Topical exposures to the skin can cause burning sensation, erythema, and transient numbness; high dose exposure to the hands while cooking has a well-described syndrome of ‘Hunan hand’ which presents with severe pain in the fingers after chopping chili peppers.⁶ Inadvertent exposure to the eyes can result in severe pain, lacrimation, visual blurring, conjunctival injection, lid swelling; corneal injuries are possible.

Capsaicin pepper exposures send about 300-350 people to the hospital annually.⁷ Boerhaave syndrome was described in a 47-year-old man after eating ghost pepper.⁸ Seizures and thunderclap headache from reversible cerebral vasoconstriction syndrome have been reported.^8,9 There is one case of a 17-year-old who died from acute cerebellar stroke after participating in the “One Chip Challenge” (eating a capsaicin infused food chip as a game) that prompted Hershey Co. to recall the product.¹¹ Pepper spray (oleoresin capsicum) is also used by law enforcement (and others) as non-lethal means of defense and results in about 600 hospital visits annually after exposure with eyes being most common site of injury.^7,12

Medical Uses of Capsaicin

It is used primarily for control pain with application of capsaicin containing compounds. The purported effect is an overstimulation of the pain fibers that eventually become transiently unresponsive. Capsaicin is used in alternative or adjunctive medicine for many maladies including—Topically: uremic pruritus, post-herpetic neuralgia, osteoarthritis pain, cannabinoid induced hyperemesis; intravesical instillation: overactive bladder syndrome; intranasal capsaicin spray for rhinitis; oral rinses for burning mouth syndrome, among others.¹³

Antidote

Treatment is generally supportive with copious irrigation for dilution as a mainstay. For ingestions there are many suggested techniques to assist with severe burning oral and throat pain. Effective agents include: milk and dairy products, which contain casein that works to breaks down capsaicin (found in whole, skim milk, ice cream), high sugar drinks (Kool Aid), and cooling the mouth with cold drink or ice.

Topical exposures (pepper sprays, etc.) should be washed off the face using copious water (adding mild dish detergent may help). Ocular exposures are managed with contact lens removal and application of topical anesthetic, flushing eyes with water or saline for at least 15 minutes. Referral for ophthalmology for patients with signs of corneal damage. The airway should be evaluated for bronchospasm and swelling, with supplementary oxygen or inhaled bronchodilators given if necessary.

After experiencing a burning mouth (that interestingly felt worse when I exhaled and improved when I inhaled), drenching scalp sweat, rhinorrhea, forearm piloerection, that lasted for about one hour, the sensation began to abate. Using the proposed lexicon, I would rate the experience as follows: