Treatment of Spider Bites

Most spider bites are harmless and can easily be treated at home using an over-the-counter pain remedy in conjunction with a cooling pack or wet cloth to relieve any swelling. These local reactions usually resolve without further wound treatment over a period of 7–10 days. Occasionally, an individual can develop an allergic reaction to a spider bite, even from a non-poisonous spider, but this is more likely to be due to contact with a spider itself than from a spider bite.(1)

The two spider bites which should be the cause of greatest concern in the US are those from a black widow or a brown recluse spider. A patient who is bitten by a black widow spider is likely to feel systematically ill within 3 hours of the bite, although the wound itself is unlikely to be remarkable and rarely requires treatment beyond locally applied ice to ease any pain.  Systemic treatment for a black widow spider bite includes anti-venom, muscle relaxers and non-steroidal anti-inflammatory medications.(2,3) A tetanus booster should also be considered.(2) Black widow bites are rarely fatal, although death can occur in vulnerable individuals or those with comorbidities.(3)

Unlike the black widow spider bite, a bite from a brown recluse spider may require considerable medical attention. The wound has a characteristic presentation of red inflammation, blue thrombosis, and white ischemia, which may lead to a centrally necrotic area progressing to eschar.(2) Basic wound management principles apply for a brown recluse spider bite, including aggressive debridement of necrotic tissue and moist wound healing. Some benefit has been reported from the use of topical nitroglycerine patches.(2) Early surgical excision is contraindicated as this may spread the venom, although it may be beneficial if the wound fails to heal after 6–8 weeks of care. Up to 3% of patients may ultimately require a skin graft. Treatment of systemic effects are usually addressed using steroids and antihistamines, while topical dapsone is sometimes used to inhibit the patient’s immune response.(2)

Approximately 10,000 spider bites are reported to poison control centers every year in the US. Many are a misdiagnosis, but a significant number will require medical attention. An awareness of the appropriate treatment of spider bites is important for all wound care practitioners. Studying for a certification in wound care allows all healthcare practitioners to become more familiar with relatively unusual wounds such as spider bites.

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 References

1. Spider Bites. MedicineNet.com (http://www.medicinenet.com/spider_bites_black_widow_and_brown_recluse/article.htm)
2. Myers BA. Wound management principles and practice. 2nd ed. Upper Saddle River, NJ: Pearson; 2008.
3. de Araujo T, Kirsner RS. Atypical wounds. In: Baranoski S, Ayello EA, eds. Wound Care Essentials: Practice Principles. 2nd Edition. Lippincott Williams & Wilkins, Ambler PA. 2008.