Based on NIH | Can fibromyalgia cause a skin rash, and how can I tell if a new rash is related to fibromyalgia or another condition?

Fibromyalgia does not typically cause a true skin rash on its own. Fibromyalgia is best known for widespread pain, fatigue, sleep problems, and sensory sensitivity; standard medical summaries list pain, stiffness, sleep issues, “fibro fog,” tingling or numbness, and sensitivity to temperature, light, and noise but not a characteristic rash. ^{[1] [2]} People with fibromyalgia may feel burning, stinging, or tingling of the skin and can be more sensitive to stimuli, which can make normal skin issues feel more intense. ^{[3] [4]}

What skin symptoms can occur with fibromyalgia?

• Heightened skin sensations: Many report burning, tingling, throbbing, or soreness of the skin without visible changes. These are sensory symptoms, not rashes. ^[3]
• Sweating changes: Increased sweating (hyperhidrosis) has been found more often in people with fibromyalgia than other specific skin diagnoses. ^[5]
• Itch without clear cause: Some individuals report itching or neurodermatitis-related lesions, but no single rash pattern is unique or consistently overrepresented in fibromyalgia. ^[5]

Why skin symptoms happen

A subset of people labeled with fibromyalgia may actually have or overlap with small‑fiber neuropathy (SFN), a condition affecting tiny nerve fibers that control pain and autonomic functions like sweating. Objective testing has shown reduced nerve fiber density in skin biopsies in some individuals diagnosed with fibromyalgia, which can explain burning pain, dysesthesia, and sweating changes. ^{[6] [7]} SFN often presents with burning pain, abnormal temperature sensation, and autonomic symptoms such as altered sweating, rather than a distinct rash. ^{[8] [9]}

Can fibromyalgia cause a butterfly rash or bruising?

A “butterfly” rash across the cheeks and nose, easy bruising, swollen lymph nodes, mouth ulcers, and Raynaud‑like color changes of the fingers are more suggestive of autoimmune diseases like lupus, not fibromyalgia. These features point toward conditions that can co‑exist with fibromyalgia but are distinct and need separate evaluation. ^[10]

How to tell if a new rash is related to fibromyalgia vs. another condition

Because fibromyalgia itself does not have a hallmark rash, a new visible rash is more likely from another cause (for example, dermatitis, infection, allergy, medication reaction, autoimmune disease, or sun sensitivity). Use the checklist below:

• Visible changes vs. sensations only:

  • If you have burning or tingling without visible redness, bumps, blisters, or scaling, fibromyalgia-related sensory symptoms or SFN may be contributing. ^{[3] [6]}
  • If you see a clear rash (redness, bumps, blisters, scaling, oozing, crusting), think of dermatitis, infection, allergy, or autoimmune causes. ^[11]

• Location and pattern:

  • Butterfly pattern across cheeks and nose suggests lupus rather than fibromyalgia. ^[10]
  • Rash after sun exposure may suggest photosensitive eruptions rather than fibromyalgia. ^[12]

• Triggers and timing:

  • Contact with new soaps, plants, metals (nickel), or cosmetics suggests contact dermatitis. It often itches and may swell or ooze. ^[11]
  • New medications or supplements can cause drug eruptions.

• Systemic symptoms:

  • Fever, joint swelling, mouth ulcers, hair loss, color changes of fingers in the cold, or swollen lymph nodes raise concern for autoimmune disease. ^[10]

• Autonomic features without rash:

  • Excess sweating, heat intolerance, or orthostatic dizziness can point toward small‑fiber neuropathy, which can overlap with fibromyalgia. ^{[8] [13]}

When to seek medical care

Most rashes are not emergencies, but certain features need prompt attention. Seek urgent care if the rash is widespread, painful, rapidly spreading, blistering around eyes/mouth/genitals, or paired with trouble breathing. ^{[12] [14]} Call your clinician if the rash is extremely itchy, severe or widespread, looks worrisome, involves sensitive areas (eyes, mouth, face, genitals), or doesn’t improve within about three weeks. ^[11]

Practical steps you can take

• Document the rash: Take clear photos in good light, note when it started, exposures (new products, outdoors/sun), new medications, and associated symptoms (fever, joint pain, mouth sores). This helps your clinician distinguish causes. ^[11]
• Gentle skin care: Use fragrance‑free cleansers and moisturizers; avoid hot water and scratching; consider a short course of over‑the‑counter hydrocortisone for localized itchy dermatitis unless near eyes or broken skin. Stop new topical products if irritation begins. ^[11]
• Track sensory symptoms: If you have burning/tingling without visible rash plus sweating changes or temperature sensitivity, ask your clinician about evaluation for small‑fiber neuropathy (skin biopsy or autonomic tests may be considered). ^{[6] [8]}
• Review medications: Some pain medicines, antibiotics, and supplements can trigger rashes; share a full list with your clinician. ^[14]

Key takeaways

• Fibromyalgia itself does not have a defining skin rash; it is primarily a pain and sensory processing condition. ^{[1] [2]}
• Skin sensations (burning, tingling) and sweating changes can occur and may reflect overlapping small‑fiber neuropathy. ^{[3] [6]}
• A visible new rash is more likely due to another condition such as dermatitis, allergy, infection, photosensitivity, or autoimmune disease and should be evaluated if severe, persistent, or accompanied by other symptoms. ^{[11] [12] [14]}

If you’d like, I can help you sort through your specific rash features and exposures to narrow down likely causes and next steps.