Caution with topical capsaicin

Akel, Reem; Cohen, C E; Fuller, Claire

doi:10.1111/ced.14226

Cited by 3 publications

(4 citation statements)

References 3 publications

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“…The adverse‐effect profile does not warrant prescribing capsaicin for women, as it can cause vulvar burning and can result in vulvar nerve damage. 39 …”

Section: Treatments For Vulvar Pain and Dyspareuniamentioning

confidence: 99%

“…Capsaicin is the active ingredient found in chili peppers and has been used in many over‐the‐counter pain preparations. The adverse‐effect profile does not warrant prescribing capsaicin for women, as it can cause vulvar burning and can result in vulvar nerve damage 39 …”

Section: Treatments For Vulvar Pain and Dyspareuniamentioning

confidence: 99%

“…The adverse-effect profile does not warrant prescribing capsaicin for women, as it can cause vulvar burning and can result in vulvar nerve damage. 39 One percent hydrocortisone cream decreases inflammation. Long-term use of hydrocortisone causes thinning of skin and vulvar mucosa.…”

Section: Topical Treatmentsmentioning

confidence: 99%

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Evaluation and Treatment of Vulvodynia: State of the Science

Schlaeger

Glayzer

Villegas-Downs

et al. 2022

J Midwife Womens Health

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Vulvodynia affects 7% of American women, yet clinicians often lack awareness of its presentation. It is underdiagnosed and often misdiagnosed as vaginitis. The etiology of vulvodynia remains unknown, making it difficult to identify or develop effective treatment methods. The purpose of this article is to (1) review the presentation and evaluation of vulvodynia, (2) review the research on vulvodynia treatments, and (3) aid the clinician in the selection of vulvodynia treatment methods. The level of evidence to support vulvodynia treatment varies from case series to randomized controlled trials (RCTs). Oral desipramine with 5% lidocaine cream, intravaginal diazepam tablets with intravaginal transcutaneous electric nerve stimulation (TENS), botulinum toxin type A 50 units, enoxaparin sodium subcutaneous injections, intravaginal TENS (as a single therapy), multimodal physical therapy, overnight 5% lidocaine ointment, and acupuncture had the highest level of evidence with at least one RCT or comparative effectiveness trial. Pre to posttest reduction in vulvar pain and/or dyspareunia in non‐RCT studies included studies of gabapentin cream, amitriptyline cream, amitriptyline with baclofen cream, up to 6 weeks’ oral itraconazole therapy, multimodal physical therapy, vaginal dilators, electromyography biofeedback, hypnotherapy, cognitive behavioral therapy, cold knife vestibulectomy, and laser therapy. There is a lack of rigorous RCTs with large sample sizes for the treatment of vulvodynia, rendering it difficult to determine efficacy of most treatment methods. Clinicians will be guided in the selection of best treatments for vulvodynia that have the highest level of evidence and are least invasive.

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“…The adverse‐effect profile does not warrant prescribing capsaicin for women, as it can cause vulvar burning and can result in vulvar nerve damage. 39 …”

Section: Treatments For Vulvar Pain and Dyspareuniamentioning

confidence: 99%

Section: Treatments For Vulvar Pain and Dyspareuniamentioning

confidence: 99%

See 1 more Smart Citation

Evaluation and Treatment of Vulvodynia: State of the Science

Schlaeger

Glayzer

Villegas-Downs

et al. 2022

J Midwife Womens Health

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“…Because it is associated with significant pain during initial use and has a lack of durable response, capsaicin therapy for PVD has been met with understandable resistance, with even with some clinicians voicing opposition to study of the medication in the literature. 10 Studies of capsaicin therapy for PVD have also been limited by sample size and inability to blind patients to application. 9 However, for patients with severe symptoms who cannot or do not want surgery and for whom other therapies have failed, more substantial therapeutic side effects may be acceptable in pursuit of relief.…”

Section: Introductionmentioning

confidence: 99%

A survey of patient tolerance and satisfaction with capsaicin for neuroproliferative vestibulodynia

