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Millipede Envenomation: Treatment & Medication
Updated: Apr 20, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Prehospital Care
- Any millepede secretions on the patient's skin should be washed away with soap and water.
- If the eyes are involved, they should be copiously washed with water as soon as possible.
Emergency Department Care
- The exposed skin should be washed thoroughly with soap and water.
- Eye exposure should prompt immediate instillation of local anesthetic drops, followed by copious irrigation with saline solution or water.
- Adequate tetanus immunization status should be ensured.
- Topical steroid creams may be beneficial for local skin irritation.
Medication
Significant conjunctivitis or dermatitis caused by toxic millipede secretions can be treated with topical steroids.
Ophthalmic agents
These agents prevent further ulcerations of the cornea and should be given in consultation with an ophthalmologist.
Prednisolone, ophthalmic (Pred Forte)
Decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Adult
Solution: 1-2 gtt into conjunctival sac qh during day and q2h during night; once desired response is obtained, use 1 gtt q4h; may reduce to 1 gtt tid/qid to control symptoms
Suspension: Shake well before using, instill 1-2 gtt into conjunctival sac 2-4 times qd; may increase dosing frequency during initial 1-2 d prn
Pediatric
Administer as in adults
None reported
Documented hypersensitivity; viral, fungal, or tubercular skin lesions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in hypertension; known to cause cataract formation with chronic use; in prolonged use, withdraw treatment by gradually decreasing frequency of applications to avoid adrenal insufficiency
Sulfacetamide sodium and prednisolone (Isopto)
Treats steroid-responsive inflammatory ocular conditions that have a risk of infection.
Adult
Solution: Instill 1-3 gtt q2-3h while awake and hs until favorable response
Ointment: Apply 0.5-inch ribbon into lower conjunctival sac 1-4 times qd and once hs
Pediatric
<2 months: Not established
>2 months: Administer as in adults
Decreases effects of silver compounds and gentamicin
Documented hypersensitivity; mycobacterial infection
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in severe dried eyes; ointment may retard corneal epithelial healing
Corticosteroid, Topical
Used to treat erythema and skin irritation that result from chemical insults. Prevent further ulcerations of the skin.
Triamcinolone (Triderm 0.1%, Aristocort 0.025%, 0.1%, and 0.5% cream)
Treats inflammatory dermatitis that is responsive to steroids. Decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.
Adult
Apply thin film bid/tid until favorable response
Pediatric
Administer as in adults
None reported
Documented hypersensitivity; fungal, viral, and bacterial skin infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Do not use in patients diagnosed with decreased skin circulation
Hydrocortisone (Cortaid 1%, Cortizone-10, Westcort 0.2%)
Treats inflammatory dermatitis responsive to steroids. Decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.
Adult
Apply thin film to affected area tid/qid until favorable response
Pediatric
Administer as in adults
None reported
Documented hypersensitivity; viral, fungal, or tubercular skin infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Prolonged use, applying over large surface areas, application of potent steroids, and occlusive dressings may increase systemic absorption of corticosteroids and may cause Cushing syndrome, reversible HPA axis suppression, hyperglycemia, and glycosuria
More on Millipede Envenomation |
| Overview: Millipede Envenomation |
| Differential Diagnoses & Workup: Millipede Envenomation |
 Treatment & Medication: Millipede Envenomation |
| Follow-up: Millipede Envenomation |
| Multimedia: Millipede Envenomation |
| References |
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References
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Hare T. Poisonous Dwellers of the Desert. Tucson, AZ: Southwest Parks and Monuments Association; 1995.
Hendrickson RG. Millipede exposure. Clin Toxicol (Phila). 2005;43(3):211-2. [Medline].
Hudson BJ, Parsons GA. Giant millipede 'burns' and the eye. Trans R Soc Trop Med Hyg. Mar-Apr 1997;91(2):183-5. [Medline].
Mason GH, Thomson HD, Fergin P, Anderson R. Spot diagnosis. The burning millipede. Med J Aust. Jun 6 1994;160(11):718, 726. [Medline].
Peters S. A Colour Atlas of Arthropods in Clinical Medicine. Barcelona, Spain: Wolfe Publishing Ltd; 1992.
Radford AJ. Giant millipede burns in Papua New Guinea. P N G Med J. Sep 1976;18(3):138-41. [Medline].
Radford AJ. Millipede burns in man. Trop Geogr Med. Sep 1975;27(3):279-87. [Medline].
Williams LA, Singh PD, Caleb-Williams LS. Biology and biological action of the defensive secretion from a Jamaican millipede. Naturwissenschaften. 1997;84(4):143-4. [Medline].
Further Reading
Keywords
millipede envenomations, millipede sting, millipede bite, Diplopoda, Arthropoda, millipede exposure, centipede
