Can Stress Cause Hives? The Answer Is Complicated
Stress Can Make Hives Worse in Those Who Are Already Prone to Getting Them
“For most individuals, stress isn’t an independent risk factor for hives — or else wouldn’t we all have hives?” says Adam Friedman, MD, a professor of dermatology at the George Washington University School of Medicine & Health Sciences in Washington, DC.
It’s much more likely that stress plays a role in the development of hives in those who are already susceptible to getting hives, he adds.
RELATED: All About the Physical Toll Stress Takes on Our Bodies
For instance, there is some evidence that hives may affect women more than men. (1) Hives are also more common in people with autoimmune diseases. (2) And hives also tend to be common in people who have other allergic reactions, too — and when they do, stress can make those hives worse.
If you fall into one of those groups, stress may trigger hives. But for other individuals stress alone may not be enough to trigger hives.
There is one form of chronic hives, cholinergic urticaria (wherein the hives are triggered by elevated body temperature), in which emotional stress can induce the rash, says Anthony M. Rossi, MD, an assistant attending dermatologist at Memorial Sloan Kettering Cancer Center in New York City. And that condition tends to be more common in people with conditions like asthma, eczema, and allergic rhinitis.
Stress may influence hives in another way, too, if that stress causes you to pick or scratch your skin (which is a common habit, Dr. Friedman says). Friction or pressure on the skin is a risk factor for hives, and the act of scratching that skin can cause the release of the chemical histamine, he says. When that happens, your body reacts by producing a hive.
Another mechanism by which stress affects hives is in people who have a condition called dermatographia, Dr. Rossi says. When people who have this condition scratch their skin, even lightly, those scratches result in a raised welt that looks like a hive. The skin has erroneously released histamine because it’s not been triggered by a response from the body’s immune system, but rather by an external stimulus, like exercise, heat, stress, vibration, or exposure to the cold. (3)
Doctors aren’t entirely sure what causes this condition, but it’s estimated to affect 2 to 5 percent of the population. (3)
Ask the experts
Before my wedding, before job interviews, and anytime I have a bit of stress, my arms, wrists, and hands break out in an itchy rash. Can stress cause a rash? How do I prevent this from occurring, and how do I treat it?
Stress is one of the known triggers of hives, an outbreak of raised, red spots (or welts) on the skin that often itch. Hives are usually indicative of an allergic reaction, but they can also occur as a result of sun or cold exposure, infections, excessive perspiration, and emotional stress. It is not known exactly why stress may precipitate an outbreak of hives, but it is likely related to the known effects of stress on the immune system. The medical term for hives is urticaria.
Developing an effective stress management plan may be able to help reduce the outbreaks if your rash is indeed related to stress. Your doctor can also order tests for allergies that may be causing the outbreaks. There are a number of ways to ease the symptoms of hives, including taking over-the-counter antihistamines to reduce itching, cool compresses or baths, wearing nonirritating, loose-fitting clothes, and avoiding excessive sweating, direct sunlight, and hot baths. If hives are severe, your doctor may recommend taking prescription antihistamines or other medications to help control the outbreak.
Stress Rash: Tips for Identification, Treatment, and More
It’s possible to confuse a stress rash with other common skin conditions. These include:
- heat rash
- pityriasis rosea
- contact dermatitis
Here’s what you need to know:
If you live or work in hot, humid conditions, you may be experiencing heat rash. This happens when your pores become blocked and sweat is unable to escape.
The most common form of heat rash, miliaria crystallina, causes clear or white bumps. Miliaria rubra can cause small red bumps that itch similar to hives.
Unlike some cases of hives, heat rash almost always clears up on its own. It typically goes away in a few days. Consult your doctor if you begin to experience:
- pus draining from the bumps
Pityriasis rosea is a common type of rash that often goes away on its own. It typically starts with a large patch of red, raised skin. This “mother patch” or “herald patch” may be surrounded by small red bumps called “daughter patches” that are typically oval in shape. It’s also sometimes called a Christmas tree rash.
It’s unclear what causes this rash, but it’s most common during the spring and fall. It may or may not be itchy.
Pityriasis rosea typically fades without treatment in six to eight weeks. During this time, you can use an OTC anti-itch medication, like diphenhydramine (Benadryl) or cetirizine (Zyrtec) to ease your symptoms.
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If your symptoms worsen or persist, consult your doctor. They may be able to recommend a prescription-strength anti-itch medication.
Rosacea is another common skin condition. Depending on the type, it often causes small, red — sometimes pus-filled — bumps to form on the skin. The skin can thicken in these areas.
The rash typically covers the cheeks, nose, and forehead, but it can involve other areas of the face. These bumps may appear for weeks to months before disappearing and appearing again at a later time.
Although rosacea can affect anyone, it’s most common in middle-aged women who have fair skin. There’s no cure for rosacea, so treatments focus on management techniques. This includes wearing a broad-spectrum sunscreen and moisturizing frequently.
If you think you’re experiencing rosacea, consult your doctor. They can make a diagnosis and prescribe medication to help reduce redness.
Prescription medications include:
Contact dermatitis is usually an acute condition that causes a red, itchy rash to appear on the skin. You may also experience bumps or blisters, swelling, and tenderness.
The exact cause of contact dermatitis varies from person to person, though it develops after coming into contact with something that triggers nonallergic irritation or an allergic reaction on your skin.
Common causes include:
- plants, such as poison ivy
- laundry detergent
Although it’s helpful to identify the exact cause of your contact dermatitis, there are steps you can take to treat this general rash.
- applying anti-itch glucocorticosteroid cream or calamine lotion
- taking OTC anti-itch medication, such as diphenhydramine (Benadryl)
- soaking in a cool oatmeal bath
- avoiding scratching
- using mild soaps without dyes or perfumes
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If your symptoms persist after one to two weeks, consult your doctor. They can make a diagnosis, if needed, and prescribe prescription-strength medication.
Eczema is a chronic condition that can also make your skin red and itchy. Although it begins most commonly in children, it can occur at any age.
Eczema generally starts as small, raised bumps. These bumps may leak fluid if scratched. The rash can also form thickened areas of the skin — called plaques — over a larger area.
You may also experience red patches around your:
- hands or wrists
- feet or ankles
- upper chest
- face, especially the cheeks
- elbow crease
- knees, generally on the back
You may be able to manage your symptoms by:
- applying an anti-itch glucocorticosteroid cream or calamine lotion
- taking an oral anti-itch medication, such as diphenhydramine (Benadryl)
- moisturizing at least twice daily
- taking an oatmeal bath
- using a humidifier
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Consult your doctor if your symptoms persist for more than one to two weeks. They can make a diagnosis and prescribe medication.