While walking down the hallway in my office, I keep hearing more and more patients concerned about a “spider bite”. Think about this: how many spiders could there be out there, especially in the winter and early spring months? Also, these “spider bites” occur on really weird places; a baby’s bottom, the inner thigh, or even on the palm of the hand. The poor spiders are being maligned when in fact they have nothing to do with these random skin lesions at all. In most cases, a patient had never even seen the offending spider!
In reality, all of those “spider bites” are often due to a community acquired MRSA (methicillin resistant Staph Areus) infection of the skin and soft tissue. The frequency of these infections continues and parents should be aware of the fact that an unusual “bite” that is becoming more tender, has surrounding redness (erythema), feels warm to the touch and may have the appearance of a large pimple or boil needs, to be examined.
In some cases that I have seen, a parent has tried to open the lesion with a needle. DO NOT take needles, pins, finger nails or anything else to open the lesion!! I tell the older kids, “if your mom or dad comes at you with a needle run Toto run!!”
Once a “spider bite” has been correctly diagnosed as a MRSA infection, it is appropriate to try and drain some of the purulent material for a culture. This is usually easily done in the pediatrician’s office. By obtaining some of the purulent discharge the correct diagnosis may be made, and an antibiotic that treats community acquired MRSA may be prescribed.
For larger lesions it is appropriate to drain them, and this may be done under sterile conditions (no home needles). There are certain times a pediatric surgeon may need to actually drain these larger lesions.
There have been numerous journal articles debating the pros and cons of drainage versus antibiotic use. In most cases in my office, we culture the drainage, and prescribe an oral antibiotic. There are some articles that advocate drainage only without the use of antibiotics. There is not a definitive opinion on this and I would defer to your doctor to decide the appropriate individual treatment.
So… if you think the spiders have invaded your home, think MRSA instead.
That’s your daily dose for today. We’ll chat again tomorrow.