By Gary M. White, MD
Courtesy Theodore Sebastian, MD
The bite of the brown recluse spider (Loxosceles reclusa) can cause significant local damage to the skin. During the winter time, the spider typically goes indoors and may hide in closets, old clothes, and boxes. Patients are often bitten during the Spring as they pull out old clothes or go through storage boxes. Outdoors, the spider may be found in woodpiles, barns and in the grass. "Brown" refers to its color and "recluse" to the fact that it likes seclusion.
The lesions are not painful initially. Within 24 hours, however, the pain may be severe [JAMA Derm 2014;150;1205]. The area becomes erythematous with a central, firm, hemorrhagic pustule. Pus may develop. Potential serious systemic manifestations include intravascular hemolysis, disseminated intravascular coagulation, and acute renal failure. Death may occur.
A mnemonic device (NOT RECLUSE) has been created to help avoid the false diagnosis of Brown Recluse Spider Bite (BRSB) [JAMA Derm 2017;153;377].
The Journal of the Missouri State Medical Association (July/August 2017) recommended the following:
Ice bags, elevations, and a CBC to rule out hemolytic anemia or thrombocytopenia are appropriate. Some have recommended dapsone, e.g., 100 mg BID for one week then taper, but there is not good evidence that it helps. Others have recommended prednisone, e.g., 100 mg/d or intralesions triamcinolone. The home may be fumigated.
RICE therapy (Rest, Ice, Compression and Elevation) for the pain may be recommended initially. If needed, narcotic analgesics may be needed.
Eplasty. 2012; 12: e26
Spider and geographic distribution. Clin Kidney J. 2013 Dec; 6(6): 609–612
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