Capsaicin (trans-8-methyl-N-vinillyl-6-nonenamide) is known to reduce only the nociceptor activity of c fibers. Topical 0.025 % capsaicin cream was used to treat 13 patients with painful diabetic neuropathy. The cream was prepared by mixing extracts of red pepper and Sahne® cream. Among the 13 patients, 12 tolerated the trial, and completed more than 2 months of the therapy. One patient dropped out because of a severe local burning sensation. Of the 12 patients, 6 achived an excallent result (more than 80 % relief of pain), and 3 achieved a good result (79-50 % relief) after 6 weeks of the treatment. The only adverse reaction was a local burning senestion experienced by 2 patients including the one who dropped out. Topical capsaicin may be a safe agent for the management of painful diabetic neuropathy, however it requires vehicle-controlled clinical trials with many subjects.