrotic Wounds

The brown recluse spider bite often presents a diagnostic challenge because bites from other spider species and a variety of dermatologic conditions may produce similar clinical presentations. As patients rarely present with a spider for positive identification, diagnosis is infrequently definitive. Misdiagnosing a necrotic wound as a brown recluse spider bite may result in inappropriate treatment and delay necessary care.

Brown Recluse Spider Envenomation

While there were many remedies used in the past, including dapsone and glucocorticoids, management of cutaneous lesions focuses on local wound care and tetanus prophylaxis, when appropriate. Additionally, many patients require pain control and use of cold compresses (Auerbach et al.). Symptoms should be expected to resolve within several weeks, though skin damage may persist and form scars. Surgical debridement of necrotic tissue can be considered when initial swelling subsides after 1-2 weeks, but there is no evidence for early surgical intervention (Rees et al.). Admission and supportive care are appropriate for patients displaying systemic symptoms.

Brown Recluse Spider Envenomation

It’s bite is painless – so even if bitten by one, you may not recognize the spider. Odd escar? Think of the Brown Recluse!

Brown recluse spiders: Facts, bites & symptoms

Here's what to know about brown recluse spiders and how to avoid getting bitten by them.

Hemolytic Anemia after Brown Recluse Envenomation

Classically, the lesion from brown recluse envenomation is referred to as the “red, white, and blue” sign due to the central, necrotic area, surrounded by an area of blanching ischemia, which is surrounded by an area of erythema.

Hold the Chemo! Leukostasis, a Presentation of Brown Recluse Spider Bite: A Case Report

Brown recluse spiders, also known as Loxosceles reclusa, are endemic to the Southwest and Central Midwestern United States. A bite from this spider can cause a range of clinical manifestations, anywhere from a painless papular lesion to life-threatening reactions.

Slandered Spiders: That Probably Isn’t a Brown Recluse Bite

And we’ve blamed spiders for treacherous bites for centuries at least—in medieval Europe, spiders were blamed for spreading plague, an infectious disease that was later correctly linked to the flea.

Welcome to Louisiana, Just Watch Out for the Spider That Turns Your Flesh Into Pizza

We moved to New Orleans from New York, where the most frightening bugs are bed bugs. I had bed bugs. They're terrible, but child's play compared to the recluse. Can bed bugs rot your face off? No. For me, however, they left giant welts that itched for weeks, a worst reaction than most endure. And herein lies my dilemma. I'm extremely sensitive to bug bites, even a mosquito will light me up with welts. Simple bug arithmetic tells me, if mosquitos do nothing much to the average person but give me welts, then the recluse, which leaves saucer-sized holes in the average person would dissolve my entire upper body.

Why You Need Not Fear the Poor, Misunderstood Brown Recluse Spider

It’s hard to think of a critter that inspires as much hyperbolic hysteria as the brown recluse spider. They’re pretty much universally hated.