How should brown recluse spider bites be treated?

First aid measures are important and can be remembered by the mnemonic RICE. Rest, ice, compression, and elevation of the bite site decrease blood flow, temperature, and enzymatic activity of the dermonecrotic toxin. General wound care, tetanus toxoid, antibiotics such as erythromycin or cephalexin for secondary infection, and observation for systemic hematologic problems may be necessary until the wound heals. Although dapsone and corticosteroids have been used to treat brown recluse spider bites, the use is controversial because some animal studies and nonrandomized human series have not demonstrated a beneficial effect. As serious as these bites can be, it is important to remember that most bites are inconsequential and heal without any problem. In those rare patients with hemolytic anemia, blood transfusions and intravenous fluid replacement is indicated.


Elston DM, Miller SD, Young RJ 3rd, et al: Comparison of colchicine, dapsone, triamcinolone, and diphenhydramine therapy for the treatment of brown recluse spider envenomation: a double-blind, controlled study in a rabbit model, Arch Dermatol 141:595–597, 2005.

Mold JW, Thompson DM: Management of brown recluse spider bites in primary care, J Am Board Fam Pract 17:347–352, 2004.