Hunan hand syndrome: benign capsaicininduced contact dermatitis presenting with alarming symptoms

Background: Hunan hand syndrome (HHS) is a painful, self-limited capsaicin-induced contact dermatitis that occurs after exposure to Capsicum species. Capsaicin activates transient receptor potential vanilloid-1 receptors on nociceptive fibers, producing intense burning pain that can mimic the sensation of burns or allergic reactions. Although benign, HHS can prompt emergency department (ED) visits and unnecessary investigations if not recognized promptly. Case Presentation: A 44-year-old woman presented to the ED with severe burning pain in both palms after chopping a large quantity of red bell peppers without gloves. Vital signs were unremarkable (blood pressure 129/83 mm Hg, heart rate 73 beats per minute, temperature 36.8°C, respiratory rate 18 breaths per minute). Examination showed bilateral palmar erythema, mild swelling, and marked hyperesthesia without blistering. Initial treatment with diphenhydramine and a hydrogel burn shield containing tea tree oil provided minimal relief. Lidocaine gel was applied for 30 minutes, followed by 0.25% β-sitosterol, sesame oil, and beeswax (Mebo cream), and intravenous ketorolac and morphine. Her symptoms improved markedly, and she was discharged with Mebo cream and dermatology follow-up. Telephone follow-up confirmed complete resolution without recurrence. Conclusion: This case highlights HHS as an important diagnostic consideration in patients with acute palmar pain and erythema after food preparation. Early recognition targeted symptomatic treatment with topical anesthetics and emollients, and patient education on chili pepper handling can reduce anxiety, prevent unnecessary investigations, and improve ED care.