Dermatological Conditions Inducing Acute and Chronic Pain


  • Mathilde Hayoun-Vigouroux Department of Dermatology, Centre Hospitalier Régional Universitaire Morvan, 2 avenue Foch, FR-29200 Brest, France
  • Laurent Misery



pain, dermatoses, dermatology, neuropathic pain


Pain is a common condition in dermatology. The aim of this review is to analyse the characteristics of pain in dermatology. Some skin diseases are conventionally known to cause pain; e.g. ulcers, pyoderma gangrenosum and herpes zoster. Common dermatoses, such as psoriasis or atopic dermatitis, can also cause significant pain. Some conditions are characterized by neuropathic pain and/or pruritus, without visible primary lesions: e.g. the neurocutaneous diseases, including small fibre neuropathies. Patients often fear pain in skin surgery; however, surgical procedures are rather well tolerated and any pain is mainly due to administration of local anaesthetic. Some therapies may also be uncomfortable for the patient, such as photodynamic therapy or aesthetic procedures. Thus, pain in dermatology is common, and its aetiology and characteristics are very varied. Knowledge of the different situations that cause pain will enable dermatologists to propose suitable analgesic solutions.


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Terminology | International Association for the Study of Pain. International Association for the Study of Pain (IASP). [accessed 2021 Sept 1]. Available from: https: //

Al-Ghazawi FM, Ramien ML, Brassard A, Shear NH, Beecker J. Management of pain associated with selected conditions in dermatology. Am J Clin Dermatol 2016; 17: 463-474. DOI:

Beiteke U, Bigge S, Reichenberger C, Gralow I. Pain and pain management in dermatology. J Dtsch Dermatol Ges 2015; 13: 967-987. DOI:

Enamandram M, Rathmell JP, Kimball AB. Chronic pain management in dermatology: a guide to assessment and nonopioid pharmacotherapy. J Am Acad Dermatol 2015; 73: 563-573; quiz 573-574. DOI:

Misery L, Ständer S. Pruritus, 2nd edn. USA, Springer International Publishing.

Rafaa M, de la Tour A, Sigal M-L. Prise en charge de la douleur en dermatologie: aspects fondamentaux. Ann Dermatol Venereol 2011; 138: 436-441. DOI:

Misery L, Saint Aroman M, Zkik A, Briant A, Martin L, Sigal M-L, et al. Chronic pain in patients with skin disorders. Acta Derm Venereol 2017; 97: 986-988. DOI:

Leren L, Johansen E, Eide H, Falk RS, Juvet LK, Ljoså TM. Pain in persons with chronic venous leg ulcers: a systematic review and meta-analysis. Int Wound J 2020; 17: 466-484. DOI:

Meaume S, Téot L, Lazareth I, Martini J, Bohbot S. The importance of pain reduction through dressing selection in routine wound management: the MAPP study. J Wound Care 2004; 13: 409-413. DOI:

Green J, Jester R, McKinley R, Pooler A. The impact of chronic venous leg ulcers: a systematic review. J Wound Care 2014; 23: 601-612. DOI:

Eusen M, Brenaut E, Schoenlaub P, Saliou P, Misery L. Neuropathic pain in patients with chronic leg ulcers. J Eur Acad Dermatol Venereol 2016; 30: 1603-1605. DOI:

Zhou K, Jia P. Depressive symptoms in patients with wounds: a cross-sectional study. Wound Repair Regen 2016; 24: 1059-1065. DOI:

González-Consuegra RV, Verdú J. Quality of life in people with venous leg ulcers: an integrative review. J Adv Nurs 2011; 67: 926-944. DOI:

Persoon A, Heinen MM, van der Vleuten CJM, de Rooij MJ, van de Kerkhof PCM, van Achterberg T. Leg ulcers: a review of their impact on daily life. J Clin Nurs 2004; 13: 341-354. DOI:

Tamási B, Brodszky V, Péntek M, Gulácsi L, Hajdu K, Sárdy M, et al. Validity of the EQ-5D in patients with pemphigus vulgaris and pemphigus foliaceus. Br J Dermatol 2019; 180: 802-809. DOI:

Fine J-D, Johnson LB, Weiner M, Suchindran C. Assessment of mobility, activities and pain in different subtypes of epidermolysis bullosa. Clin Exp Dermatol 2004; 29: 122-127. DOI:

