Do You Break Out in Hives When You're Stressed? Here's Why


Between working through a pandemic and witnessing protests fighting the world's injustices, my mind isn't the only thing stressed the eff out right now—my skin is, too.

See, a few days ago, 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. 

They didn't last long and weren't terribly worrisome, but I still had to know: What was up with those splotches? Turns out, according to a few dermatologists, I had a stress rash, manifested as my annoyingly itchy chest. If you're in the same boat (and let's face it, you might be right now), here's everything you need to know.

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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, tells 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 Amercan Academy of Dermatology 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 tells 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 . Mosquito bite to the neck . , eczema, rosacea, among others. Depending on your skin condition, related stress rashes will show up in the same spot and manner—anywhere you're exposed to your unique allergens or triggers, or where your body is particularly hot, moist, or feeling pressure like a waistband, bra strap, or arm creases.

But whatever type of stress rash you're experiencing, you're not alone; everyone experiences stress, so stress rashes and hives are super common. According to the Cleveland Clinic, women are more likely to get stress rashes, and sometimes they don't show up until she reaches her 30s, 40s, or 50s. And, of course, the more you're exposed to stress, the more likely you are to experience a stress rash.

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Why does the body react to stress this way?

When you're stressed, your body's cortisol levels begin to increase, leading to increased oil production that can cause acne breakouts, and revving up your body's histamine response, or a release of inflammatory chemicals that often make you feel uncomfortable.

stress-rash-legs stress-rash-legs

How can I treat a stress rash or hives caused by stress?

Luckily, Dr. Nazarian says stress rashes are completely transient, meaning, that 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 are really stressing you out, Dr. Nazarian and Dr. Jaliman both recommend over-the-counter treatments such as antihistamines like Benadryl or Zyrtec, or a cortisone cream to decrease the inflammation that results in itching. Dr. Nazarian also suggests 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 says.

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

It 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 says. "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, even with a simple telehealth visit. 

Also worth nothing: You can work to prevent a stress rash, too, by reducing stress altogether through limiting screen time and social media use, practicing mindfulness, or even taking a walk outside. Your skin (and mind) will thank you.

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