Why your skin hurts to touch
Your nerves normally send information to your brain about touch. But for some people, nerves become oversensitive or their brain’s response to the stimulus is exaggerated. There are two skin sensitivity conditions: Hyperalgesia (hypersensitivity) and allodynia.
Hyperalgesia is when you experience pain from something that is usually just mildly uncomfortable for others. For example, cold can be uncomfortable for many people, but cold may be especially painful in people with hyperalgesia.
Allodynia is pain from something that is not usually painful for others, like when your sheets touch your feet in bed. People with scalp allodynia might describe feeling like their scalp is on fire if they run a brush through their hair.
These symptoms are common in different pain disorders and affect 15% to 50% of people with a pain disorder, according to a review in The Lancet Neurology.
What it feels like
People describe these types of pain in many ways. Some common descriptions are:
- Burning pain or like your skin is on fire
- Like walking on glass
- Stabbing pain or pins and needles pain
What are allodynia symptoms?
“Typical words patients use when describing allodynia are burning, searing, stabbing, broken glass, on fire.”—Dr. Karen Hoerst
A migraine is a severe headache that is often accompanied by nausea and sensitivity to light, sound, or touch. The American Migraine Foundation estimates that about half of people who get migraines experience allodynia. The skin sensitivity often occurs on the scalp and usually on the side of the head that is most affected by the headache.
Medications can be used to stop a migraine headache that has already started. These include a class of drugs called triptans or newer medications called CGRP inhibitors. These can be taken as pills, or be inhaled or injected.
To prevent migraines, you can take blood pressure medications, anticonvulsants, or even antidepressants. Botox treatments can also be used to prevent migraine.
Your doctor may also recommend behavior and lifestyle changes, such as exercise, proper sleep, a healthy diet, or weight loss, to help decrease the number of migraines you get.
2. Diabetic neuropathy
- Numbness in hands or feet
- Burning pain in hands and feet
- Problem with balance
Diabetic neuropathy occurs when a person with diabetes (too much glucose or sugar in the bloodstream) develops nerve damage (neuropathy). This damage tends to occur in the parts of the nerves that are the farthest from the brain and spinal cord, like the feet and hands.
In some cases, the damage may cause pain. You may notice this pain at night when you get in bed and put the sheets over your feet. It can feel like burning pain or pins and needles or like you’re walking on broken glass.
When the damage is severe, the loss of sensation can increase your risk of developing injuries or ulcers on the feet.
Treating diabetic neuropathy
Your doctor may need to do other tests, such as nerve conduction tests, to determine the cause of your neuropathy. The most important thing you can do is to keep your blood sugar under control. Once diabetic neuropathy develops, the numbness is usually not reversible but the pain can be managed with medications like gabapentin.
3. Complex regional pain syndrome
- Severe pain over a part of the body
- Sensitivity to touch (hypersensitivity or allodynia)
- Skin color changes
Complex regional pain syndrome, or CRPS, typically happens after an injury, such as a fracture or sprain. The cause of CRPS is not known.
CRPS usually begins a few weeks to months after the injury and causes severe or deep pain. Allodynia or skin sensation changes may also occur. CRPS may also cause changes in skin color (becoming either pale or purplish), temperature (skin can be warm or cold), and swelling at the site of pain.
CRPS is difficult to treat and usually requires a variety of approaches. Physical therapy and occupational therapy can help improve your pain symptoms.
Medications such as ibuprofen and gabapentin can control your pain. Over-the-counter creams such as lidocaine or capsaicin (pepper) creams may help to lessen allodynia symptoms.
At times, cognitive behavioral therapy can be used to help identify other pain triggers and help with coping strategies.
Why does my skin suddenly feel sensitive?
“If you have pain with activities that shouldn’t typically cause pain, talk to your doctor. There might be an underlying reason for the pain that needs to be addressed or a way to improve the symptoms you are experiencing."—Dr. Hoerst
4. Shingles and postherpetic neuralgia
- Burning pain
- Rash, often on your side and back
Shingles or herpes zoster is caused when the virus that causes chickenpox gets reactivated. It is common in older adults and people with immune system disorders like HIV or those receiving chemotherapy for cancer.
The reactivated virus causes inflammation and damage to nerve cells leading to a painful rash. The rash often occurs on your side and back, but it can occur on any part of your body. It typically follows the path of a single nerve called a “dermatome.”
If the virus affects the eye area, it can cause damage to the eye. This occurs in about 10% to 25% of people who get shingles. Rarely, in less than 1% of people who get shingles, it can cause an infection in the brain, called meningoencephalitis. This is more common in people who are over the age of 60, pregnant, or immunocompromised.
Shingles is treated with antiviral medications like valacyclovir and pain medications, such as ibuprofen or gabapentin. After the shingles rash goes away, you can have ongoing pain in the area. Taking antiviral medications early can help reduce the likelihood of chronic pain (called postherpetic neuralgia). Your doctor may prescribe gabapentin for long-term pain, but if the pain is severe, you may need other pain medications.
- Vulvar pain
- Pain with sex
Vulvodynia is pain in the external part of the female genital area, called the vulva. The pain is often described as burning, and can be triggered or worsened by things such as sex, inserting a tampon, clothes that are tight, and sitting or riding a bike. The cause is unknown. It’s not clear how prevalent vulvodynia is because women often don’t tell their doctors about it.
Treatments include pelvic floor therapy, biofeedback, lidocaine and hormone creams, or antidepressants.
Other possible causes
Other conditions may also cause skin hypersensitivity, including stroke and fibromyalgia.
When to call the doctor
If you are having ongoing problems with skin sensitivity, talk to your doctor to see if a cause can be identified. If you develop a rash with severe pain, you may have shingles and should get treatment right away and see if other testing is needed.
If you notice sensation problems in your feet, such as numbness or tingling, call your doctor. It could be a sign of diabetes.
Red spot on skin hurts to touch
“You need to let your doctor know if you have any headaches or vision changes, especially if your rash is on or near your face and eye. Shingles can cause serious complications if it affects the eye or brain and it is important to identify these complications early for appropriate treatment.”—Dr. Hoerst
Should you go to the ER?
If you have a sudden change in sensation (either loss of sensation or pins and needles sensation) that affects one side of the body, go to the ER immediately to be evaluated for a stroke.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen.
- Over-the-counter creams like lidocaine cream and capsaicin cream
- Seizure and nerve pain medications like gabapentin or antidepressants like venlafaxine
- Physical therapy (including pelvic floor therapy for vulvodynia)
- Medication injections from pain management such as steroids
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