Brun J, Chiaverini C, Devos C, Leclerc-Mercier S, Mazereeuw J, Bourrat E, et al. Pain and quality of life evaluation in patients with localized epidermolysis bullosa simplex. Orphanet J Rare Dis 2017; 12: 119. DOI:

von Bischhoffshausen S, Ivulic D, Alvarez P, Schuffeneger VC, Idiaquez J, Fuentes C, et al. Recessive dystrophic epidermolysis bullosa results in painful small fibre neuropathy. Brain 2017; 140: 1238-1251. DOI:

Schräder NHB, Yuen WY, Jonkman MF. Pain quality assessment scale for epidermolysis bullosa. Acta Derm Venereol 2018; 98: 346-349. DOI:

Valeyrie-Allanore L, Ingen-Housz-Oro S, Colin A, Thuillot D, Sigal M-L, Binhas M. Prise en charge de la douleur dans le syndrome de Stevens-Johnson/Lyell et les autres dermatoses bulleuses étendues. Ann Dermatol Venereol 2011; 138: 694-697; quiz 692-693, 698. DOI: DOI:

Lefaucheur J-P, Valeyrie-Allanore L, Ng Wing Tin S, Abgrall G, Colin A, Hajj C, et al. Chronic pain: a long-term sequela of epidermal necrolysis (Stevens-Johnson syndrome/toxic epidermal necrolysis) - prevalence, clinical characteristics and risk factors. J Eur Acad Dermatol Venereol 2021; 35: 188-194. DOI:

Vakharia PP, Chopra R, Sacotte R, Patel KR, Singam V, Patel N, et al. Burden of skin pain in atopic dermatitis. Ann Allergy Asthma Immunol 2017; 119: 548-552.e3. DOI:

Huet F, Shourick J, Séité S, Taïeb C, Misery L. Pain in atopic dermatitis: an online population-based survey. Acta Derm Venereol 2020; 100: adv00198. DOI:

Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, et al. Pain is a common and burdensome symptom of atopic dermatitis in united states adults. J Allergy Clin Immunol Pract 2019; 7: 2699-2706.e7. DOI:

Thyssen JP, Halling-Sønderby A-S, Wu JJ, Egeberg A. Pain severity and use of analgesic medication in adults with atopic dermatitis: a cross-sectional study. Br J Dermatol 2020; 182: 1430-1436. DOI:

Maarouf M, Kromenacker B, Capozza KL, Kempton D, Hendricks A, Tran K, et al. Pain and itch are dual burdens in atopic dermatitis. Dermatitis 2018; 29: 278-281. DOI:

Misery L, Belloni Fortina A, El Hachem M, Chernyshov P, von Kobyletzki L, Heratizadeh A, et al. A position paper on the management of itch and pain in atopic dermatitis from the International Society of Atopic Dermatitis (ISAD)/Oriented Patient-Education Network in Dermatology (OPENED) task force. J Eur Acad Dermatol Venereol 2021; 35: 787-796. DOI:

Ikoma A, Fartasch M, Heyer G, Miyachi Y, Handwerker H, Schmelz M. Painful stimuli evoke itch in patients with chronic pruritus: central sensitization for itch. Neurology 2004; 62: 212-217. DOI:

Misery L, Shourick J, Taieb C. Skin pain and psoriasis. J Am Acad Dermatol 2020; 83: 245-246. DOI:

Patruno C, Napolitano M, Balato N, Ayala F, Megna M, Patrì A, et al. Psoriasis and skin pain: instrumental and biological evaluations. Acta Derm Venereol 2015; 95: 432-438. DOI:

Ljosaa TM, Bondevik H, Halvorsen JA, Carr E, Wahl AK. The complex experience of psoriasis related skin pain: a qualitative study. Scand J Pain 2020; 20: 491-498. DOI:

Pithadia DJ, Reynolds KA, Lee EB, Wu JJ. Psoriasis-associated cutaneous pain: etiology, assessment, impact, and management. J Dermatolog Treat 2019; 30: 435-440. DOI:

Loft N, Nguyen TT, Kristensen LE, Thyssen JP, Egeberg A. Disease burden, symptoms, and use of analgesics in patients with psoriasis with or without psoriatic arthritis: a cross-sectional study. J Am Acad Dermatol 2021; 86: 590-597. DOI:

Gallo L, Megna M, Cirillo T, Caterino P, Lodi G, Mozzillo R, et al. Psoriasis and skin pain: real-life effectiveness of calcipotriol plus betamethasone dipropionate in aerosol foam formulation. J Eur Acad Dermatol Venereol 2019; 33: 1312-1315. DOI:

