Capsaicin Safe, Effective for Intractable Pruritis Ani
Wednesday, August 27th 2003
Capsaicin (an active ingredient found in Cayenne Pepper) is safe and effective for the treatment of intractable pruritis ani, according to the results of a randomized, placebo-controlled, crossover study published in the September issue of Gut.
"Topical capsaicin is known to be effective and safe in the treatment of pain and itching," write J. Lysy, from Hadassah University Hospital in Jerusalem, Israel, and colleagues. "Although the precise mechanism of action is not fully understood, evidence suggests that capsaicin exercises an active depressant effect in the synthesis, storage, transport, and release of substance P."
An initial open pilot study on five patients established that capsaicin 0.006% was more acceptable than higher doses when effectiveness was weighed against adverse effects. In a double-blind, crossover study involving two four-week treatment phases separated by a one-week washout, 44 patients with chronic, intractable pruritis ani received either active capsaicin (0.006%) or placebo (menthol 1%) ointment. After completing the controlled study, responders from both groups continued with open-label capsaicin treatment.
Of 44 patients, 31 had relief of itching during capsaicin treatment but not during menthol treatment, and only one responded to menthol but not to capsaicin (P < .0001). Of 13 patients in whom treatment with capsaicin was unsuccessful, eight patients did not respond to capsaicin treatment, one responded equally to capsaicin and placebo, and four others dropped out because of intolerable burning sensation or urticaria. Subjects in both the menthol and capsaicin groups experienced perianal burning on application of the two creams. There were no other reported adverse events or complications.
During a mean follow-up of 10.9 months, 29 responders needed repeated applications of capsaicin to remain symptom-free or nearly symptom-free. Interval of reapplication ranged from 0.5 to 7 days (mean, 1.6 ± 1.2).
"Capsaicin is a new, safe, and highly effective treatment for severe intractable idiopathic pruritus ani," the authors write. "Burning sensation decreased in most patients over time and probably a more concentrated capsaicin preparation can be used in most patients, if required. Further studies are necessary to more precisely establish the range of effective capsaicin concentration for long-term treatment.... The study also suggests that the neuropeptide substance P may play a key role as a mediator of itching in chronic pruritus ani."
In an accompanying article, P. Anand, from Hammersmith Hospital in London, U.K., discusses the physiology of itching and possible mechanisms of action for topical capsaicin.
"Classical observations on functional desensitisation of nociceptors by capsaicin may explain the beneficial effects but the recent discovery of a range of receptors which respond to capsaicin, menthol, and temperature, and their expression in subsets of sensory nerve fibres, provides an exciting prospect towards advancing our understanding and treatment of sensory dysfunction," he writes. "Further studies correlating sensory thresholds with tissue markers of subsets of nerve fibres and their activators may reveal the distinct "signature" of pathophysiological itch -- we now have the molecular tools to unravel this fascinating conundrum."
Footnote from Ideal Health:
The following all contain Cayenne Pepper or are helping for itching:
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