Many other bites and injuries have been falsely labeled as brown recluse envenomations. This has resulted in a paucity of human clinical therapeutic trials and difficulty in deciding therapy for individuals with indurated or necrotic skin lesions that may or may not be from a brown recluse spider bite. One to several hours following the initial painless bite, erythema, itching, and swelling may be present. Gradually the induration spreads and central necrosis is seen. The peak of induration is associated with lymphadenopathy and occurs within 48 to 96 hours.
Wound healing is delayed and can take weeks to months.
There is no absolute proven therapy for these lesions. The options include a conservative, supportive approach, in which cleansing, tetanus prophylaxis, and antipruritics are used. Antibiotics are given only when there is a recognized infection, and no steroids are recommended. Excision and grafting are recommended only if the lesions are severe. A more traditional approach would include routine antibiotics, steroids, and plastic repair and skin grafting as needed.