Feldman SR, Krueger GG. Psoriasis assessment tools in clinical trials. Ann Rheum Dis 2005; 64: ii65-68; discussion ii69-73. DOI:

Ljosaa TM, Stubhaug A, Mork C, Moum T, Wahl AK. Improvement in Psoriasis Area and Severity Index score predicts improvement in skin pain over time in patients with psoriasis. Acta Derm Venereol 2013; 93: 330-334. DOI:

Finlay AY. Quality of life assessments in dermatology. Semin Cutan Med Surg 1998; 17: 291-296. DOI:

Blome C, Gosau R, Radtke MA, Reich K, Rustenbach SJ, Spehr C, et al. Patient-relevant treatment goals in psoriasis. Arch Dermatol Res 2016; 308: 69-78. DOI:

Matusiak Ł, Szczęch J, Kaaz K, Lelonek E, Szepietowski JC. Clinical characteristics of pruritus and pain in patients with hidradenitis suppurativa. Acta Derm Venereol 2018; 98: 191-194. DOI:

Patel ZS, Hoffman LK, Buse DC, Grinberg AS, Afifi L, Cohen SR, et al. Pain, psychological comorbidities, disability and impaired qualify of life in hidradenitis suppurativa. Curr Pain Headache Rep 2017; 21: 49. DOI:

Garcovich S, Muratori S, Moltrasio C, Buscemi AA, Giovanardi G, Malvaso D, et al. Prevalence of neuropathic pain and related characteristics in hidradenitis suppurativa: a cross-sectional study. J Clin Med 2020; 9: E4046. DOI:

Le P, Rothberg M. Herpes zoster infection. BMJ 2019; 364: k5095. DOI:

Guenther LC, Lynde CW. A refresher on herpes zoster, current status on vaccination, and the role of the dermatologist. J Cutan Med Surg 2011; 15: 185-191. DOI:

Shumway NK, Cole E, Fernandez KH. Neurocutaneous disease: neurocutaneous dysesthesias. J Am Acad Dermatol 2016; 74: 215-228; quiz 229-230. DOI:

Zagarella S. Nerve entrapment syndromes in dermatology: review and practical approach to treatment. Australas J Dermatol 2018; 59: 286-290. DOI:

Misery L, Bodere C, Genestet S, Zagnoli F, Marcorelles P. Small-fibre neuropathies and skin: news and perspectives for dermatologists. Eur J Dermatol 2014; 24: 147-153. DOI:

Misery L, Ständer S, Szepietowski JC, Reich A, Wallengren J, Evers AWM, et al. Definition of sensitive skin: an expert position paper from the special interest group on sensitive skin of the International Forum for the Study of Itch. Acta Derm Venereol 2017; 97: 4-6. DOI:

Misery L, Weisshaar E, Brenaut E, Evers AWM, Huet F, Ständer S, et al. Pathophysiology and management of sensitive skin: position paper from the special interest group on sensitive skin of the International Forum for the Study of Itch (IFSI). J Eur Acad Dermatol Venereol 2020; 34: 222-229. DOI:

Glass JS, Hardy CL, Meeks NM, Carroll BT. Acute pain management in dermatology: risk assessment and treatment. J Am Acad Dermatol 2015; 73: 543-560; quiz 561-562. DOI:

Talour K, Schollhammer M, Garlantezec R, Quinio B, Misery L. Facteurs prédictifs de la douleur dans les gestes techniques dermatologiques. Ann Dermatol Venereol 2013; 140: 5-14. DOI:

Harris K, Curtis J, Larsen B, Calder S, Duffy K, Bowen G, et al. Opioid pain medication use after dermatologic surgery: a prospective observational study of 212 dermatologic surgery patients. JAMA Dermatol 2013; 149: 317-321. DOI:

Lopez JJ, Warner NS, Arpey CJ, Baum CL, Brewer JD, Otley CC, et al. Opioid prescribing for acute postoperative pain after cutaneous surgery. J Am Acad Dermatol 2019; 80: 743-748. DOI:

Beqqal K, Debie J, Constantin S, Chau E, Burnouf M, Stephanazzi J, et al. Evaluation of local anesthesia and pain control in dermatological surgery: a prospective study of 120 patients. Eur J Dermatol 2010; 20: 349-353. DOI:

Firoz BF, Goldberg LH, Arnon O, Mamelak AJ. An analysis of pain and analgesia after Mohs micrographic surgery. J Am Acad Dermatol 2010; 63: 79-86. DOI:

Limthongkul B, Samie F, Humphreys TR. Assessment of postoperative pain after Mohs micrographic surgery. Dermatol Surg 2013; 39: 857-863. DOI:

