Contact Dermatitis Associated With Capsaicin: Hunan Hand Syndrome

doi:10.1016/S0196-0644(95)70188-5

Annals of Emergency Medicine

Volume 25, Issue 5, May 1995, Pages 713-715

https://doi.org/10.1016/S0196-0644(95)70188-5 Get rights and content

Abstract

"Hunan hand" is a contact dermatitis resulting from the direct handling of chili peppers containing capsaicin. Capsaicin also is found in an over-the-counter topical agent for treatment of postherpetic neuralgia, diabetic neuropathy, and arthritis. We present the case of a patient with capsaicin-induced dermatitis and discuss the pathophysiology, therapy, and current uses of capsaicin.

[Williams SR, Clark RF, Dunford JV: Contact dermatitis associated with capsaicin: Hunan hand syndrome. Ann Emerg Med May 1995;25:713-715.]

Section snippets

INTRODUCTION

"Hunan hand" syndrome is a painful contact dermatitis named for people who experience the syndrome while preparing chili peppers for Chinese meals.1, 2This disorder also occurs along the Mexico-United States border because the peppers are used commonly as condiments.¹Capsaicin is the ingredient in chili peppers that causes symptoms. It is also the active ingredient in self-defense sprays and has been studied for the treatment of pain due to diabetic neuropathy, herpes zoster, and arthritis. We

CASE REPORT

A 31-year-old woman presented to an urgent care facility complaining of burning palms after preparing salsa with jalapeno peppers the previous night. She had not worn glo ves while preparing the salsa. The patient described intense burning pain in her palms. Ice water provided some relief. She had washed her hands repeatedly but believed that the "taste" of the pepper was still present. Her allergies included penicillin, and her only medication was an oral contraceptive. The patient was alert

DISCUSSION

Capsaicin is the active component that causes the pungency of the fruits in the Caspicum genus. Of all the spices, fruits of the plant Capsicum have the oldest recorded use in cuisines throughout the world. The Mexican Indians used chilies as early as 7000 BC . Capsicum was first noted in 1492 by Chauca, a physician on the second expedition of Columbus to the New World.3, 4Chauca noted both the culinary and medicinal uses of Capsicum . The native Indians used the irritant smoke from burning

SUMMARY

Capsaicin-induced dermatitis occurs in areas where handling of chili peppers is commonplace. Treatment of this dermatitis is challenging because of persistent pain. Because of the increasing availability of products containing capsaicin, such as self-defense sprays and over-the-counter creams, the emergency physician must be aware of alternative causes and potential treatments for Hunan hand.

