Management of brown recluse spider bite

Dermatologic Problems in the Intensive Care Unit: Part II

Skin disorders are present in many patients hospitalized in the intensive care unit. They range in severity from being the reason for admission to being a nuisance during care. These cutaneous problems have been categorized into four groups: (1) serious skin diseases that may incur life-threatening complications; (2) subtle skin problems associated with systemic disorders that may be characterized by critical events; (3) prominent cutaneous manifestations that accompany life-threatening systemic diseases; and (4) skin disorders that develop as complications during intensive care. Diseases in the first category were discussed in Part I of this article [1]. In Part II, we discuss diseases in the second category. The remaining disorders will be covered in Parts III and IV.

Loxoscelism: Old obstacles, new directions

Loxosceles spiders have a worldwide distribution and are considered one of the most medically important groups of spiders. Envenomation (loxoscelism) can result in dermonecrosis and, less commonly, a systemic illness that can be fatal. The mechanism of venom action is multifactorial and incompletely understood. The characteristic dermonecrotic lesion results from the direct effects of the venom on the cellular and basal membrane components, as well as the extracellular matrix. The initial interaction between the venom and tissues causes complement activation, migration of polymorphic neutrophils, liberation of proteolytic enzymes, cytokine and chemokine release, platelet aggregation, and blood flow alterations that result in edema and ischemia, with development of necrosis. There is no definitive treatment for loxoscelism. However, animal model studies suggest the potential value of specific antivenom to decrease lesion size and limit systemic illness even when such administration is delayed.

Managing arthropod bites and stings

Most arthropod bites and stings cause limited swelling, itching, pain, and redness and can be managed by ice application and tetanus prophylaxis as necessary. Stings by bees, wasps, and stinging ants can cause anaphylaxis that may require treatment with epinephrine and antihistamines and respiratory and cardiac maintenance measures. Widow spider bite management is controversial, but interventions for systemic reactions include calcium gluconate, methocarbamol, diazepam, narcotics, and antivenom. Victims of brown spider bites may need hospitalization if lesions enlarge rapidly or there are signs of systemic poisoning. Those stung by a bark scorpion may require oxygen, an intravenous line, pulse oximetry, and cardiac monitoring.

Brown recluse spider bites

The brown recluse spider (Loxosceles reclusa), found in many areas of the United States, is capable of producing significant medical problems and potentially life-threatening systemic manifestations. This paper reviews the clinical presentation, diagnostic workup, pathophysiology, and management of the brown spider bite. Emphasis is placed on the potential for error in establishing this diagnosis. The need for a simplified management program is discussed along with current concepts on how to achieve this management program. Attention is also directed to the more serious complications.