Pepper extract provides relief for pruritus ani.(Clinical Rounds)

NEW ORLEANS -- A specially compounded ointment containing 0.006% capsaicin extract is effective at relieving recalcitrant pruritus ani, as well as pruritus of the vulva and scrotum, Timothy Berger, M.D., reported at the annual meeting of the American Academy of Dermatology.

Although the ointment takes a few days to achieve maximum efficacy, "about 60% of patients respond, with about a 50% reduction of their itch," Dr. Berger of the University of California, San Francisco, said in an interview. Long-term use is necessary to achieve the best results, and some mild to moderate burning occurs upon application.

Pruritus ani can be a stubborn problem. It's sometimes caused by a fungal infection or pinworms, both of which can be treated. However, it persists in many patients despite therapy with topical anesthetics, hydrocortisone, or topical steroids. For those patients, capsaicin may be an option.

Capsaicin--a natural alkaloid extracted from red chili peppers--appears to work by depleting the neurokinin substance P from peripheral nerves. Substance P sensitizes C fibers, which transmit pain signals, and it is linked to increased inflammation.

Several topical capsaicin products are available; however, they contain a much greater percentage of the extract (0.035%-0.025%). Dr. Berger recommends a milder formulation of 0.006% extract, which he has ...