I was bitten by something but didn’t notice til a huge bruise spread…

the wound is pretty large and has two smaller marks on either side that scab up. It’s red and black in the middle…just won’t heal so getting kinda worried…doesn’t hurt though but it’s been almost a month.

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Brown Recluse Spider Bite Overview

Most spiders are absolutely harmless to humans. In fact, of the 20,000 different species of spiders that inhabit the Americas, only 60 are capable of biting humans. Within that small group, only four are known to be dangerous to humans: the brown recluse, the black widow, the hobo or aggressive house spider, and the yellow sac spider. Within this select group, only the brown recluse and the black widow spider have ever been associated with significant disease and very rare reports of death.

• Deaths from brown recluse spiders have been reported only in children younger than seven years. Brown recluse spiders are native to the Midwestern and Southeastern states. Documented populations of brown recluse spiders outside these areas are extremely rare. Fewer than 10 individual spiders have ever been collected outside of these native states. Most false sightings are due to confusion with one of the 13 other species found in the same family.
  • The most common non-brown recluse spiders are the desert recluse found in Texas, Arizona, and California, and the Arizona recluse. No deaths have ever been reported from non-brown recluse spiders. Bites from these cousins produce mild to moderate local skin disease.
• Features: Brown recluse spiders are notable for their characteristic violin pattern on the back of the cephalothorax-the body part to which the legs attach. The violin pattern is seen with the base of the violin at the head of the spider and the neck of the violin pointing to the rear. These small nonhairy spiders are yellowish-tan to dark brown in color with darker legs. They have legs about one inch in length. The name of the genus, Loxosceles, means six eyes. Most other spiders have eight eyes. Yet this unique feature of the brown recluse is lost on the casual observer because the eyes are too small to be seen with the naked eye.
• Habits: These spiders are not aggressive and bite only when threatened, usually when pressed up against the victim’s skin. They seek out dark, warm, dry environments such as attics, closets, porches, barns, basements, woodpiles, and old tires. Its small, haphazard web, found mostly in corners and crevices, is not used to capture prey. Most bites occur in the summer months.

Brown Recluse Bite – Causes

The brown recluse venom is extremely poisonous, even more potent than that of a rattlesnake. Yet recluse venom causes less disease than a rattlesnake bite because of the small quantities injected into its victims. The venom of the brown recluse is toxic to cells and tissues.

• This venom is a collection of enzymes. One of the specific enzymes, once released into the victim’s skin, causes destruction of local cell membranes, which disrupts the integrity of tissues leading to local breakdown of skin, fat, and blood vessels. This process leads to eventual tissue death (necrosis) in areas immediately surrounding the bite site.
• The venom also induces in its victim an immune response. The victim’s immune system releases inflammatory agents-histamines, cytokines, and interleukins-that recruit signal specific disease-fighting white blood cells to the area of injury. In severe cases, however, these same inflammatory agents can themselves cause injury. These secondary effects of the venom, although extremely rare, can produce these more significant side effects of the spider bite:
  • Destruction of red blood cells
  • Low platelet count
  • Blood clots in the capillaries and loss of ability to form clots where needed
  • Acute renal failure (kidney damage)
  • Coma
  • Death

Brown Recluse Bite Symptoms

Brown recluse spider bites often go unnoticed initially because they are usually painless bites. Occasionally, some minor burning that feels like a bee sting is noticed at the time of the bite. Symptoms usually develop two to eight hours after a bite. Keep in mind that most bites cause little tissue destruction.

• Victims may experience these symptoms:
  • Severe pain at bite site after about four hours
  • Severe itching
  • Nausea
  • Vomiting
  • Fever
  • Myalgias (muscle pain)
• Initially the bite site is mildly red and upon close inspection may reveal fang marks. Most commonly, the bite site will become firm and heal with little scaring over the next few days or weeks. Occasionally, the local reaction will be more severe with erythema and blistering, sometimes leading to a blue discoloration, and ultimately leading to a necrotic lesion and scaring. Signs may be present include:
  • Blistering (common)
  • Necrosis (death) of skin and subcutaneous fat (less common)
  • Severe destructive necrotic lesions with deep wide borders (rare)

When to Seek Medical Care

If you think you or someone you know has been bitten by a brown recluse spider, then the individual should be seen by a doctor that day. If possible, bring the spider in question to the doctor’s office. Identification of the spider is very helpful in making the correct diagnosis.

If the patient is unable to be seen by a doctor that day, should seek care at a hospital’s Emergency Department.

Exams and Tests

The doctor will try to make the correct diagnosis. It helps if the patient is able to produce the spider in question. That can often be difficult, because most victims don’t even realize they have been bitten before developing symptoms.

• The doctor will ask about the bite event, time elapsed since the bite, other medical problems, medications, and allergies.
• Laboratory studies, which may be performed include complete blood count, electrolytes, kidney function studies, blood clotting studies, and urinalysis.
• No specific lab findings can confirm a brown recluse bite. Therefore, a presumptive diagnosis can occur only after a careful history and examination including the likelihood of a bite depending on the part of the country where the patient was bitten. This diagnosis can be confirmed if the spider is available and identified as a brown recluse.

Brown Recluse Bite Treatment

Self-Care at Home

Home first aid care is simple. This self-care should not replace a visit to a doctor or emergency department.

