What is the treatment for burning sensations?

Treatment of Burning Sensations

The treatment of burning sensations depends critically on the underlying cause: for burn injuries, immediate cooling followed by bland emollients and systemic analgesia is the cornerstone; for dermatologic conditions like acne, reducing application frequency and using concurrent emollients mitigates treatment-related burning; and for neuropathic burning as in erythromelalgia, topical amitriptyline-ketamine combinations with systemic gabapentin are first-line therapies. 1

Burn-Related Burning Sensations

Immediate Management

• Cool the burn with clean running water for 5-20 minutes to reduce pain and limit tissue damage, but only for burns with total body surface area <20% in adults and <10% in children without shock 1, 2, 3
• Remove jewelry before swelling occurs 3
• Monitor for hypothermia during prolonged cooling, particularly in children 3

Topical Pain Relief

• Apply bland emollients such as 50% white soft paraffin and 50% liquid paraffin to support barrier function, reduce water loss, and encourage re-epithelialization 1, 3
• Petrolatum (Vaseline) applied as a thin layer after cooling provides effective pain relief and wound protection 3
• For patients with sulfa allergies, use petrolatum-based antibiotic ointments containing polymyxin B or bacitracin instead of silver sulfadiazine 3
• Aloe vera gel or medical-grade honey can be applied directly to burns 3

Systemic Analgesia

• Short-acting opioids (fentanyl) combined with titrated IV ketamine are the preferred agents for severe burn-induced pain, as ketamine reduces morphine consumption while maintaining spontaneous breathing 1, 2
• Oral acetaminophen or NSAIDs provide adequate relief for minor burns 3
• Multimodal analgesia combining both acetaminophen and NSAIDs is recommended for significant pain 2, 3
• Inhaled nitrous oxide is useful when IV access is unavailable 1, 2
• General anesthesia is appropriate for highly painful procedures like dressing changes 1, 2

Critical Cautions

• Avoid alpha-2 receptor agonists (dexmedetomidine) in the acute phase due to hemodynamic instability risks 1, 2
• Insufficient evidence exists for lidocaine use in burn patients 1, 2
• External cooling devices should not remain in place during transport to prevent hypothermia 1

Dermatologic Treatment-Related Burning

Topical Retinoid-Induced Burning

• Reduce application frequency and use concurrent emollients to mitigate burning, stinging, and irritation from topical retinoids 1
• Apply tretinoin formulations in the evening due to photolability 1
• Concurrent daily sunscreen use reduces photosensitivity-related burning 1

Benzoyl Peroxide-Induced Burning

• Lower concentrations and water-based or wash-off formulations are better tolerated than higher concentrations and leave-on products 1
• Burning sensation is concentration and formulation-dependent 1

Capsaicin-Induced Burning

• Counsel patients that capsaicin causes initial stinging and burning sensations that typically resolve after several days of regular use 1, 4
• Apply 0.025% to 0.075% cream 3-4 times daily for 6 weeks 1, 4
• Test first on a small area of skin 4
• Avoid contact with eyes, lips, nose, and mucous membranes 4
• Stop use if severe burning persists or blistering occurs 4

Neuropathic Burning (Erythromelalgia)

First-Line Topical Therapy

• Compounded amitriptyline-ketamine cream (up to 5% combined concentration) is the preferred topical treatment for neuropathic burning 1
• This requires preparation in a compounding pharmacy 1
• Topical amitriptyline gel (ATX01) received FDA orphan drug designation in 2020 for erythromelalgia 1

Adjunctive Topical Options

• Clonidine transdermal patches (0.1-0.3 mg daily) offer weekly application convenience and can be placed anywhere on the body 1
• Over-the-counter diclofenac 1% gel or compounded gabapentin 6% ointment may provide additional relief 1
• Products containing camphor, menthol, or methyl salicylate can be used 1

Systemic Therapy Algorithm

1. Step 1: Aspirin 325 mg orally daily for 1 month trial (evidence-based, preferred) 1
2. Step 2: Gabapentin starting at 300 mg at bedtime (up to 2400 mg daily in 3 divided doses) or pregabalin 75-300 mg every 12 hours (evidence-based, preferred) 1
3. Step 3: SSRIs (sertraline preferred), amitriptyline, or sodium channel blockers (mexiletine, carbamazepine) for 3-4 month trials 1
4. Step 4: Pain rehabilitation center referral if recalcitrant 1

Pemphigus-Related Burning

Blister Management

• Offer analgesia prior to blister care procedures, as many patients report pain or burning during treatment 1
• Pierce blisters at the base with sterile needle (bevel up) to drain fluid, but leave blister roof intact as biological dressing 1
• Apply bland emollient after drainage 1

Pain Control

• Provide both acute and maintenance (background) analgesia with ability to deliver timely boosts during dressing changes 1
• Pain team consultation may be necessary for severe cases 1

Adjunctive Non-Pharmacological Approaches

• Virtual reality or hypnosis techniques may reduce pain intensity and anxiety when patients are stable 1, 2
• Covering burns with appropriate fatty dressings improves pain control 1, 5
• Regular emollient use (250-500 g weekly) is recommended for inflammatory skin conditions 6

Common Pitfalls to Avoid

• Do not apply heat to areas treated with capsaicin immediately before or after use 4
• Do not tightly wrap or bandage capsaicin-treated areas 4
• Do not use capsaicin on wounds or damaged skin 4
• Avoid prolonged use of silver sulfadiazine on superficial burns as it may prolong healing 1
• Do not delay other resuscitation interventions to apply burn dressings in the prehospital phase 1