Editing Brown recluse spider (section)

===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>