Substance in Chili Pepper Relieves Anal Itching
By Alan R. Gaby, MD
Healthnotes Newswire (January 15, 2004)—Topical application of capsaicin, a substance found in chili pepper, effectively relieves chronic anal itching (pruritus ani), according to a study in Gut (2003;52:1323–6). This report is welcome news for those who suffer from this uncomfortable, embarrassing, and often difficult-to-treat condition.
Pruritus ani is a common problem characterized by an intense urge to scratch around the anal area. Causes include persistent moisture around the anus from excessive sweating, sensitivity to various foods and beverages, fungal infection, and skin diseases such as eczema or psoriasis. In many cases, the cause of the problem cannot be identified, and attempts to treat it are unsuccessful.
In the new study, 44 people with pruritus ani of unknown cause that had failed to respond to various treatments were randomly assigned to apply a very thin layer of an ointment containing 0.006% capsaicin or a placebo ointment (1% menthol) to the anal area three times a day for four weeks. After a one-week rest period, each participant received the other treatment for an additional four weeks.
Seventy percent of the study participants experienced relief during capsaicin treatment and did not respond to the placebo; all people who did not improve with capsaicin also failed to respond to the placebo. The beneficial effect of capsaicin was usually immediate, although in some cases up to 3 days of treatment was needed before improvement was seen. Individuals who responded to capsaicin were offered a continued supply of the product after the study was completed. During a follow-up period averaging 11 months, 29 individuals (66% of the study group) remained completely or almost completely symptom-free, as long as they continued to apply capsaicin an average of every 1.6 days (range, every 12 hours to 7 days).
All participants experienced some burning around the anal area following each capsaicin application; the severity of this side effect decreased significantly after four weeks of application, but did not disappear completely. Four people discontinued capsaicin because of side effects (burning or hives).
The ointment used in this study was made by diluting a commercially available capsaicin preparation (Zostrix® 0.025%) with white soft paraffin. Prior to the study, the researchers had determined through trial and error that the 0.006% concentration of capsaicin had a better profile of effectiveness and side effects than did higher concentrations.
While the mechanism by which capsaicin ointment relieves chronic anal itching is not entirely clear, it may work by depleting from the skin a chemical messenger known as substance P that plays a role in the perception of itching.
Alan R. Gaby, MD, an expert in nutritional therapies, testified to the White House Commission on CAM upon request in December 2001. Dr. Gaby served as a member of the Ad-Hoc Advisory Panel of the National Institutes of Health Office of Alternative Medicine. He is the author of Preventing and Reversing Osteoporosis (Prima, 1994), and co-author of The Natural Pharmacy, 2nd Edition (Healthnotes, Prima, 1999), the A–Z Guide to Drug-Herb-Vitamin Interactions (Healthnotes, Prima, 1999), Clinical Essentials Volume 1 and 2 (Healthnotes, 2000), and The Patient’s Book of Natural Healing (Prima, 1999). A former professor at Bastyr University of Natural Health Sciences, in Kenmore, WA, where he served as the Endowed Professor of Nutrition, Dr. Gaby is the Chief Medical Editor for Healthnotes, Inc.
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