Differential Diagnosis for New Onset Skin Burning in a 67-Year-Old
Single Most Likely Diagnosis
- Neuropathic pain: This is often due to nerve damage or dysfunction, which can be caused by various factors including diabetes, vitamin deficiencies, or age-related wear and tear. The absence of a rash and systemic symptoms supports this diagnosis, as neuropathic pain can manifest without visible skin changes.
Other Likely Diagnoses
- Dry skin (xerosis): Common in the elderly due to decreased skin moisture, dry skin can cause a burning sensation, especially in low humidity environments or during winter months.
- Eczema (atopic dermatitis): Although the question specifies no rash, early or mild cases might not have visible lesions, and the burning sensation can precede the appearance of a rash.
- Contact dermatitis: An allergic or irritant reaction to substances like soaps, detergents, or certain fabrics can cause skin burning without an obvious rash, especially if the reaction is mild.
Do Not Miss Diagnoses
- Shingles (herpes zoster): Early stages of shingles can present with burning pain before the characteristic rash appears. Missing this diagnosis could lead to delayed antiviral treatment and potential complications like postherpetic neuralgia.
- Multiple myeloma: Although rare, multiple myeloma can cause neuropathic pain or skin sensations due to nerve damage or amyloid deposits. It's crucial to consider this in the differential due to its severe prognosis if left untreated.
- Vitamin B12 deficiency: A deficiency in vitamin B12 can lead to neuropathy, causing burning sensations among other neurological symptoms. This condition is treatable with supplementation, making early diagnosis critical.
Rare Diagnoses
- Complex regional pain syndrome (CRPS): A chronic pain condition characterized by burning pain, among other symptoms, usually following an injury. It's less common but should be considered if other diagnoses are ruled out.
- Erythromelalgia: A disorder characterized by burning pain, heat, and redness in the hands and feet. It can be primary (genetic) or secondary to other conditions like myeloproliferative disorders.
- Sjögren's syndrome: An autoimmune disorder that can cause neuropathic pain, including burning sensations, among its myriad of symptoms. It's less likely but should be considered in the context of other systemic symptoms or autoimmune diseases.