Fire needle acupuncture for postherpetic neuralgia of the oral mucosa after initial misdiagnosis: a case report

Background: The incidence of herpes zoster of the oral mucosa is relatively low, and there are rare clinical reports, which might be misdiagnosed as oral infection or oral ulcer. Case presentation: Here, we report the case of a 40-year-old Chinese female patient who was misdiagnosed with oral infection at first, where the 15-day treatment at the other clinic did not relieve her pain. She reported pain localized to the ulcer, radiating to the left zygomatic and mandibular regions, hypogeusia on the left side of the tongue, reduced appetite, and difficulty in eating. We used fire needle acupuncture, a traditional Chinese medical practice that involves the use of heated needles to stimulate specific acupoints, to prick the lesion. After five treatments over 14 days, the affected area was pain-free, with most of the ulcer surface healed, and the other symptoms resolved. Conclusion: Oral herpes zoster can be diagnostically challenging. This case report suggests that fire needle acupuncture might offer a potential benefit in alleviating its pain. However, definitive conclusions regarding efficacy require confirmation through rigorous randomized controlled trials. © The Author(s) 2025.