Management of the brown recluse spider bite.

The objectives in the treatment of the brown recluse spider bite are to prevent skin necrosis and the need for reconstructive surgery. A simple technique that consists of curetting the subcutaneous tissue in the necrotic area of the lesion, to prevent the local destructive actions of the toxin, is described. From 1981 to 1987, 18 patients were treated with this technique. The wounds were generally curetted under local anesthesia in an outpatient setting. In all but one case, the erythema, edema, and pain resolved significantly in 24 to 48 hours, and the wounds healed primarily with minimal scarring. We consider curettage the treatment of choice for brown recluse spider bites when the lesions are noted in relatively early stages. It can be performed as an outpatient procedure; it controls the symptoms and prevents further necrosis, with excellent cosmetic results.