Burning Sensation: What Causes It

Why things burn

Pain-sensing nerves have receptors that respond to heat, acid and chemical irritants. A burning feeling arises when these receptors are activated, as with a burn or acid on the lining of the esophagus, or when the nerves themselves are damaged and send faulty "hot" signals. Nerve-based burning is called neuropathic pain and is often described with tingling, pins and needles, or electric shocks.

Burning sensation causes by body area

Burning feet and hands: nerve causes

Peripheral neuropathy is the most common cause of burning in the feet. It usually starts in the toes and spreads upward in a "stocking" pattern, often worse at night, with numbness and tingling. Causes include:

• Diabetic neuropathy: the leading cause.
• Alcohol overuse.
• Vitamin B12 deficiency, including from metformin, acid reducers or a vegan diet without supplements.
• Underactive thyroid, kidney disease and some chemotherapy drugs.
• Small fiber neuropathy: burning with normal routine nerve tests.

Burning feet can also come from athlete's foot, tight shoes, and erythromelalgia, a rare condition with red, hot, painful feet. See burning feet.

Burning skin

• Sunburn: red, hot, tender skin a few hours after sun exposure.
• Shingles: burning, tingling or stabbing pain in a band on one side of the chest, back or face, followed 1 to 5 days later by a blistering rash. Antiviral treatment works best when started within 72 hours of the rash.
• Contact dermatitis: burning, itch and redness where a product or plant touched the skin.
• Skin infections such as cellulitis.
• Pinched nerves: a nerve compressed in the neck or back can cause burning down an arm or leg.

Burning in the chest and stomach

Heartburn is a burning feeling behind the breastbone, rising toward the throat, often after meals or when lying down. It is caused by stomach acid flowing back into the esophagus, as in GERD. Burning in the upper abdomen suggests gastritis or a peptic ulcer, especially with NSAID use. Heart pain can occasionally feel like burning, so new chest burning with exertion, sweating or breathlessness needs urgent care.

Burning when urinating

A burning or stinging feeling when you pass urine, often with frequency and urgency, is the classic symptom of a urinary tract infection. Other causes include chlamydia and gonorrhea, vaginal yeast infection, irritation from soaps, and kidney stones. Fever with back pain suggests the infection has spread to the kidney.

Burning mouth and genitals

• Oral thrush: white patches and soreness in the mouth. See thrush.
• Burning mouth syndrome: burning of the tongue or mouth without visible changes, most common in women after menopause.
• Vaginal burning: yeast infection, bacterial vaginosis, trichomoniasis, menopausal dryness, and vulvodynia.

How doctors find the cause

Your doctor will ask where the burning is, when it started, what makes it worse, and about rashes, numbness, diabetes, alcohol, medicines and diet. Tests are chosen by location: blood sugar and HbA1c, vitamin B12, thyroid and kidney function for nerve burning; urine test for burning urination; swabs for vaginal or mouth symptoms; and nerve conduction studies or skin biopsy for suspected neuropathy.

Relief and treatment

• Nerve burning: good blood sugar control, B12 replacement if low, and medicines for nerve pain such as duloxetine, pregabalin, gabapentin or amitriptyline. Capsaicin cream or lidocaine patches help some people. Ordinary pain relievers often work poorly for nerve pain.
• Heartburn: smaller meals, avoiding late meals and trigger foods, raising the head of the bed, antacids, and acid reducers at the label dose.
• Urine infection: antibiotics prescribed after a urine test.
• Shingles: antivirals, pain relief and keeping the rash covered.
• Skin burning: cool water or cool compresses, fragrance-free moisturizer, aloe for sunburn, and avoiding triggers.

Frequently asked questions

What causes a burning sensation with no rash?

Burning without a rash usually comes from nerves: peripheral neuropathy, a pinched nerve, or early shingles before the rash appears. Burning mouth syndrome and some vitamin deficiencies also cause burning without visible skin changes.

What causes burning feet at night?

Burning feet at night are most often caused by peripheral neuropathy, commonly from diabetes, alcohol or vitamin B12 deficiency. Nerve pain tends to feel worse at rest and in the evening. Athlete's foot and erythromelalgia are other causes.

Can anxiety cause a burning sensation?

Anxiety can cause tingling, prickling or burning feelings, especially in the hands, face and lips during overbreathing. It also worsens awareness of nerve pain. Persistent burning in one area still needs a physical check.

Is a burning sensation a sign of nerve damage?

Often, yes. Burning, tingling and numbness together, especially starting in the toes, strongly suggest peripheral nerve damage. Shingles and pinched nerves also cause nerve-type burning. A doctor can confirm it with examination and nerve tests.