Editing Brown recluse spider (section)

==Bite==
{{Main|Loxoscelism}}
Like all members of the ''Loxosceles'' genus, the brown recluse has potent [[cytotoxicity|tissue-destroying]] [[venoms]] containing the dermonecrotic agent [[Sphingomyelin phosphodiesterase D|sphingomyelinase D]].<ref name=STDB>
{{cite web
 |title=Sphingomyelinase&nbsp;D (LiSicTox-{{mvar|α}}IA2ai)
 |series=Spider toxin database
 |website=ArachnoServer.org
 |publisher=[[QFAB Bioinformatics|Queensland Facility for Advanced Bioinformatics]]
 |url=http://www.arachnoserver.org/toxincard.html?id=138
 |url-status=dead  |access-date=15 July 2021
 | archive-url = https://web.archive.org/web/20161010220451/http://www.arachnoserver.org/toxincard.html?id=138
 | archive-date=10 October 2016
}}
</ref>
Most bites are minor with no dermonecrosis, but a small number of brown recluse bites produce [[loxoscelism]],<ref>
{{cite journal
 |last=Vetter |first=Richard S.
 |year=2006
 |title=Loxoscelism
 |journal=Clinics in Dermatology
 |volume=24 |issue=3 |pages=213–221
 |doi=10.1016/j.clindermatol.2005.11.006
 |pmid=16714202
 |url=https://pubmed.ncbi.nlm.nih.gov/16714202/
 |access-date=1 January 2020
}}
</ref> a condition where the skin around the bite dies. While loxoscelism usually manifests as a skin condition (cutaneous loxoscelism), it can also include systemic symptoms like fever, nausea, and vomiting (viscerocutaneous loxoscelism). In very rare cases, bites can even cause [[hemolysis]] – the bursting of [[red blood cells]].<ref>
{{cite magazine
 |title=Greta Binford 1997–
 |year=2008
 |magazine=Biography Today
 |series=General Series  |volume=17  |issue=1  |page=14
 |issn=1058-2347  |isbn=978-0-7808-1016-7
 |quote=American biologist, arachnologist, and pioneering researcher [o]n spider venom
 |url=https://archive.org/details/biographytodayge0000unse_y5i7
 |via=archive.org  |url-access=registration
}}
</ref>
In one study of clinically diagnosed brown recluse bites, skin necrosis occurred 37% of the time, while systemic illness occurred 14% of the time.<ref name=Leach>
{{cite journal
 |vauthors=Leach J, Bassichis B, Itani K
 |date=July 2004
 |title=Brown recluse spider bites to the head: Three cases and a review
 |journal= Ear, Nose & Throat Journal 
 |volume=83  |issue=7  |pages=465–470
 |doi=10.1177/014556130408300712 |doi-access=free
 |pmid=15372917
 |url=http://www.thefreelibrary.com/Brown+recluse+spider+bites+to+the+head%3A+three+cases+and+a+review-a0124261634
|url-access=subscription
 }}, in turn citing:<br/>
{{cite journal
 | last1 = Wright | first1 = S.W.       | last2 = Wrenn | first2 = K.D.
 | last3 = Murray | first3 = L.         | last4 = Seger | first4 = D.
 | year = 1997
 | title = Clinical presentation and outcome of brown recluse spider bite
 | journal = Annals of Emergency Medicine
 | volume = 30 | issue = 1 | pages = 28–32
 | doi = 10.1016/s0196-0644(97)70106-9
 | pmid = 9209221
}}</ref>

