The feeling of skin burning, medically known as dysesthesia or paresthesia, is an abnormal sensation that occurs without any external heat source. This uncomfortable symptom can manifest as tingling, prickling, stinging, or a painful heat, often signaling a disruption in the body’s sensory signaling system. While a temporary “pins and needles” feeling after a limb “falls asleep” is common and harmless, chronic or unexplained burning sensations can point to a wide range of underlying issues. These causes can stem from surface-level skin inflammation to complex problems involving the nervous system or systemic diseases.
Inflammatory and Allergic Skin Conditions
A burning sensation may be directly related to inflammation and irritation on the skin’s surface, where the immune system is actively responding to a trigger. This type of burning often co-occurs with visible signs like redness, a rash, or scaling.
Contact dermatitis is a common culprit, resulting from the skin’s reaction to an irritant or an allergen. Irritant contact dermatitis, which is generally more painful than itchy, can be caused by harsh chemicals, soaps, or prolonged exposure to water. Allergic contact dermatitis involves a delayed hypersensitivity response to a substance like nickel, latex, or certain cosmetic ingredients.
Conditions like eczema frequently cause burning and stinging, particularly during a flare-up. The skin’s barrier function is compromised in eczema, leading to increased dryness, inflammation, and heightened sensitivity to external stimuli. Rosacea, a chronic facial skin condition, commonly presents with burning and flushing. Severe dryness, known as xerosis, can also make the skin feel tight and painfully hot.
The Role of Nerve Damage (Neuropathic Causes)
When the burning sensation originates not from surface inflammation but from within the nervous system, it is termed neuropathic pain, involving damaged or dysfunctional nerves. This mechanism results in the nerves sending confused or heightened pain signals to the brain, even when there is no actual stimulus.
Small-fiber neuropathy (SFN) affects the small nerve fibers responsible for transmitting pain and temperature sensations. Damage to these fibers causes the burning quality of pain, often described as an electric shock, prickling, or painful cold sensation. This type of neuropathy frequently begins in the feet and hands, sometimes exhibiting a “stocking-glove” distribution.
Another localized neuropathic cause is nerve compression, or entrapment, where physical pressure on a nerve disrupts its function. Examples include carpal tunnel syndrome, where a nerve in the wrist is compressed, or a pinched nerve in the spine, which can cause burning and numbness along the nerve’s path. Post-herpetic neuralgia (PHN) is a persistent and painful complication following a shingles outbreak, caused by the varicella-zoster virus damaging nerve fibers. This condition is defined as continuous burning or stabbing pain lasting for at least 90 days after the rash has healed.
Internal Diseases and Systemic Triggers
The skin’s burning can also be a symptom of a systemic medical condition, often by initiating or exacerbating nerve damage or chronic inflammation. The most common systemic cause of neuropathy is diabetes mellitus, where persistently high blood sugar levels gradually damage peripheral nerves, leading to burning and tingling in the extremities.
Autoimmune conditions, such as systemic lupus erythematosus or Sjögren’s syndrome, can trigger a burning sensation by causing inflammation that attacks the body’s own tissues, including the peripheral nerves. Even thyroid disorders can play a role, as both hypothyroidism and hyperthyroidism can lead to peripheral neuropathy or changes in skin integrity that result in sensory abnormalities.
A deficiency in certain micronutrients, particularly vitamin B12, is a direct systemic trigger for nerve dysfunction. Vitamin B12 is necessary for maintaining a healthy nervous system, and low levels can cause the development of paresthesia. Additionally, many prescription medications, including some chemotherapy agents, can cause drug-induced neuropathy, leading to chronic burning pain.
Seeking Professional Diagnosis
A burning skin sensation that is persistent, unexplained, or interferes with daily life warrants a medical evaluation to identify the underlying cause. Sudden onset of severe burning, rapid spreading, or accompanying symptoms like muscle weakness, numbness, or fever require immediate attention.
Diagnosis typically begins with a detailed medical history and a physical examination, including inspection of the affected skin and a neurological assessment. To investigate systemic causes, initial diagnostic steps often include blood tests to check for diabetes, thyroid dysfunction, and vitamin deficiencies, especially B12. If nerve damage is suspected, specialized tests such as nerve conduction studies or electromyography may be used to assess the function and health of the peripheral nerves.