Differential Diagnosis for Burning Nerve Pain in Thighs and Stretch Mark-Like Streaks

Single Most Likely Diagnosis

• Lichen Sclerosus: This condition is characterized by thin, white, and wrinkled skin patches, often accompanied by itching, pain, or burning sensations. The stretch mark-like streaks in the inner thighs near the pelvis could be indicative of lichen sclerosus, especially given the location and description.

Other Likely Diagnoses

• Nerve Entrapment or Compression: Conditions such as meralgia paresthetica, where the lateral femoral cutaneous nerve is compressed, can cause burning pain in the thighs. This could be a plausible explanation for the burning nerve pain.
• Erythema Nodosum: This condition involves the formation of painful nodules under the skin, often on the shins but can appear elsewhere, including the thighs. It could potentially cause burning pain and might be associated with skin changes.
• Psoriasis or Eczema: Both conditions can cause skin lesions and itching or burning sensations. While less likely to cause the specific pattern of stretch mark-like streaks, they should be considered in the differential diagnosis due to their potential to cause skin changes and discomfort.

Do Not Miss Diagnoses

• Diabetic Neuropathy: Although less likely given the specific location and nature of the skin changes, diabetic neuropathy can cause burning nerve pain and should not be missed due to its implications for diabetes management and potential for significant morbidity.
• Lymphoma or Other Malignancies: Certain malignancies can cause skin changes and nerve pain. While rare, missing a diagnosis of lymphoma or another cancer could have severe consequences, making it crucial to consider in the differential diagnosis.

Rare Diagnoses

• Sjögren's Syndrome: An autoimmune disorder that can cause skin and nerve symptoms, including burning sensations. It's less common but could be considered if other diagnoses are ruled out.
• Notalgia Paresthetica: A condition characterized by burning pain or itching in the middle to upper back but can occasionally present in other areas, including the thighs. It's rare and usually involves the skin changes or hyperpigmentation rather than stretch mark-like streaks.
• Fabry Disease: A genetic disorder that can cause burning pain in the extremities, including the thighs, due to nerve involvement. It's rare and typically presents with systemic symptoms, but it should be considered in cases where other diagnoses are not fitting.