As suggested by its [[specific name (zoology)|specific name]] ''reclusa'' (recluse), the brown recluse spider is rarely aggressive, and bites from the species are uncommon. In 2001, more than 2,000&nbsp;brown recluse spiders were removed from a heavily infested home in Kansas, yet the four residents who had lived there for years were never harmed by the spiders, despite many encounters with them.<ref>
{{cite journal
 | last1 = Vetter | first1 = Richard S.
 | last2 = Barger | first2 = Diane K.
 | date=November 2002
 | title = An infestation of 2,055&nbsp;brown recluse spiders (Araneae: Sicariidae) and no envenomations in a Kansas home: Implications for bite diagnoses in nonendemic areas
 | journal = Journal of Medical Entomology
 | volume = 39 | issue = 6 | pages = 948–951
 | doi=10.1603/0022-2585-39.6.948 | doi-access = free
 | pmid=12495200 | s2cid = 18535207
}}
</ref><ref name=rgj>
{{cite web
 |last=Robison |first=Mark
 |date=28 June 2011
 |title=Is that a brown recluse in your bathtub?
 |department=Fact checker
 |newspaper=[[Reno Gazette-Journal]]
 |place=Reno, NV
 |url=http://www.rgj.com/article/20110628/NEWS20/106260379/Fact-Checker-brown-recluse-your-bathtub-?nclick_check=1
 |url-status=dead |access-date=22 May 2013
 |archive-url=https://archive.today/20130615192631/http://www.rgj.com/article/20110628/NEWS20/106260379/Fact-Checker-brown-recluse-your-bathtub-?nclick_check=1
 |archive-date=15 June 2013
}}
</ref>
The spider usually bites only when pressed against the skin, such as when tangled within clothes, shoes, towels, bedding, inside work gloves, etc. Many human victims report having been bitten after putting on clothes or shoes that had not been worn recently or had been left for many days undisturbed on the floor. The fangs of the brown recluse are not large enough to penetrate most fabric.<ref name=Sandidge2009>
{{cite report
 |last=Sandidge |first=J.S. <!-- |author-link=Jamél S. Sandidge -->
 |year=2009
 |title=Brown recluse spiders: A knowledge based guide to control and elimination
 |publisher= BRS Pest Control 
 |location=[[McLouth, Kansas|McLouth]], KS
}}
</ref>

When both types of loxoscelism do result, systemic effects may occur before necrosis, as the venom spreads throughout the body in minutes. Children, the elderly, and the debilitatingly ill may be more susceptible to systemic loxoscelism. The systemic symptoms most commonly experienced include nausea, vomiting, fever, rashes, and muscle and joint pain. Rarely, such bites can result in hemolysis, [[thrombocytopenia|low platelet levels]], [[disseminated intravascular coagulation|blood clots throughout the body]], organ damage, and even death.<ref name=NEJM2005-Wasserman>
{{cite journal
 | last = Wasserman | first = G.
 | year = 2005
 | title = Bites of the brown recluse spider
 | journal = [[New England Journal of Medicine]]
 | volume = 352 | issue = 19 | pages = 2029–2030; author reply 2029–2030
 | pmid = 15892198
 | doi = 10.1056/NEJM200505123521922
}}
</ref>
Most fatalities are in children under the age of seven<ref>
{{cite news
 |title=Tenn. boy ruled killed by spider bite
 |date=8 October 2004
 |agency=[[Associated Press]]
 |website=MSNBC.com
 |url=http://www.msnbc.msn.com/id/6209004/
 |url-status=dead
 |archive-url=https://web.archive.org/web/20070313202521/http://www.msnbc.msn.com/id/6209004/
 |archive-date=13 March 2007
}}
</ref>
or those with a weak immune system.

While the majority of brown recluse spider bites do not result in any symptoms, [[skin|cutaneous]] symptoms occur more frequently than systemic symptoms. In such instances, the bite forms a necrotizing [[Ulcer (dermatology)|ulcer]] as the result of [[soft tissue]] destruction and may take months to heal, leaving deep [[scar]]s. These bites usually become painful and itchy within 2–8&nbsp;hours. Pain and other local effects worsen 12–36&nbsp;hours after the bite, and the necrosis develops over the next few days.<ref name=ClinTox-Wasserman>
{{cite journal
 | vauthors = Wasserman G, Anderson P
 | year = 1983–1984
 | title = Loxoscelism and necrotic arachnidism
 | journal = [[Journal of Toxicology: Clinical Toxicology]]
 | volume = 21 | issue = 4–5 | pages = 451–72
 | pmid = 6381752
 | doi = 10.3109/15563658308990434
}}
</ref>
Over time, the wound may grow to as large as 25&nbsp;cm (10&nbsp;inches). The damaged tissue becomes [[gangrene|gangrenous]] and eventually sloughs away. ''L.&nbsp;reclusa'' can produce slightly more than 0.1&nbsp;[[μL]] of venom, though the average yield is less.<ref>
{{cite journal
 |first=Charles  |last=Kristensen
 |date=10 October 2005
 |title=Comments on the natural expression and artificial extraction of venom gland components from spiders
 |journal=[[Toxin Reviews]]
 |volume=24  |issue=3–4  |pages=257–270 
 |publisher=Taylor & Francis
 |lccn=2005245307 |issn=1556-9543
 |doi=10.1080/07313830500236168
 |lang=en
 |quote=Milking or gland extraction can be used to harvest ... toxins ... from spiders that are suitable for a wide variety of studies, but the milked venom and extracts should not be assumed to be equivalent to naturally expressed venoms&nbsp;... 
}}
</ref>

