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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
You’ve been stressed out. You feel a little itchy, look at your skin, and see red blotches on your body. Is this a stress rash, or could it be something else?
What causes a stress rash?
When you feel stressed, your body’s nervous system releases stress hormones, including cortisol. Cortisol is an important hormone that affects your entire body, including your immune system and how your body handles stress.
While mild stress doesn’t usually cause skin rashes, extreme or chronic stress levels can affect your skin because of higher than average cortisol. The increased cortisol triggers your immune system to be more reactive. Your immune system then makes your skin more sensitive and can cause redness, hives, and skin rashes (Konstantinou, 2020).
In some people, emotional stress alone can cause a skin rash. For others, hives or skin rash can have physical causes, including other illnesses, things you eat or drink, or your environment.
Other people have an allergic or histamine reaction to medications like penicillin or other antibiotics, pet dander, or plant pollen. Some people have allergic reactions to food. Some of the more common food allergies include dairy (specifically, cow’s milk), nuts, wheat, corn, and soy. Some people develop an allergic skin rash to sunlight, water, or temperature (Bansal, 2019).
These allergic reactions cause the blood vessels to widen, bringing more blood to the skin’s surface. This causes skin redness and swelling. Some people may feel that the skin surface where the rash is located is warmer or more sensitive than other areas. That sensitivity can increase the discomfort of the skin rash and itchy skin (Golpanian, 2021).
Some people feel embarrassed or frustrated by their red, bumpy, itchy skin, which can itself increase stress levels and trigger a stress rash. It can become a vicious cycle. Most stress rashes are short-lived and usually mild, but you may want to take action to manage the outbreak to stop the stress – skin rash – stress cycle (Golpanian, 2021).
No matter the cause of the skin rash, drinking alcohol or caffeine or being in a warm environment can worsen the hives and itchy skin.
How do I know it is a stress rash and not something else?
Hives—sometimes called wheals or welts—usually characterize a stress skin rash. Hives are red, swollen, and can be flat or raised. They range in size from very small (the size of the tip of your pinky) to very large (the size of a dinner plate). They can be separate or connected, forming a large red patch (Dabija, 2021).
Hives, wheals, or welts don’t have a preferred place to be on the body; they can occur anywhere on the skin. Some people may develop just one, while others can have them over the entire body (Dabija, 2021).
Usually, hives are pretty itchy, though some people may feel tingling, stinging, or burning sensations rather than itchy skin. Hives don’t usually last long. Each hive generally lasts about 24 hours, but some people may keep getting new hives after the older one fades away. If this continual cycle lasts more than six weeks from the first breakout of stress hives, this is called chronic urticaria (Schaefer, 2017).
Please note: if your hives come with fever, joint and body pain, large fluid-filled blisters, or skin peeling, please seek medical advice or see your dermatologist as soon as possible. These symptoms may require prescription-strength medication or other interventions.
If your face or lips swell up or you can’t breathe, this can be a life-threatening allergic reaction. Please go to the nearest emergency room immediately.
Other types of skin rashes
Other skin rashes may look like a stress rash, including:
- Contact dermatitis resembles stress rash, but is caused by an allergic reaction or a histamine release from a substance touching the skin. Usually, people get contact dermatitis from soap, detergent, certain fabrics, metal jewelry, or plants like poison ivy. This type of itchy rash can happen to anyone at any time (Murphy, 2019).
- Eczema is a chronic condition with small bumps that form red patches called plaques. These red bumps are itchy and can occasionally have fluid inside of them. Eczema usually begins in childhood, but anyone can develop this condition throughout their lifetime. You can find this skin condition anywhere on the body (Nemeth, 2020).
- Heat rash is caused by hot and humid weather. This type of rash can happen to anyone at any age. Some people’s pores get clogged, and they can’t sweat, which causes small, white, or clear bumps on the skin. Some people have red bumps instead and those are much itchier than the clear bumps. This type of skin rash almost always clears up by itself, even without any treatment (Guerra, 2020).
- Pityriasis rosea is another type of skin rash that usually clears up without treatment. This rash can occur in people of any age but is most common in those aged 15–30. It’s sometimes called a Christmas tree rash because of its shape. It usually has a single large rash, sometimes called the “herald or mother patch,” that arrives first. The mother patch may then be surrounded by smaller rashes, known as “daughter patches.” Some people get this rash in autumn or spring. It lasts about 6–8 weeks and is usually not itchy (Lichtman, 2020).
- Rosacea happens on the face rather than the body. It causes small, raised, red bumps on the forehead, nose, and cheeks. Some people develop thickened skin in those areas. Rosacea comes and goes and is considered a chronic condition. Middle-aged women with fair skin are more prone to rosacea (Farschian, 2020).
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Although these skin rashes have other causes, stress hormones can also affect the skin with a stress rash occurring simultaneously. These stress hormones can also prevent your skin from healing faster.
Typically, most stress skin rashes will clear up quickly—usually within a few days. However, if your skin rash lasts longer than six weeks, it’s time to seek some medical advice if you haven’t already.
What is the treatment for stress rash?
