mace to the face? — what’s the best treatment for capsaicin exposure?

18 Mar

capsaicin (the toxin found in many types of peppers) is the main ingredient in most pepper sprays

causes severe local inflammatory response, which resolves rapidly as capsaicin depletes substance P

not absorbed well through intact skin

ingestion/inhalation cause the expected responses

eye exposure can cause chemical conjunctivitis, keratitis (assess with fluorescein)

general treatment: irrigation, analgesics



49 volunteer, adult law enforcement trainees were exposed (facial) to oleoresin capsaicin (pepper spray) during a routine training exercise

randomized to one of 5 treatment groups:

  • aluminum hydroxide-magnesium hydroxide [Maalox],
  • 2% lidocaine gel,
  • baby shampoo, 
  • milk,
  • water

After initial self-decontamination with water, subjects rated their pain using a 10-cm visual analog scale (VAS) and then every 10 minutes, for a total of 60 minutes.

There was a significant difference in pain with respect to time (p < 0.001), but no significant interaction between time and treatment (p > 0.05).

There was no significant difference in pain between treatment groups (p > 0.05).



small study showed no significant difference in pain relief with different treatments (water, milk, maalox, etc)

like with most topical exposures, irrigation makes sense

cases often resolve rapidly and without sequelae



References:  Rosen’s Emergency Medicine (2011) – pg. 2472; article; picture

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