===Misdiagnosis===
There is an [[ELISA]]-based test for brown recluse venom that can determine whether a wound is a brown recluse bite, although it is not commercially available and not in routine clinical use. Clinical diagnoses often use [[Occam's razor|Occam's razor principle]] in diagnosing bites based on what spiders the patient likely encountered and previous similar diagnoses.<ref name=NEJM2005-Vetter/><ref name=Leach/><ref>
{{cite journal
 | vauthors = Gomez H, Krywko D, Stoecker W
 | year = 2002
 | title = A new assay for the detection of ''Loxosceles'' species (brown recluse) spider venom
 | journal = [[Annals of Emergency Medicine]]
 | volume = 39 | issue = 5 | pages = 469–474
 | pmid = 11973553 | pmc = 3201721
 | doi = 10.1067/mem.2002.122914
}}
</ref>

{{harvp|Stoecker|Vetter|Dyer|2017}} suggested the [[mnemonic]] "NOT RECLUSE", shown below, as a memory device to help laymen and medical professionals more objectively screen and diagnose potential cases of loxoscelism.<ref name=Evans-2017-02-22>
{{cite news
 |first=John |last=Evans
 |date=22 February 2017
 |title=NOT RECLUSE – New mnemonic to prevent misdiagnosis of skin conditions as spider bites
 |website=derm.city
 |url=https://www.derm.city/post/2017/02/22/not-recluse-new-mnemonic-to-prevent-misdiagnosis-of-skin-conditions-as-spider-bites
}} — free access news article gives the full mnemonic
</ref><ref>
{{cite journal
 |last1=Stoecker |first1=William V.
 |last2=Vetter   |first2=Richard S.
 |last3=Dyer     |first3=Jonathan A.
 |year=2017
 |title=NOT RECLUSE – A mnemonic device to avoid false diagnoses of brown recluse spider bites
 |journal=JAMA Dermatology
 |volume=153 |issue=5 |pages=377–378
 |doi=10.1001/jamadermatol.2016.5665
 |pmid=28199453
}}
</ref>
:{| style="text-align:left;vertical-align:top;"
|+ '''NOT RECLUSE''' mnemonic<ref name=Evans-2017-02-22/>
|-
|colspan=2 align=center|''Note that these are '''contrary''' criteria: Any '''one''' being true indicates that the injury is '''not''' a brown recluse bite.''
|- style="vertical-align:top;"
| {{big|'''N'''}}umerous
| {{big|&nbsp;}}More than one wound.
|- style="vertical-align:top;"
| {{big|'''O'''}}ccurrence&nbsp;
| {{big|&nbsp;}}The injury did not occur in a place where brown recluses are likely to be found:<br/>{{big|&nbsp;}}Either outside of the spider's geographic territory ... or not in an enclosed space<br/>{{big|&nbsp;}}like a box, closet, or attic.{{big|&nbsp;}}
|- style="vertical-align:top;"
| {{big|'''T'''}}iming
| {{big|&nbsp;}}The wound arose sometime between November and March.
|- style="vertical-align:top;"
| {{big|'''R'''}}ed center
| {{big|&nbsp;}}The center of the wound is red.
|- style="vertical-align:top;"
| {{big|'''E'''}}levated
| {{big|&nbsp;}}The middle of the wound is elevated, not sunken.
|- style="vertical-align:top;"
| {{big|'''C'''}}hronic
| {{big|&nbsp;}}The wound has persisted for more than three months.
|- style="vertical-align:top;"
| {{big|'''L'''}}arge
| {{big|&nbsp;}}The wound is more than {{convert|10|cm|in|0|abbr=off}} wide.
|- style="vertical-align:top;"
| {{big|'''U'''}}lcerates<br/> too early
| {{big|&nbsp;}}The wound gets crusty within the first week.
|- style="vertical-align:top;"
| {{big|'''S'''}}wollen
| {{big|&nbsp;}}The wound swells up if it's below the neck.
|- style="vertical-align:top;"
| {{big|'''E'''}}xudative
| {{big|&nbsp;}}The wound is "wet" – oozing pus or clear fluid.
|}