Some people find their stress rashes and hives resolve even without treatment. Others need to control the itch. You can easily treat a stress skin rash at home with over-the-counter antihistamines, such as (Schaefer, 2017):
- Allegra (fexofenadine)
- Benadryl (diphenhydramine)
- Claritin (loratadine)
- Zyrtec (cetirizine)
Some people also find relief by cooling their skin either by bathing or showering in cool water or using cold compresses on the itchy skin.
When should I seek medical advice?
While most people can treat their stress skin rash at home, you may want to see your healthcare provider if you have any of the following:
- Your hives have yellow or green fluid in them or are very hard.
- You have areas of peeling skin or a fever or pain together with the skin rash.
- You just took antibiotics or another medication.
These are not stress rash symptoms and require medical attention.
If you have a preexisting skin or health condition like psoriasis, you may want to speak to your healthcare provider as soon as you see hives. You may need to adjust your medications or treatment.
If over-the-counter antihistamines don’t work for treating your itching and hives, your healthcare provider may order prescription-strength antihistamines, oral steroids (prednisone), or even antibiotics. If these don’t work, the next step is seeing a dermatologist or an allergist.
Preventing stress rash
You can’t totally remove all physical and emotional stressors from your life. Still, there are stress management techniques that can help you. While most of these are for overall wellness, they can help reduce your stress levels and improve your skin if you are prone to stress skin rashes (Golpanian, 2021).
- Diet—Make sure to eat a high-quality, nutritious, and balanced diet. Stress skin rash comes from inflammation, and you can reduce the effects of inflammation by removing processed and sugary foods and increasing fruits, vegetables, and water in your diet.
- Exercise—Move your body to decrease the impact of stress. Exercise releases hormones that combat the excess cortisol that affects your skin’s integrity. Some people begin a yoga practice to help them reduce their stress levels.
- Sleep—Make sure you get enough sleep. Good sleep helps lower cortisol, which in turn decreases inflammation.
- Skincare—Create a skincare routine to improve the health and quality of your skin.
- Relaxation—Give yourself time for quiet reflection or meditation, or do something that helps you relax. Some people get a massage, listen to music, dance, bake, or take a luxurious bath.
- Support—Some people reduce their stress levels by talking to a good friend, spiritual guide, or therapist.
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An itchy problem
It is not always possible to prevent a stress skin rash. Both physical and emotional stress can cause itchy hives. Most people find they go away on their own. If they don’t, you can use over-the-counter antihistamines to treat the itching, inflammation, and irritation and prevent it from getting worse. If you continue to have a stress skin rash for more than six weeks or notice other symptoms, seek medical advice.
- Bansal, C.J., Bansal, A.S. Stress, pseudoallergens, autoimmunity, infection and inflammation in chronic spontaneous urticaria. Allergy Asthma & Clinical Immunology 15, 56 (2019). doi: 10.1186/s13223-019-0372-z. Retrieved from https://aacijournal.biomedcentral.com/articles/10.1186/s13223-019-0372-z
- Dabija, D., & Tadi, P. (2021). Chronic urticaria. StatPearls [Internet]. Retrieved from https://www.statpearls.com/ArticleLibrary/viewarticle/43025
- Farshchian, M., & Daveluy, S. (2020). Rosacea. StatPearls [Internet]. Retrieved from https://www.statpearls.com/ArticleLibrary/viewarticle/28642
- Golpanian, R. S., Kim, H. S., & Yosipovitch, G. (2020). Effects of stress on itch. Clinical Therapeutics, 42(5), 745-756. doi: 10.1016/j.clinthera.2020.01.025. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0149291820300643
- Guerra, K. C., & Krishnamurthy, K. (2020). Miliaria. StatPearls [Internet]. Retrieved from https://www.statpearls.com/ArticleLibrary/viewarticle/25158
- Henry, D., Ackerman, M., Sancelme, E., Finon, A., & Esteve, E. (2020). Urticarial eruption in COVID-19 infection. Journal of the European Academy of Dermatology and Venereology : JEADV, 34(6), e244–e245. doi: 10.1111/jdv.16472. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262133/
- Konstantinou, G. N., & Konstantinou, G. N. (2020). Psychological stress and chronic urticaria: a neuro-immuno-cutaneous crosstalk. a systematic review of the existing evidence. Clinical Therapeutics; 42(5): 771-782. doi: 10.1016/j.clinthera.2020.03.010. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0149291820301727
- Litchman, G., Nair, P. A., & Le, J. K. (2020). Pityriasis rosea. StatPearls [Internet]. Retrieved from https://www.statpearls.com/ArticleLibrary/viewarticle/27255
- Murphy, P. B., Hooten, J. N., Atwater, A. R., & Gossman, W. (2019). Allergic contact dermatitis. StatPearls [Internet]. Retrieved from https://www.statpearls.com/ArticleLibrary/viewarticle/19927
- Nemeth, V., & Evans, J. (2020). Eczema. StatPearls [Internet]. Retrieved from https://www.statpearls.com/ArticleLibrary/viewarticle/20891
- Schaefer, P. (2017). Acute and chronic urticaria: evaluation and treatment. American Family Physician, 95(11), 717-724. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28671445/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.