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White spider bit me3/8/2024 ![]() There is scant evidence for the use of dapsone or antivenom. Antibiotics are only necessary if there is associated cellulitis. NSAIDs can provide pain management, but some people may need opioids. Clean the wound with soap and water and ensure the patient’s tetanus immunization is up to date. The activity of sphingomyelinase D is temperature dependent so an ice pack to the area should help halt the necrosis process. Elevate the extremity above the heart or at least in a neutral position. Initial treatment should begin with simple first aid. After this step, skin sloughing can occur, and the wound will eventually heal by secondary intention, but this can take several weeks. ![]() Over the next few days, a blister will form, and the center of the ulcer will turn a blue/violet color with a hard, stellate, sunken center. From there, the center of the bite will become paler as the outer edge becomes red and edematous this relates to vasospasm which will cause the pain to become more severe. ![]() The bite site may initially have two small puncture wounds with surrounding erythema. In children, the systemic reaction is more severe and may also include weakness, fever, joint pain, hemolytic anemia, thrombocytopenia, organ failure, disseminated intravascular coagulation, seizures, and death. The initial bite will be painless, but over the subsequent two to eight hours it will become increasingly painful. Systemic symptoms of brown recluse venom can present as malaise, nausea, headache, and myalgias. If the bite is more severe, the course usually is as follows. Some bites will present with only an urticarial rash. Brown recluse spider bites usually occur while indoors and as a defense mechanism as they are crushed or rolled over in bed.
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