There are numerous documented infectious and noninfectious conditions that produce wounds that have been initially misdiagnosed as recluse spider bites by medical professionals, including:
{{div col|colwidth=15em}}
* ''[[Pyoderma gangrenosum]]''
* Infection by ''[[Staphylococcus]]''
* Infection by ''[[Streptococcus]]''
* Herpes
* Diabetic ulcers
* Fungal infection
* Chemical burns
* [[Urushiol-induced contact dermatitis|''Toxicodendron dermatitis'']]
* [[Squamous cell carcinoma]]
* Localized [[vasculitis]]
* [[Syphilis]]
* [[Toxic epidermal necrolysis]]
* [[Sporotrichosis]]
* [[Lyme disease]]<ref>
{{cite journal
 |vauthors=Osterhoudt KC, Zaoutis T, Zorc JJ
 |year=2002
 |title=Lyme disease masquerading as brown recluse spider bite
 |journal=[[Annals of Emergency Medicine]]
 |volume=39 |issue=5 |pages=558–561
 |pmid=11973566  |doi = 10.1067/mem.2002.119509
}}
</ref>
{{div col end}}

Many of these conditions are far more common and more likely to be the source of necrotic wounds, even in areas where brown recluse spiders actually occur.<ref name=NEJM2005-Vetter/> The most important of these is [[methicillin-resistant Staphylococcus aureus|methicillin-resistant ''Staphylococcus aureus'']] (MRSA), a bacterium whose necrotic lesions are very similar to those induced by recluse bites, and which can be lethal if left untreated.<ref>
{{cite news
 |url=http://www.ktla.com/news/landing/ktla-spider-bite-death,0,5285653.story
 |title=Spider bite: Coroner's office says Pomona teen died of staph infection, not spider bite
 |website=[[KTLA]].com <!-- Bot generated title -->
 |archive-url=https://web.archive.org/web/20120318102617/http://www.ktla.com/news/landing/ktla-spider-bite-death%2C0%2C5285653.story
 |archive-date=18 March 2012
}}
</ref> Misdiagnosis of MRSA as spider bites is extremely common (nearly 30% of patients with MRSA reported that they initially suspected a spider bite), and can have fatal consequences.<ref>
{{cite journal
 | last1 = Moran | first1 = G.J.
 | display-authors = etal
 | year = 2006
 | title = Methicillin-resistant ''S. aureus'' infections among patients in the emergency department
 | journal = [[New England Journal of Medicine]]
 | volume = 355 | issue = 7 | pages = 666–674
 | doi=10.1016/0304-3940(90)90780-d | doi-access = free
 | pmid = 1691470
}}
</ref>

Reported cases of brown recluse bites occur primarily in [[Arkansas]], [[Colorado]], [[Kansas]], [[Missouri]], [[Nebraska]], [[Oklahoma]], and [[Texas]].
There have been many reports of brown recluse bites in California – though a few related species of spiders may be found there, none of the related spiders in California is known to bite humans.<ref name=VetterMyth/>

To date, the reports of bites from areas outside of the spider's native range have been either unverified or, if verified, the spiders have been moved to those locations by travelers or commerce.

==== Other spiders ====
: ''For a comparison of the toxicity of several kinds of spider''
: ''bites, see the [[list of medically significant spider bites]]''

Many arachnologists believe that a large number of bites attributed to the brown recluse in the [[West Coast of the United States|U.S. West Coast]] are either from other spider species or not spider bites at all. Other spiders in western states that might possibly cause necrotic injuries are the [[hobo spider]], [[Loxosceles deserta|desert recluse spider]], and the [[yellow sac spider]].

