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Antibiotics are indicated if there are signs of secondary infection Some authors recommend corticosteroids if the patient presents within 12 hours of a bite but the efficacy of this approach is unproven An antivenom exists if there are systemic signs FIGURE 88.4 Spider recluse It is important to point out that spider bites are often blamed for solitary or several skin lesions There is a literature that suggests spiders are unfairly maligned in this regard, and that misdiagnosis is extremely common Especially in areas where the brown recluse spider is rare or totally absent, it is important to consider mimics such as Staphylococcus aureus abscess, herpes zoster, and Sporothrix schenckii infections, to name a few Scabies Infestation Please see Chapter 67 Rash: Vesiculobullous for more details The cardinal symptom of any infestation with scabies is pruritus Two clues should be considered when attempting to make this diagnosis: (i) Distribution (small red papules with concentration on the hands, feet, and folds of the body, especially the finger webs and genital areas) and (ii) involvement of other family members It is important not only to ask other family members if they have pruritus but also