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A survey of plants responsible for causing irritant contact dermatitis in the Amathole district, eastern cape, South Africa
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The alkaloids as a chemical group are very diverse and include many of the commonly known bioactive compounds derived from plants, such as ephedrine, morphine, and quinolones (Modi et al., 2009). Capsaicin (8-methyl-N-vanillyl-6-nonenamide) is an alkaloid derived from members of the Solanaceae family and is responsible for the pungency of chili peppers (Williams et al., 1995). In humans, capsaicin binds to vanilloid receptors on sensory neurons, which can also be stimulated by heat and pain.
Potentially harmful plants grow almost everywhere, hence, it is not practical to eradicate them all. However, a basic understanding of adverse cutaneous reactions and the common plants that cause each type can enable vulnerable individuals to discover the source of their dermatitis and thus prevent re-exposure. The aim of this study therefore, was to document the plants responsible for irritant contact dermatitis (ICD) in the Eastern Cape, along with their respective irritants and clinical presentations.
Study participants (161) in 12 locations were selected by convenient sampling with particular focus on local people who regularly interact with plants or plant products. Interview questions were focused on the local names of plants that contain irritating chemicals and physical characteristics that cause ICD.
Forty four plant species distributed in 24 families and 34 genera were reported as causative agents of irritant contact dermatitis. Herbs constituted 67.35%, trees 24.49% and shrubs 8.16%. Mechanical ICD was reported to be caused by 23 species, closely followed by chemical ICD (20 species) and mechanico-chemical ICD (6 species). Species with the highest frequency of citations were Allium cepa, Acacia karroo, Capsicum annuum, Citrus limon and Zea mays. The most representative families were Euphorbiaceae (for chemical ICD), Urticaceae (for mechanico-chemical ICD), Fabaceae and Rutaceae for mechanical ICD. Most of the classes of chemical compounds identified as being responsible for chemical ICD were restricted to plants of specific genera such as the diterpenes in Euphorbia spp., disulphides in Allium spp., terpenes in Citrus spp. and isothiocyanates in Brassica spp.
Thorns and hairs were reported for causing Mechanical ICD in 6 plant species each, including widely cultivated plants such as Acacia karoo and Citrus reticulata.
Irritant contact dermatitis is a common cutaneous disorder in individuals exposed to plants in the Eastern Cape, especially among workers of the food and flower industries. Health practitioners should therefore consider the possible work-related causes of dermatitis, especially in cases associated with a clear history of symptoms.
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Topical antacid therapy for capsaicin-induced dermal pain: a poison center telephone-directed study
2010, American Journal of Emergency Medicine
Citation Excerpt :
It is used in foods as a flavoring agent, in personal protection sprays and animal repellents, and in topical creams and ointments for the treatment of chronic pain. Dermal exposure of capsaicin affects cutaneous sensory neurons, inducing burning, redness, irritation, and pain that sometimes can be excruciating and last for hours to days after exposure [1]. Symptomatic exposures to capsaicin are common.
The study aimed to assess the effects of topical antacids for treatment of capsaicin-induced dermal pain after exposure to capsaicin containing hot peppers, personal protection sprays, or topical creams.
Participants of the study were California Poison Control System (CPCS) hotline callers 12 years or older with dermal pain from exposure to capsaicin-containing products or plants. Participants were instructed to apply a topical antacid and assessed for perceived pain (using a 0-10 scale) pre- and posttreatment. A positive response was defined as a sustained reduction of pain 33% or more within 30 minutes or achieving a pain score of 0 to 1.
Of 93 eligible patients, 64 applied antacids and had outcome data available. Patients contacted the CPCS a median of 1 hour postexposure with a median initial pain score of 7.5/10. Thirty-six (56%) were exposed to unrefined (natural) peppers and 28 (44%) to refined capsaicin (eg, capsaicin-containing cream). Before calling the CPCS, 57 (89%) attempted at least one treatment. Forty-five (70%) reported positive response to antacid treatment as a 33% reduction in pain in 30 minutes (n = 17), a reduction in pain to a score of 0 to 1 (n = 3), or both (n = 25). A 33% reduction in pain within 30 minutes was associated with exposure to refined capsaicin (odds ratio, 3.37; 95% confidence interval, 0.98-11.66). Concomitant refined capsaicin exposure and early treatment (<1 hour of symptoms) was associated with even greater odds of response (odds ratio, 5.4; 95% confidence interval, 1.4-21.2).
Topical application of antacids for capsaicin-induced pain is effective, particularly in early treatment of exposure to refined capsaicin.
Irritant Dermatitis
2010, Hayes' Handbook of Pesticide Toxicology
This chapter discusses the factors influencing irritant potential, delineates general clinical presentations of irritant dermatitis, and addresses workup and treatment. In addition, it addresses methods of evaluating a chemical's irritant potential and discusses the irritation potential of some agricultural chemicals and plants. Irritant contact dermatitis (ICD) is defined as nonimmunologic skin inflammation after contact to a substance or physical factor. Although epidemiologic data are scarce, ICD appears to be an important cause of occupational and nonoccupational skin disease. Various factors influence a chemical's irritant potential. Intrinsic molecular properties such as molecular structure, size, ionization state, lipid solubility, and pKa determine the chemical's interaction with the skin barrier and epidermal cells. Irritant potential is also dependent on the molar concentration and volume and duration of the exposure. Physical factors such as extremes of temperature and humidity, as well as mechanical factors such as occlusion and friction, can enhance irritation of chemicals or act as irritants. Endogenous factors such as age, anatomical site, preexisting dermatologic conditions, and genetic background may influence an individual's predisposition to irritant dermatitis. There is a decreased susceptibility of irritation with increasing age, with children younger than 8 years being most susceptible to skin irritation. Few human studies exist, and new studies are currently inhibited by the U.S. Environmental Protection Agency's ethics system. Lastly, epidemiologic data that are so helpful for many contact allergens remain scarce for agricultural irritants. The techniques and assays are efficient; however, a regulatory system that promotes developing and registering relevant data in this arena is lacking.
Irritant Dermatitis
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This chapter discusses the factors influencing irritant potential, delineates general clinical presentations of irritant dermatitis, and addresses workup and treatment. In addition, it addresses methods of evaluating a chemical's irritant potential and discusses the irritation potential of some agricultural chemicals and plants. Irritant contact dermatitis (ICD) is defined as nonimmunologic skin inflammation after contact to a substance or physical factor. Although epidemiologic data are scarce, ICD appears to be an important cause of occupational and nonoccupational skin disease. Various factors influence a chemical's irritant potential. Intrinsic molecular properties such as molecular structure, size, ionization state, lipid solubility, and pKa determine the chemical's interaction with the skin barrier and epidermal cells. Irritant potential is also dependent on the molar concentration and volume and duration of the exposure. Physical factors such as extremes of temperature and humidity, as well as mechanical factors such as occlusion and friction, can enhance irritation of chemicals or act as irritants. Endogenous factors such as age, anatomical site, preexisting dermatologic conditions, and genetic background may influence an individual's predisposition to irritant dermatitis. There is a decreased susceptibility of irritation with increasing age, with children younger than 8 years being most susceptible to skin irritation. Few human studies exist, and new studies are currently inhibited by the U.S. Environmental Protection Agency's ethics system. Lastly, epidemiologic data that are so helpful for many contact allergens remain scarce for agricultural irritants. The techniques and assays are efficient; however, a regulatory system that promotes developing and registering relevant data in this arena is lacking.

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^☆: From the University of California-San Diego Medical Center, Department of Emergency Medicine, San Diego, California.

^☆☆: Address for reprints: Saralyn R Williams, MD, UCSD Medical Center, Department of Emergency Medicine, 8676, 200 West Arbor Drive, San Diego, California 92103-8676, 619-543-6463, Fax 619-543-3115

^★: Reprint no. 47/1/63619

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Contact Dermatitis Associated With Capsaicin: Hunan Hand Syndrome☆,☆☆,★

Abstract

Section snippets

INTRODUCTION

CASE REPORT

DISCUSSION

SUMMARY

Biochem Pharmacol

J Am Acad Dermatol

Capsicum pepper dermatitis

Cutis

Hunan hand

N Engl J Med

Capsaicin: Identification, nomenclature, and pharmacotherapy

Ann Pharmacother

Capsaicin and substance P

Clin Dermatol

Capsaicin: Cellular targets mechanisms of action, and selectivity for thin sensory neurons

Pharmacol Rev