For example, the venom of the [[hobo spider]], a common European species now established in the northwestern United States and southern [[British Columbia]], has been reported to produce similar symptoms as the brown recluse bite when injected into laboratory rabbits. However, the toxicity of hobo spider venom has been called into question: Actual bites (rather than syringe injections) have not been shown to cause necrosis, and no necrotic hobo spider bites have ever been reported where it is native.<ref name=AnnEmergMed2004-Isbister>
{{cite journal
 | vauthors = Vetter R, Isbister G
 | year = 2004
 | title = Do hobo spider bites cause dermonecrotic injuries?
 | journal = [[Annals of Emergency Medicine]]
 | volume = 44 | issue = 6 | pages = 605–607
 | pmid = 15573036
 | doi = 10.1016/j.annemergmed.2004.03.016
}}
</ref>

Numerous other spiders have been associated with necrotic bites in the medical literature. Other recluse species, such as the [[Loxosceles deserta|desert recluse]] (found in the deserts of southwestern United States), are reported to have caused necrotic bite wounds, though only rarely.<ref name = Vetter2008>
{{cite journal
 | last = Vetter | first = R.S.
 | year = 2008
 | title = Spiders of the genus ''Loxosceles'' (Araneae, Sicariidae): A review of biological, medical, and psychological aspects regarding envenomations
 | journal = [[Journal of Arachnology]]
 | volume = 36 | pages = 150–163
 | s2cid = 7746032
 | doi = 10.1636/RSt08-06.1
 | url = https://www.biodiversitylibrary.org/part/229051
}}
</ref>
The hobo spider and the [[yellow sac spider]] have also been reported to cause necrotic bites. However, the bites from these spiders are not known to produce the severe symptoms that can follow from a recluse spider bite, and the level of danger posed by these has been called into question.<ref>
{{cite journal
 |vauthors=Bennett RG, Vetter RS
 |date=August 2004
 |title=An approach to spider bites. Erroneous attribution of dermonecrotic lesions to brown recluse or hobo spider bites in Canada
 |journal=Canadian Family Physician
 |volume=50  |issue=8  |pages=1098–1101
 |pmid=15455808 |pmc=2214648
 |url=http://www.cfp.ca/cgi/reprint/50/8/1098.pdf
}}
</ref><ref>
{{cite journal
 |first=James H. |last=Diaz
 |date=April 2005
 |title=Most necrotic ulcers are not spider bites
 |journal=American Journal of Tropical Medicine and Hygiene
 |volume=72 |issue=4 |pages=364–367
 |doi=10.4269/ajtmh.2005.72.364 |doi-access=free
}}
</ref>

So far, no known necrotoxins have been isolated from the venom of any of these spiders, and some arachnologists have disputed the accuracy of spider identifications carried out by bite victims, family members, medical responders, and other non-experts in arachnology.
There have been several studies questioning the danger posed by some of the other spiders mentioned: In these studies, scientists examined case studies of bites in which the spider in question was identified by an expert, and found that the incidence of necrotic injury diminished significantly when "questionable" identifications were excluded from the sample set.<ref name=WhiteTail>
{{cite journal
 |vauthors=Isbister GK, Gray MR
 |date=August 2003
 |title=White-tail spider bite: A prospective study of 130 definite bites by ''Lampona'' species
 |journal=The Medical Journal of Australia
 |volume=179 |issue=4 |pages=199–202
 |pmid=12914510 |s2cid=46155627
 |doi=10.5694/j.1326-5377.2003.tb05499.x
 |url=http://www.mja.com.au/public/issues/179_04_180803/isb10785_fm.html
|url-access=subscription
 }}
</ref><ref>
{{cite journal
 |vauthors=Isbister GK, Hirst D
 |date=August 2003
 |title=A prospective study of definite bites by spiders of the family Sparassidae (huntsmen spiders) with identification to species level
 |journal=Toxicon
 |volume=42 |issue=2 |pages=163–171
 |pmid=12906887
 |doi= 10.1016/S0041-0101(03)00129-6
|bibcode=2003Txcn...42..163I
 }}
</ref>

===Bite treatment===
First aid involves the application of an ice pack to control [[inflammation]] and prompt medical care. If it can be easily captured, the spider should be brought with the patient in a clear, tightly closed container so it may be identified by an arachnologist; if there is no specimen at all, then confirmation by an expert is impossible.<ref name=AnnEmergMed2002-Vetter/>

