Stress Rashes and Stress Hives—Here's What You Should Know

Stress can take a toll on your skin. Here's how to help it.

In my experience of working through the COVID-19 pandemic and witnessing protests fighting the world's injustices, my mind felt stressed—and my body's reaction to that stress showed up on my skin.

During this stressful period in my life, I caught myself scratching my chest more than usual under my hoodie. Concerned, I looked down and noticed red splotches from my neck to my navel. I'm not necessarily new to skin issues (I deal with eczema on my hands from frequent hand-washing and stress-related breakouts are pretty normal), but this was different.

The red splotches didn't last long and weren't terribly worrisome, but I still had to know: What was up with them? It turned out, according to a few dermatologists, that I had a stress rash, manifested as my annoyingly itchy chest. So, if you're in the same boat (and let's face it, everyone goes through stressful periods in life), here's everything you need to know.

What Is a Stress Rash—And Can Stress Cause Hives?

"A stress rash is any skin flare-up that stress can trigger," Debra Jaliman, MD, a New York-based dermatologist, said to Health. "If you're under a lot of stress, you can get hives, for example, or you could get an exacerbation of any skin rash that you already have."

Hives, also known as urticaria, according to the American Academy of Dermatology Association are itchy welts that can vary in size and appear anywhere on the body.

"Stress hives typically look like swollen little mosquito bites," Rachel Nazarian, MD, a New York-based dermatologist said to Health. "They're slightly raised, swollen red or pink patches on the skin, but depending on your skin tone they might look a little different." (As a dark-skinned woman, my stress hives looked more reddish-purple with a tiny mosquito bite-like feel.)

Mosquito bite to the neck .
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Johns Hopkins Medicine explained that stress can trigger chronic skin inflammation. Examples of chronic skin conditions that cause inflammation on the skin and can be stress-induced include psoriasis, eczema, or rosacea, among others.

But whatever type of stress rash you're experiencing, you're not alone; everyone experiences stress, and stress rashes and hives may be more common than you think. And if you are a female in your 30s or 40s who has experienced hives before (even if it was a reason other than stress), you may be at a higher risk for stress-related hives, per The American Institute of Stress.

Why Does the Body React to Stress This Way?

When stressed, your body has a chemical response that may contribute to skin inflammation. Harvard Health Publishing explained that when you are stressed, a pathway called the hypothalamus-pituitary-adrenal (HPA) axis is triggered. This process leads to the release of cortisol, other stress hormones, and mast cells.

Mast cells are a key component behind itchy, irritated skin as they make the chemical histamine, per the American Academy of Family Physicians.

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Unfortunately, how that histamine response results in a rash or flare-up of your other skin conditions is still unclear. "We don't know how or why the skin responds to your stress hormones, but it's not a direct relationship," said Dr. Nazarian. "We may not know exactly why the trigger happens, but we know how to fix it."

How Can I Treat a Stress Rash or Hives Caused by Stress?

Luckily, Dr. Nazarian said stress rashes are completely transient, meaning they can go away on their own, usually within 24 hours (though you can probably expect future stress rashes if you start feeling extra stressed again).

But if your stress rash or hives bother you, Dr. Nazarian and Dr. Jaliman recommend over-the-counter treatments. These treatments include antihistamines like Benadryl or Zyrtec, or cortisone cream to decrease the inflammation that results in itchy skin.

Dr. Nazarian also suggested removing any irritating factors like increased heat or tight-fitting clothes around the area of your stress rash. "Heat is known to be an aggravant, as well as pressure," Dr. Nazarian said.

If you don't see any improvements after trying over-the-counter remedies, Dr. Nazarian and Dr. Jaliman recommended taking the time to see a dermatologist. The reason is that the rash could signify something else is going on. "The average person can totally misdiagnose, so don't be afraid to seek out a dermatologist," said Dr. Jaliman.

Treatment may even be as simple as needing a stronger remedy than over-the-counter medication. "There are also some people who require a stronger medication to control the histamine release, so they may want to try a prescription antihistamine or prescription cortisone cream," Dr. Nazarian said. "Some areas have thinner skin that is easy to treat like your arms or legs. But thicker areas like your hands or feet, an over-the counter-cream doesn't penetrate as well."

And if even your non-prescription treatments aren't working, don't fret. Your dermatologist will help you get to the bottom of it. A telehealth visit may even be an option so you don't have to take time out of your day to go to a clinic.

Also worth noting: You can work to prevent a stress rash by relieving stress. Methods you could try include limiting screen time and social media use, practicing mindfulness, or taking a walk outside. Your skin (and mind) will thank you.

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