4-56
substances from glands along the body segments that may cause skin vesication like millipede exposure.
A single fatality has been reported in a child bitten on the head by a large centipede. Most small species
are innocuous.
Subjective: Symptoms
Severe local pain, swelling and redness; swollen, painful lymph nodes; headache; palpitations; nausea/
vomiting; anxiety.
Objective: Signs
Local: Edema, erythema, tenderness and local necrosis around bite; lymphangitis/lymphadenopathy
General: Significant anxiety, possible systemic toxic reaction (unlikely)
Assesment:
Diagnose based on the bite history or identification of the centipede.
Differential Diagnosis - Anaphylaxis (see Shock); other bug bites and stings including hymenoptera and
spiders (see Skin: Bug Bites and Stings); cellulitis (fever, hot wound, advancing erythema)
Plan:
Treatment: Supportive: Apply ice/cold (some prefer heat), acetaminophen or NSAIDs (see Symptom: Joint
Pain for NSAIDs doses). There is no known antivenin.
Patient Education
Prevention: Never handle centipedes. Use caution when turning soil and when moving or climbing over
rocks. Use work gloves in endemic areas.
No Improvement/Deterioration: Return for fever, or reddening or blackening of the skin.
Follow-Up Actions
Return Evaluation: Observe for potential secondary infection or tissue blackening (necrosis is uncommon).
Evacuation/Consultation criteria: Evacuation not necessary unless bite complicated by necrosis. Consult
primary care or preventive medicine physician, or entomologist as needed.
Skin: Millipede Exposure
COL Roland J. Weisser, Jr., MC, USAIntroduction: Millipedes are elongated, worm-like arthropods having two pairs of legs on each body segment
(centipedes have one pair of legs per segment). They range in size from almost microscopic to 30 cm
in length, with 100-300 pairs of legs. They are generally brown/black/gray in color, slow moving, nocturnal
herbivores that live in humid environments and can be found in soil, leaf litter, under stones or decaying
wood. Millipedes sense primarily with their antennae, having only rudimentary eyesight. When threatened,
they coil up into a ball to protect their more vulnerable underbelly. Millipedes do not have biting mouthparts
or fangs, but they secrete an irritating, repellent liquid from pores along the sides of their bodies when they
feel threatened. In large doses these secretions can be corrosive and cause blistering of skin. No deaths
have been reported from millipede exposures, and it is unlikely that any such exposure, even to a small
child, would prove fatal.
Subjective: Symptoms
Painful, irritated skin, eye irritation and pain (ocular exposures).
Objective: Signs
Brown staining of the skin at the site of contact, along with erythema, mild edema and vesicle formation;
skin may later crack, slough and heal; conjunctivitis may progress to ulceration of the conjunctiva and cornea
(ocular exposures).