Skin Burning Sensation

Why skin burns

Burning is carried by small nerve fibers in the skin that sense heat and pain. They fire when the skin is inflamed (from sun, chemicals, infection or allergy), or when the nerves themselves are damaged or overexcited. Nerve-related burning often comes with tingling, numbness, pins and needles or pain from light touch (allodynia).

Burning skin with a rash or redness

Burning skin without a rash

Early shingles

Shingles often causes burning, tingling or pain in a band or patch on one side of the body for 1 to 5 days before the rash appears. Anyone over 50, or with a weakened immune system, who gets new one-sided burning pain should watch for a rash.

Peripheral neuropathy

Burning that starts in both feet and spreads upward, often worse at night, with numbness and tingling. Diabetes is the most common cause; others include alcohol, vitamin B12 deficiency, chemotherapy, kidney disease and thyroid disease. See peripheral neuropathy.

Nerve compression

• Meralgia paresthetica: burning and numbness on the outer thigh from a compressed nerve, linked to tight belts, weight gain and pregnancy.
• Notalgia paresthetica: burning or itch between the shoulder blades.
• Carpal tunnel syndrome: burning and tingling in the thumb and fingers, often at night.
• Sciatica: burning down the leg.

Postherpetic neuralgia

Burning, aching or stabbing pain that persists in the area of a previous shingles rash for 3 months or more. See postherpetic neuralgia.

Other causes

• Fibromyalgia: widespread pain that can feel burning, with fatigue and poor sleep.
• Multiple sclerosis: burning or electric sensations from damaged nerve pathways in the brain or spinal cord.
• Anxiety and panic: hyperventilation can cause tingling and burning around the mouth and in the hands.
• Erythromelalgia: episodes of red, hot, burning hands or feet triggered by warmth and eased by cooling.
• Burning mouth or vulvar burning syndromes affecting specific areas.

Burning skin at night

Nerve pain is often worse at night, when there are fewer distractions and the skin warms under bedding. Burning feet at night are a hallmark of peripheral neuropathy. Eczema and other itchy, burning rashes also flare at night.

How the cause is diagnosed

A clinician will ask where the burning is, when it started, whether a rash appeared, about new products, sun exposure, medicines, diabetes, alcohol and other symptoms. They examine the skin and test sensation and reflexes. Tests may include:

• blood tests: blood sugar and HbA1c, B12, thyroid, kidney and liver function
• swabs of blisters for the shingles virus
• patch testing for contact allergy
• nerve conduction studies or skin biopsy for small fiber neuropathy
• MRI if multiple sclerosis or nerve compression is suspected

Relief and treatment

For skin causes

• Cool (not ice-cold) compresses or a cool shower.
• Fragrance-free moisturizers, and aloe vera gel for sunburn.
• Stop using any suspected product; wash skin with a gentle cleanser.
• Hydrocortisone 1% cream for small areas of irritant or allergic rash.
• Acetaminophen (paracetamol) or ibuprofen, following the label dose.
• Loose, soft cotton clothing.

For shingles

Antiviral medicines work best when started within 72 hours of the rash. Pain relief and cool compresses help. The shingles vaccine is recommended for adults 50 and older, and for younger adults with weakened immunity, to prevent shingles and postherpetic neuralgia.

For nerve-related burning

• Treat the cause, such as improving blood sugar control or correcting B12 deficiency.
• Prescription medicines that calm nerve signals, such as certain antidepressants or anti-seizure medicines.
• Lidocaine patches or capsaicin cream for localized burning.
• Loosen tight belts and clothing for meralgia paresthetica.

Frequently asked questions

Why does my skin burn but there is no rash?

Burning without a rash usually comes from the nerves rather than the skin. Common causes are early shingles, peripheral neuropathy, nerve compression and, less often, multiple sclerosis or fibromyalgia. If burning is on one side of the body in a band, watch closely for a shingles rash.

Can anxiety cause a burning skin sensation?

Yes. Anxiety can heighten sensitivity to body sensations, and rapid breathing during panic can cause tingling and burning in the hands, feet and around the mouth. Persistent burning should still be checked for nerve or skin causes before it is put down to anxiety.

What does shingles feel like before the rash?

Many people feel burning, tingling, itching or sharp pain in a strip on one side of the body or face for 1 to 5 days before blisters appear. Some feel unwell with headache or fever. See a doctor early, as antivirals work best soon after the rash starts.

What helps burning skin at night?

Keep the bedroom cool, use light bedding, and apply a cool compress before bed. Moisturize dry, irritated skin. For nerve-related burning, such as in neuropathy, a doctor can prescribe medicines that reduce nerve pain and improve sleep.