Arachnidism by Segestria bavarica with severe neuropathic pain successfully treated with lidocaine 5% plaster.

Spider poisoning in Europe is rare, and only a few families within the Araneae order are medically relevant. In particular, spiders of dermatological concern mainly belong to Latrodectus and Loxosceles genus. A case of a 45 year-old woman referred to us for an escharotic lesion of forearm associated with consensual lymphangitis and axillary lymphadenitis due to Segestria bavarica bite. The patients also had severe neuropathic pain that we treated with lidocaine 5% plaster. The lesion resolved with a small depressed and hypopigmented scar and just a mild hypoesthesia to the touch. We want to emphasize the exceptionality of Segestria bavarica bite, never previously described as responsible for attack humans, the particular skin lesion characterized by escharotic area resolving in a scar, and especially the utility of 5% lidocaine plaster in this form of neuropathic painSkin lesions due to Segestriidae are usually painful; burning sensation and hypoesthesia, suggesting LNP as in our patient, were previously described. Segestriidae venom contains neuro-toxins responsible for neuropathic pain.The good result obtained with lidocaine 5% plaster is due to a dual mode ofaction, by providing a mechanical barrier effect and a pharma-cological action via voltage-gated sodium channel blockade asa direct result of lidocaine action. This therapy is successfully used in LNP, especially in postherpetic neuralgia, burn sequelaein children, and in various other neuropathic and oncological conditions. It produces effective pain relief, reducing theassociated area of allodynia and maintaining benefits in long-term use, with an excellent tolerability profile. Minor application-site reactions are rarely reported, with minimal risk of systemicadverse events and drug-to-drug interactions. In our opinion, this therapy, never used in the treatment of LNP caused by spi-der bite, can be an effective and safe therapeutic option for thisrare but hard-to-handle condition.