Burning Sensation on Face and Arms: Differential Diagnosis

Burning dysesthesia of face/arms suggests:

Dermatologic

• Atopic/contact dermatitis, rosacea, seborrheic dermatitis.
• Herpes zoster (dermatomal, vesicular, pre-eruptive pain).
• Solar urticaria, polymorphous light eruption.

Neurologic

• Trigeminal neuralgia (face), cervical radiculopathy (arm), small fiber neuropathy (diabetes, Sjögren’s, idiopathic).
• Multiple sclerosis (Lhermitte’s, paroxysmal dysesthesias).

Systemic

• SLE, scleroderma, dermatomyositis (photosensitivity, vasculopathy).
• Carcinoid syndrome (flushing + burning).
• Medication reactions (chemotherapy, ARBs, statins).

Evaluation

History (distribution, triggers, timing), neuro exam, labs (ANA, ESR, glucose, B₁₂, TSH), EMG/NCS if neuropathy suspected, skin biopsy for small fiber. Treatment targets etiology.