Millipedes are elongated cylindrical segmented arthropods that bear two pairs of legs per body segment. They are found in a wide variety of habitats. They are generally very slow-moving creatures and are relatively innocuous. Falling into the class Diplopoda and the phylum Arthropoda, millipedes comprise some 7000 species.[1, 2, 3, 4, 5, 6, 7]
See the images below.
Millipedes do not have biting mouthparts or fangs. Their medical importance comes from their ability to secrete an irritating defensive liquid from pores along their sides. Such secretions contain benzoquinones, aldehydes, hydrocyanic acid, phenols, terpenoids, nitroethylbenzenes, and other substances.[8, 9, 10, 11, 12]
Some species are capable of squirting these liquids to distances of up to 80 cm.[13] Most envenomations occur from direct contact of the millipede with the skin.
Millipede envenomations are self-limited. No deaths have been documented from millipede exposures, and it is unlikely that such an exposure could be fatal, even to a small child.[14]
The history may indicate that a patient was handling a millipede. On occasion, the history of a patient (eg, a sleeping victim, small child) may be obscure.[15, 16, 17, 18, 19]
Skin irritation
Pain
Brown staining at the site of contact
Slight blistering
Eye irritation and pain
Physical examination findings include the following:
Local erythema
Mild edema
Vesicles
Occasionally, cracked skin that may slough and then heal
Conjunctivitis, which may lead to ulceration of the conjunctiva and cornea
Cutaneous exposures generally heal without complications.
Conjunctivitis or corneal ulcerations can complicate eye exposures.
Also consider trash foot.[20]
No laboratory studies are required.
Any millepede secretions on the patient's skin should be washed away with soap and water.
Eye exposure should be treated similarly to corneal burns, with prompt immediate instillation of local anesthetic drops, followed by copious irrigation with saline solution or water.[13, 21] In consultation with ophthalmology, topical antimicrobials and topical steroids can be considered.[13]
Adequate tetanus immunization status should be ensured.
Topical steroid creams may be beneficial for local skin irritation.
Beyond avoidance of handling millipedes, little deterrence is required.
Follow-up care is generally unnecessary for millipede envenomation unless local complications ensue or the eyes are involved.
In ocular cases, the patient should be examined daily until the eye is healed.
Significant conjunctivitis or dermatitis caused by toxic millipede secretions can be treated with topical steroids.
These agents prevent further ulcerations of the cornea and should be given in consultation with an ophthalmologist.
Prednisolone ophthalmic decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Prednisolone/sulfacetamide ophthalmic treats steroid-responsive inflammatory ocular conditions that have a risk of infection.
These agents are used to treat erythema and skin irritation that result from chemical insults. They help prevent further ulcerations of the skin.
Triamcinolone topical treats inflammatory dermatitis that is responsive to steroids. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.
Hydrocortisone topical treats inflammatory dermatitis responsive to steroids. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.