Routine treatment should include immobilization of the affected limb, application of ice, local wound care, and [[tetanus]] prophylaxis. Many other therapies have been used with varying degrees of success, including [[hyperbaric oxygen]], [[dapsone]], [[antihistamines]] (e.g., [[cyproheptadine]]), [[antibiotics]], [[dextran]], [[glucocorticoids]], vasodilators, [[heparin]], [[nitroglycerin]], [[electric shock]], [[curettage]], [[surgery|surgical excision]], and [[antivenom]].<ref>
{{cite journal
 |vauthors=Maynor ML, Moon RE, Klitzman B, Fracica PJ, Canada A
 |date=March 1997
 |title=Brown recluse spider envenomation: A prospective trial of hyperbaric oxygen therapy
 |journal=[[Academic Emergency Medicine]]
 |volume=4 |issue=3 |pages=184–192
 |pmid=9063544
 |doi= 10.1111/j.1553-2712.1997.tb03738.x |doi-access=free
}}
</ref><ref>
{{cite journal
 |vauthors=Maynor ML, Abt JL, Osborne PD
 |year=1992
 |title=Brown recluse spider bites: Beneficial effects of hyperbaric oxygen
 |journal=Journal of Hyperbaric Medicine
 |volume=7 |issue=2 |pages=89–102
 |issn=0884-1225
 |url=http://archive.rubicon-foundation.org/4477
 |url-status=usurped |access-date=July 22, 2008
 |archive-url=https://web.archive.org/web/20110727224716/http://archive.rubicon-foundation.org/4477
 |archive-date=27 July 2011
}}
</ref>
In almost all cases, bites are self-limited and typically heal without any medical intervention.<ref name=NEJM2005-Vetter/>

[[Outpatient care|Outpatient]] [[palliative care]] following discharge often consists of a weak or moderate strength [[opioid]] (e.g. [[codeine]] or [[tramadol]], respectively) depending on pain scores, an [[anti-inflammatory]] agent (e.g. [[naproxen]], [[cortisone]]), and an [[antispasmodic]] (e.g. [[cyclobenzaprine]], [[diazepam]]), for a few days to a week. If the pain or spasms have not resolved by this time, a second medical evaluation is generally advised, and [[differential diagnosis|differential diagnoses]] may be considered.{{medical citation needed|date=August 2022}}

====Specific treatments====
In presumed cases of recluse bites, [[dapsone]] is often used for the treatment of necrosis, but controlled clinical trials have yet to demonstrate efficacy.<ref>
{{cite journal
 | last1 = Elston | first1 = D.M.     | last2 = Miller  | first2 = S.D.
 | last3 = Young  | first3 = R.J.     | last4 = Eggers  | first4 = J.
 | last5 = McGlasson | first5 = D.    | last6 = Schmidt | first6 = W.H.
 | last7 = Bush   | first7 = A.
 | year = 2005
 | title = 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
 | journal = [[Archives of Dermatology]]
 | volume = 141  | issue = 5  | pages = 595–597
 | doi=10.1001/archderm.141.5.595  | pmid=15897381
}}
</ref>
However, dapsone may be effective in treating many "spider bites" because many such cases are actually misdiagnosed microbial infections.<ref name=AnnEmergMed2002-Vetter>
{{cite journal
 | vauthors = Vetter R, Bush S
 | year = 2002
 | title = The diagnosis of brown recluse spider bite is overused for dermonecrotic wounds of uncertain etiology
 | journal = [[Annals of Emergency Medicine]]
 | volume = 39 | issue = 5 | pages = 544–546
 | pmid = 11973562 | doi = 10.1067/mem.2002.123594
}}
</ref>
There have been conflicting reports about its efficacy in treating brown recluse bites, and some have suggested it should no longer be used routinely, if at all.<ref name=AmJEmergMed2003-Bryant>
{{cite journal
 | vauthors = Bryant S, Pittman L
 | year = 2003
 | title = Dapsone use in ''Loxosceles reclusa'' envenomation: is there an indication?
 | journal = [[American Journal of Emergency Medicine]]
 | volume = 21  | issue = 1  | pages = 89–90
 | pmid = 12563594  | doi = 10.1053/ajem.2003.50021
}}
</ref>