Theunissen M, Peters ML, Bruce J, Gramke H-F, Marcus MA. Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain. Clin J Pain 2012; 28: 819-841. DOI:

Sniezek PJ, Brodland DG, Zitelli JA. A randomized controlled trial comparing acetaminophen, acetaminophen and ibuprofen, and acetaminophen and codeine for postoperative pain relief after Mohs surgery and cutaneous reconstruction. Dermatol Surg 2011; 37: 1007-1013. DOI:

Chen AF, Landy DC, Kumetz E, Smith G, Weiss E, Saleeby ER. Prediction of postoperative pain after Mohs micrographic surgery with 2 validated pain anxiety scales. Dermatol Surg 2015; 41: 40-47. DOI:

Fink C, Enk A, Gholam P. Photodynamic therapy - aspects of pain management. J Dtsch Dermatol Ges 2015; 13: 15-22. DOI:

Wang B, Shi L, Zhang YF, Zhou Q, Zheng J, Szeimies RM, et al. Gain with no pain? Pain management in dermatological photodynamic therapy. Br J Dermatol 2017; 177: 656-665. DOI:

Ang JM, Riaz IB, Kamal MU, Paragh G, Zeitouni NC. Photodynamic therapy and pain: a systematic review. Photodiagnosis Photodyn Ther 2017; 19: 308-344. DOI:

Organization WH. Traitement de la douleur cancéreuse. Genève: Organisation mondiale de la Santé. 1987. [Accessed 2021 Jan 26]. Available from: https: //

Wiffen PJ, Derry S, Bell RF, Rice AS, Tölle TR, Phillips T, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev 2017; 6: CD007938. DOI:

Derry S, Wiffen PJ, Aldington D, Moore RA. Nortriptyline for neuropathic pain in adults. Cochrane Database Syst Rev 2015; 1: CD011209. DOI:

Derry S, Bell RF, Straube S, Wiffen PJ, Aldington D, Moore RA. Pregabalin for neuropathic pain in adults. Cochrane Database Syst Rev 2019; 1: CD007076. DOI:

Thompson T, Terhune DB, Oram C, Sharangparni J, Rouf R, Solmi M, et al. The effectiveness of hypnosis for pain relief: a systematic review and meta-analysis of 85 controlled experimental trials. Neurosci Biobehav Rev 2019; 99: 298-310. DOI:

Maillard H, Bara C, Célérier P. Intérêt de l'hypnose dans les injections palmaires de toxine botulique A. Ann Dermatol Venereol 2007; 134: 653-654. DOI:

Paquier-Valette C, Wierzbicka-Hainaut E, Cante V, Charles S, Guillet G. Évaluation de l'hypnose à visée antalgique dans la photothérapie dynamique: étude pilote. Ann Dermatol Venereol 2014; 141: 181-185. DOI:

Shenefelt PD. Anxiety reduction using hypnotic induction and self-guided imagery for relaxation during dermatologic procedures. Int J Clin Exp Hypn 2013; 61: 305-318. DOI:

Zhou M, Chen N, He L, Yang M, Zhu C, Wu F. Oxcarbazepine for neuropathic pain. Cochrane Database Syst Rev 2017; 12: CD007963. DOI:

Watson Brown T, Nelson S, Nelson T. Should nonselective nonsteroidal anti-inflammatory drugs be avoided following dermatological surgery? A critically appraised topic with a proposed approach to postoperative analgesia. Clin Exp Dermatol 2020; 45: 134-136. DOI:

Obagi ZA, Rundle CW, Dellavalle RP. Widening the scope of virtual reality and augmented reality in dermatology. Dermatol Online J 2020; 26: 13030/qt6mz1s20x. DOI:

Higgins S, Feinstein S, Hawkins M, Cockburn M, Wysong A. Virtual reality to improve the experience of the Mohs patient-a prospective interventional study. Dermatol Surg 2019; 45: 1009-1018. DOI:

Sigal M-L, Rafaa M, Caravias J-L. Prise en charge de la douleur en dermatologie: les opioïdes forts. Ann Dermatol Venereol 2011; 138: 524-529. DOI:

Lunn MPT, Hughes RAC, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev 2014; CD007115. DOI:

Gamboa J, Cameron MC, Fathi R, Alkousakis T. A review of non-pharmacologic approaches to enhance the patient experience in dermatologic surgery. Dermatol Online J 2020; 26: qt7mp372nd. DOI:

