Centipede envenomation: bringing the pain to Hawai'i and Pacific Islands

Scolopendra subspinipes is the only clinically significant centipede found in Hawai'i. Envenomation typically leads to extreme localized pain, erythema, induration, and tissue necrosis and possible lymphedema or lymphangitis. Mortality is uncommon and results from secondary infection or anaphylaxis. Management is supportive and includes wound care, pain control, and treatment with topical or oral antihistamines and anti-inflammatory medications.