Wound infection is rare. Antibiotics are not recommended unless there is a credible diagnosis of infection.<ref name=MoMed1998-Anderson>
{{cite journal
 | last = Anderson | first = P.
 | year = 1998
 | title = Missouri brown recluse spider: A review and update
 | journal = Missouri Medicine
 | volume = 95 | issue = 7 | pages = 318–322
 | pmid = 9666677
}}
</ref>

Studies have shown that surgical intervention is ineffective and may worsen outcomes. Excision may delay wound healing, cause [[abscesses]], and lead to scarring.<ref name=AnnSurg1985-Rees>
{{cite journal
 | vauthors = Rees R, Altenbern D, Lynch J, King L
 | year = 1985
 | title = Brown recluse spider bites: A comparison of early surgical excision versus dapsone and delayed surgical excision
 | journal = [[Annals of Surgery]]
 | volume = 202 | issue = 5 | pages = 659–663
 | pmid = 4051613 | pmc = 1250983
 | doi = 10.1097/00000658-198511000-00020
}}
</ref>

Purportedly application of [[Glyceryl trinitrate (pharmacology)|nitroglycerin]] stopped necrosis.<ref>
{{cite web
 |last=Burton |first=K.
 |year=2021
 |title=The brown recluse spider: Finally stopped in its tracks
 |series=Yosemite forest
 |website=geocities.com
 |url=http://www.geocities.com/Yosemite/Forest/2021/recluse/intro.html
 |access-date=September 2, 2006
 |archive-url=https://web.archive.org/web/20060420183312/http://www.geocities.com/Yosemite/Forest/2021/recluse/intro.html
 |archive-date=April 20, 2006
}}
</ref> However, one scientific animal study found no benefit in preventing necrosis, with the study's results showing it increased inflammation and caused symptoms of [[Loxoscelism|systemic envenoming]]. The authors concluded the results of the study did not support the use of topical nitroglycerin in brown recluse envenoming. <!--
Are there medical experiments with leeches? Yes, there are many, they're even used in surgery sometimes, but not specifically recorded in cases of brown recluse evenoming.
--><ref name=AnnEmergMed2001-Lowry>
{{cite journal
 | vauthors = Lowry B, Bradfield J, Carroll R, Brewer K, Meggs W
 | year = 2001
 | title = A controlled trial of topical nitroglycerin in a New Zealand white rabbit model of brown recluse spider envenomation
 | journal = Annals of Emergency Medicine
 | volume = 37 | issue = 2 | pages = 161–165
 | pmid = 11174233  | doi = 10.1067/mem.2001.113031
}}
</ref>

Antivenom is available in South America for the venom of related species of recluse spiders. However, the bites, often being painless, usually do not present symptoms until 24 or more hours after the event, possibly limiting the effect of this intervention.<ref name=ClinTox2003-Isbister>
{{cite journal
 | vauthors = Isbister G, Graudins A, White J, Warrell D
 | year = 2003
 | title = Antivenom treatment in arachnidism
 | journal = Journal of Toxicology: Clinical Toxicology
 | volume = 41  | issue = 3  | pages = 291–300
 | pmid = 12807312  | s2cid = 37946164
 | doi = 10.1081/CLT-120021114
}}
</ref>

====Spider population control====
Due to increased fear of these spiders prompted by greater public awareness of their presence in recent years, the extermination of domestic brown recluses is performed frequently in the lower midwestern United States. Brown recluse spiders possess a variety of adaptive abilities, including the ability to survive up to 10 months with no food or water.<ref name=Sandidge>
{{cite journal
 |vauthors=Sandidge JS, Hopwood JL
 |year=2005
 |title=Brown recluse spiders: A review of biology, life history and pest management
 |journal=[[Transactions of the Kansas Academy of Science]]
 |volume=108 |issue=3–4 |pages=99–108
 |doi=10.1660/0022-8443(2005)108[0099:BRSARO]2.0.CO;2
 |s2cid=84863537 |jstor=20058665
}}
</ref> Additionally, these spiders survive significantly longer in a relatively cool, thermally stable environment.<ref name=Elzinga>
{{cite journal
 |last=Elzinga |first=R.J.
 |year=1977
 |title=Observations on the longevity of the brown recluse spider, ''Loxosceles reclusa'' {{small|(Gertsch & Mulaik)}}
 |journal=[[Journal of the Kansas Entomological Society]]
 |volume=50 |issue=2 |pages=187–188
 |jstor=25082920
}}
</ref>