Kopits,

Krapf,

Moss

et al. 2024

Sexual Medicine

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Background Topical capsaicin has been used to treat vulvodynia but has been poorly studied for use in neuroproliferative provoked vestibulodynia (PVD); capsaicin decreases allodynia by blocking vanilloid receptors (TRPV1) on C-afferent nociceptors, but the therapy causes discomfort to the point of intolerance in some patients. Aim The present study evaluated tolerability and efficacy of topical capsaicin to treat neuroproliferative PVD. Methods Patients with neuroproliferative PVD prescribed 0.025% capsaicin compounded in VersaBase cream were identified through prescription records. Outcome measures included the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale–Revised, and a 22-question questionnaire assessing patient experience and treatment tolerability. Outcomes Among tolerant patients, capsaicin significantly decreased vestibular pain, but tolerance was highly variable. Results Twenty-five patients responded to the follow-up questionnaire. The average age at presentation was 30 years (range, 18-52 years). Eighty percent of patients tolerated capsaicin application for the full 20 minutes within a median time of 1 to 2 weeks. Of the 16 patients reporting tolerance to 20-minute application, 12 (60%) experienced improvement in vestibular pain. On an 11-point numeric rating scale, the mean pain score was 8.96 and the median score was 10 with first application. Among all participants, 16 (64%) had reduction in pain during treatment. Fifty-six percent of patients would recommend capsaicin as a treatment for vulvar pain. Qualitative content analysis focused on categories of efficacy, value, and feasibility, which indicated that those able to tolerate the treatment experienced improvement while using the medication. The mean Female Sexual Distress Scale–Revised score was 35.96 at baseline compared with 25.09 at follow-up (P < .0001). On a numeric rating scale, the mean self-reported vulvar pain score was 8.2 at baseline compared with 5.35 when using capsaicin consistently (P < .0001). The mean FSFI pain domain score was 2.45 at baseline compared with 0.98 at follow-up (P = .005). While not statistically significant, the mean total FSFI score was 15.44 at baseline compared with 17.84 at follow-up (P = .3730). Clinical Implications Capsaicin is helpful for some patients with PVD, but thorough counseling is important because of highly variable tolerance. Strengths and Limitations Strengths include examination of a poorly studied therapy and inclusion of narrative responses from patients to inform counseling. Limitations include small sample size, retrospective design, and low survey response rate. Conclusion Patients should be appropriately selected and thoroughly counseled given high levels of intolerance, but capsaicin therapy may be considered for patients with neuroproliferative PVD who have failed conservative treatments and wish to avoid surgery.

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TRPV1 activation in human Langerhans cells and T cells inhibits mucosal HIV-1 infection via CGRP-dependent and independent mechanisms

Mariotton

Cohen

Zhu

et al. 2023

Proc. Natl. Acad. Sci. U.S.A.

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Upon its mucosal transmission, HIV type 1 (HIV-1) rapidly targets genital antigen-presenting Langerhans cells (LCs), which subsequently transfer infectious virus to CD4 + T cells. We previously described an inhibitory neuroimmune cross talk, whereby calcitonin gene-related peptide (CGRP), a neuropeptide secreted by peripheral pain-sensing nociceptor neurons innervating all mucosal epithelia and associating with LCs, strongly inhibits HIV-1 transfer. As nociceptors secret CGRP following the activation of their Ca 2+ ion channel transient receptor potential vanilloid 1 (TRPV1), and as we reported that LCs secret low levels of CGRP, we investigated whether LCs express functional TRPV1. We found that human LCs expressed mRNA and protein of TRPV1, which was functional and induced Ca 2+ influx following activation with TRPV1 agonists, including capsaicin (CP). The treatment of LCs with TRPV1 agonists also increased CGRP secretion, reaching its anti-HIV-1 inhibitory concentrations. Accordingly, CP pretreatment significantly inhibited LCs-mediated HIV-1 transfer to CD4 + T cells, which was abrogated by both TRPV1 and CGRP receptor antagonists. Like CGRP, CP-induced inhibition of HIV-1 transfer was mediated via increased CCL3 secretion and HIV-1 degradation. CP also inhibited direct CD4 + T cells HIV-1 infection, but in CGRP-independent manners. Finally, pretreatment of inner foreskin tissue explants with CP markedly increased CGRP and CCL3 secretion, and upon subsequent polarized exposure to HIV-1, inhibited an increase in LC–T cell conjugate formation and consequently T cell infection. Our results reveal that TRPV1 activation in human LCs and CD4 + T cells inhibits mucosal HIV-1 infection, via CGRP-dependent/independent mechanisms. Formulations containing TRPV1 agonists, already approved for pain relief, could hence be useful against HIV-1.

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Caution with topical capsaicin

Abstract: Epub ahead of print]. 3 Riquelme-Mc Loughlin C, Riera-Monroig J, Morgado-Carrasco D et al. Low-dose naltrexone therapy in benign chronic pemphigus (Hailey-Hailey disease): a case series.

Cited by 3 publications

References 3 publications

Evaluation and Treatment of Vulvodynia: State of the Science

Evaluation and Treatment of Vulvodynia: State of the Science

A survey of patient tolerance and satisfaction with capsaicin for neuroproliferative vestibulodynia

TRPV1 activation in human Langerhans cells and T cells inhibits mucosal HIV-1 infection via CGRP-dependent and independent mechanisms

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