Al-Qarqaz F, Al-Aboosi M, Al-shiyab D, Al Dabbagh Z. Using cold air for reducing needle-injection pain. Int J Dermatol 2012; 51: 848-852. DOI:

Greveling K, Prens EP, Liu L, van Doorn MBA. Non-invasive anaesthetic methods for dermatological laser procedures: a systematic review. J Eur Acad Dermatol Venereol 2017; 31: 1096-1110. DOI:

Tierney EP, Hanke CW. The effect of cold-air anesthesia during fractionated carbon-dioxide laser treatment: Prospective study and review of the literature. J Am Acad Dermatol 2012; 67: 436-445. DOI:

Baelen E, Dalmas S, Ducloux B, Scherpereel P. Cryoanesthésie par pulvérisation de fréon pour ponction veineuse chez l'enfant. Ann Fr Anesth Reanim 1994; 13: 6-9. DOI:

Kontochristopoulos G, Gregoriou S, Zakopoulou N, Rigopoulos D. Cryoanalgesia with dichlorotetrafluoroethane spray versus ice packs in patients treated with botulinum toxin-A for palmar hyperhidrosis: self-controlled study. Dermatol Surg 2006; 32: 873-874. DOI:

Zhu Y, Peng X, Wang S, Chen W, Liu C, Guo B, et al. Vapocoolant spray versus placebo spray/no treatment for reducing pain from intravenous cannulation: a meta-analysis of randomized controlled trials. Am J Emerg Med 2018; 36: 2085-2092. DOI:

Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev 2015; 2015: CD008242. DOI:

Sobanko JF, Miller CJ, Alster TS. Topical anesthetics for dermatologic procedures: a review. Dermatol Surg 2012; 38: 709-721. DOI:

Cuomo R, D'Aniello C, Grimaldi L, Nisi G, Botteri G, Zerini I, et al. EMLA and lidocaine spray: a comparison for surgical debridement in venous leg ulcers. Adv Wound Care 2015; 4: 358-361. DOI:

Nilsson U. The anxiety- and pain-reducing effects of music interventions: a systematic review. AORN J 2008; 87: 780-807. DOI:

Alam M, Roongpisuthipong W, Kim NA, Goyal A, Swary JH, Brindise RT, et al. Utility of recorded guided imagery and relaxing music in reducing patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures: a single-blinded randomized controlled trial. J Am Acad Dermatol 2016; 75: 585-589. DOI:

Kühlmann AYR, de Rooij A, Kroese LF, van Dijk M, Hunink MGM, Jeekel J. Meta-analysis evaluating music interventions for anxiety and pain in surgery. Br J Surg 2018; 105: 773-783. DOI:

Derry S, Wiffen PJ, Moore RA, Quinlan J. Topical lidocaine for neuropathic pain in adults. Cochrane Database Syst Rev 2014; CD010958. DOI:

Vent A, Surber C, Graf Johansen NT, Figueiredo V, Schönbächler G, Imhof L, et al. Buffered lidocaine 1%/epinephrine 1: 100,000 with sodium bicarbonate (sodium hydrogen carbonate) in a 3: 1 ratio is less painful than a 9: 1 ratio: a double-blind, randomized, placebo-controlled, crossover trial. J Am Acad Dermatol 2020; 83: 159-165. DOI:

Visconti MJ, Haidari W, Feldman SR. Transcutaneous electrical nerve stimulation (TENS): a review of applications in dermatology. J Dermatolog Treat 2020; 31: 846-849. DOI:

Derry S, Rice AS, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev 2017; 1: CD007393. DOI:

Brotzman EA, Sandoval LF, Crane J. Use of nitrous oxide in dermatology: a systematic review. Dermatol Surg 2018; 44: 661-669. DOI:

Gharib K, Mostafa A, Elsayed A. Evaluation of botulinum toxin type A injection in the treatment of localized chronic pruritus. J Clin Aesthet Dermatol 2020; 13: 12-17.

Hu Y, Zou L, Qi X, Lu Y, Zhou X, Mao Z, et al. Subcutaneous botulinum toxin-A injection for treating postherpetic neuralgia. Dermatol Ther 2020; 33: e13181. DOI:

Kim YS, Hong ES, Kim HS. Botulinum toxin in the field of dermatology: novel indications. Toxins (Basel) 2017; 9: 403. DOI:



How to Cite

Hayoun-Vigouroux, M., & Misery, L. (2022). Dermatological Conditions Inducing Acute and Chronic Pain. Acta Dermato-Venereologica, 102, adv00742.

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