• After a spider bite:
  • Apply ice to decrease pain and swelling.
  • Elevate area if possible above the level of the heart.
  • Wash the area thoroughly with cool water and mild soap.
  • Avoid any strenuous activity because this can spread the spider’s venom in the skin.
  • Use acetaminophen for pain relief.
• Do not do any of the following these techniques:
  
  • Do not apply any heat to the area. This will accelerate tissue destruction.
  • Do not apply any steroid creams to the area such as hydrocortisone cream.
  • Do not attempt to remove the spider venom with suction devices or cut out the affected tissue.
  • Do not apply electricity to the area. Anecdotal reports of high voltage electrotherapy from common stun guns have never been shown to be effective in any scientific studies. This can also cause secondary burns and deepen tissue destruction.

Medical Treatment

• After initial evaluation, the doctor may provide the following treatment:
  • Tetanus immunization
  • Pain medication
  • Antibiotics if signs of infection are present in the wound
  • Antihistamines such as diphenhydramine (Benadryl) for itch relief
• There is no antivenom available in the United States to counteract the poisonous venom of the brown recluse spider. Controversial therapies include steroids and the drug dapsone (Avlosulfon). These are often reserved for people with severe systemic disease (such as certain types of anemia, blood clotting problems, and kidney failure). The therapies have little proven benefit.
• The patient will need to follow-up with a doctor because most wounds will need to be checked daily for at least three to four days. Necrotic lesions will need close follow-up. The doctor may carefully remove dead tissue in necrotic areas to reduce secondary bacterial infections.

Next Steps

Follow-up

After the initial evaluation by a doctor, the patient may expect this type of follow-up:

• Daily follow-up of wounds for the first 96 hours to assess the possibility or extent of necrosis of wound
• Hospitalization for people with systemic disease
• Continuation of antibiotics until secondary infections clear
• Follow-up with a surgeon if necrosis of the wound is evident

Prevention

Reducing the possibility of an encounter with a brown recluse spider starts with eliminating known spider habitats.

• Perform routine, thorough house cleaning.
• Reduce clutter in garages, attics, and basements.
• Move all firewood, building materials, and debris away from the home’s foundation.
• Install tight-fitting window screens and door sweeps.
• Clean behind outside home shutters.
• Consider installing yellow or sodium vapor light bulbs outside entrances because these lights are less attractive to insects and draw fewer spiders to the area.
• Consider professional pest elimination.

Outlook

The majority of brown recluse bites cause little permanent skin damage, although, in some cases, moderate to severe tissue destruction is possible. The full extent of damage to tissues is not known for days. It may take many months for the wound to completely heal.

• Brown recluse bites are noted for somewhat slow development and often take up to 12 hours to reveal themselves. Necrosis of skin (death of the skin), if it occurs, does so in the first 96 hours. Bites older than this that do not display tissue death have not been reported to worsen.

• Necrotic lesions can be difficult to manage, and early surgery to remove dead tissue has not been shown to improve outcomes. Necrotic lesions with careful cleaning are allowed to mature for weeks until spreading stops and healing appears to begin. Then a wide area of tissue around the wound is removed and skin grafting may be done once all evidence of skin necrosis has subsided.

Pictures of Brown Recluse Spider and Spider Bites

Picture 2: Other spiders in the brown recluse family may live in these areas of the United States.

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Picture 3: The brown recluse spider and its characteristic violin markings.

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Picture 4: Brown recluse spider. Note the violin pattern on cephalothorax and light-colored, hairless abdomen.

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Picture 5: Brown recluse spider.

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Picture 6: Brown recluse spider head close-up.

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Picture 7: Blistering caused by the bite of a brown recluse spider.

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Picture 8: Necrosis or tissue death in early stages.

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Picture 9: Necrosis or tissue death in a later stage.

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Picture 10: Surgery removed dead tissue and took a wide margin around a bite area.

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Picture 11: Spider bite, brown recluse. Within an hour, the bite area swelled to the size of a quarter. The area turned blue and dark red by the evening of the first day, exceeding the boundaries of a circle drawn around the area of initial swelling by the patient’s physician. Courtesy of Dale Losher.

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Picture 12: Spider bite, brown recluse. The third day after the bite. The skin continues to die. Courtesy of Dale Losher.

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Picture 13: Spider bite, brown recluse. Another view of the wound 3 days after the bite. Courtesy of Dale Losher.

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Picture 14: Spider bite, brown recluse. Nine days after the bite. The patient endured 8 days with an open wound to drain the spider’s toxins and needed intravenous antibiotics and pain medication almost 24 hours a day. Courtesy of Dale Losher.

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Picture 15: Spider bite, brown recluse. Eleven days after the bite. A 5-inch wide area of dead tissue was excised, necessitating skin grafting. Courtesy of Dale Losher.

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Picture 16: Spider bite, brown recluse. Waiting to see skin graft results 38 days after the bite. Courtesy of Dale Losher.

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Picture 17: Spider bite, brown recluse. Skin graft results 38 days after the bite. Courtesy of Dale Losher.

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Picture 18: Spider bite, brown recluse. View of healed wound approximately 10 months after bite. Courtesy of Dale Losher.

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Synonyms and Keywords

brown recluse spider, spider bite, spider bite first aid, fiddle back spider, brown spider, violin spider, bug bite, brown recluse spider bite, insect bites, wilderness recluse spider bites

Authors and Editors

Author: Jerry R. Balentine, DO, FACEP; Samuel M Keim, MD

Editor: Melissa Conrad Stoppler, MDPrevious contributing authors and editors: Coauthor(s): Eric Van Moorlehem, MD, Resident Physician, Department of Emergency Medicine, University of Arizona.

Editors: Patrick Taylor, MD, FAAEM, Medical Director, Department of Emergency Medicine, CHRISTUS St Frances Cabrini Hospital; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Thomas Rebbecchi, MD, FAAEM, Program Director, Assistant Professor, Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey.