Stress affects more than just your emotional health. Some people lose sleep, some get high blood pressure, and others experience red, itchy skin. Unfortunately, getting a skin rash when you’re already stressed isn’t going to help you destress—it will probably only add to your concerns.

Skin rashes caused by stress are sometimes known as “stress hives”. Read on to learn everything you need to know about this uncomfortable skin condition.

Can stress cause hives?

Stress levels can make hives worse but don't necessarily cause them. However, stress can cause a skin rash like hives. The terms “stress rash” and “stress hives” are often used interchangeably. But “skin rash” is an umbrella term for many different types of skin irritation. Hives are specifically a symptom of an allergic reaction.

“Stress generally makes any health condition worse,” says Dr. Allison Edwards, Sesame’s Medical Director. “​​Any chronic condition (i.e. eczema, psoriasis, seborrheic dermatitis, etc…) will get worse with stress.” This is because stress prompts your body releases to chemicals that cause these conditions to flare up.

Hives, like other conditions, get worse with stress. Studies show that stress can increase itchiness in women with chronic hives. Hives can also cause embarrassment, adding further to the stress levels. It’s a nasty catch-22: stress can make hives worse, and the worse they get, the more stress they may cause.

What’s the difference between a skin rash and hives?

Hives are a specific immune response to an allergen; in other words, they are an allergic reaction. Skin rash is a more broad term used to describe irritation of the skin.

“Hives are technically called urticaria and are a specific skin eruption due to a local histamine release,” Dr. Edwards says. “People usually get hives because of a trigger--like a bee sting or food they've eaten.” Allergic reactions are caused by your immune system mistaking these triggers as harmful. Your immune system attacks this allergen by releasing chemicals called histamines. Histamines are supposed to be helping you, but instead, they cause the symptoms of an allergic reaction. Hives is one of these reactions.

The symptoms of hives include:

• Red, raised welts
  
• Itchy bumps on the skin
  
• “Blanching” (whiteness at the center of a welt when pressed)
  
  

Common causes of hives include:

• Foods
  
• Medication
  
• Insect bites
  
• Allergens in the air (like pollen or dust mites)
  
  

“Skin rash” is a more general term used to describe irritated, inflamed skin.

Common symptoms of skin rashes include:

• Raised, red bumps on the skin
  
• Itchiness
  
• Blisters, clear or blood-filled
  
• Blotchiness
  
• Pain
  
• Dry or cracked skin
  
• Bruise-like lesions
  
• Lightened areas of the skin (a common symptom of fungal infections)
  
  

Common types of skin rashes include:

• Contact dermatitis
  
• Rosacea
  
• Eczema
  
• Psoriasis
  
• Impetigo
  
• Chickenpox
  
• Shingles
  
  

What does a stress rash look like?

A stress-induced rash will look a lot like hives. Stress rashes can show up on any part of the body. The most common rash areas include:

• Face
  
• Chest
  
• Back
  
• Legs
  
• Arms
  
• Hands or feet
  
  

A stress rash may appear as:

• Raised red bumps on the skin
  
• Blotchiness (patchy red spots)
  
• Pink or dark-colored patches (in black or brown skin)
  
  

How to get rid of a stress rash fast

Stress rashes can be terribly uncomfortable and, frustratingly, stressful. Luckily, most cases of stress rash can be treated with a combination of home remedies and over-the-counter medications. If you can avoid scratching or irritating your rash more, it will usually clear up within 24 hours.

There are several self-care remedies you can use to reduce rash symptoms. These include:

1. Cool compress: Apply a cool or cold compress, like a washcloth soaked in cool water or an ice pack wrapped in a clean cloth, to the affected area. This can soothe the burning, itching feeling that accompanies skin rashes. Taking a cold shower or bath can have a similar soothing effect. Note: Do not apply ice directly to the skin, as this can cause further irritation.

2. Avoid heat: Try to avoid heat and humidity until your rash goes away. Heat and humid air encourage sweat, which can clog your pores and make skin irritation worse. Keep the air in your house cool and use a dehumidifier to pull excess moisture out of the air. These self-care strategies can also prevent rashes from occurring.

3. Take an oatmeal bath: A lukewarm oatmeal bath soothes irritated skin and reduces itching. Aveeno is a popular, trusted brand for soothing bath treatments.

4. Aloe vera: Aloe vera gel or lotion is commonly used to treat sunburns and heat rash. It can also soothe irritation and itching from a stress rash.

Stress can make hives worse. Antihistamines block the release of histamine, which reduces the inflammation, swelling, and itching symptoms of hives.

Recommended OTC antihistamines include:

• Allegra (fexofenadine)
  
• Zyrtec (cetirizine)
  
• Claritin (loratadine)
  
• Benadryl (diphenhydramine)
  
  

Benadryl can cause drowsiness, so it’s recommended that you only use it at night. Do not operate machinery or vehicles after taking Benadryl.

There are several OTC creams and ointments you can use to reduce the itching and discomfort from a stress rash.

Recommended OTC creams and ointments include:

1. Steroid creams: Hydrocortisone cream (available in its generic form or under the brand name Cortizone): Hydrocortisone cream helps reduce the inflammation, redness, and itching from a skin rash.

2. Calamine lotion: Calamine lotion is a commonly used topical treatment for itchiness.

3. Anti-itch cream: Creams like Benadryl Triple-Action Cream or Aveeno Anti-Itch Cream can help reduce itching from a skin rash. This helps ease discomfort while preventing you from making the rash worse by itching it.
   
   

How to prevent stress rashes

We all get stressed from time to time, but there are some steps you can take to prevent your skin from getting worse.

If stress and anxiety are causing your skin to flare up, practice these self-care techniques.

Stress-reduction strategies include:

1. Seek mental health care: Talking to a mental health care provider is a great way to work through the parts of your life that are causing you stress. Therapy and mental health care aren’t just used to address trauma or mental illness. These visits also provide an outlet for working on your daily stressors, relationship challenges, work issues, and more.

2. Practice mindfulness and deep breathing: Mindfulness and deep breathing are pillars of meditation. They are also effective stress-reduction techniques. You don’t need to be versed in meditation to be able to work these tools into your daily life. Here’s a simple exercise you can do from home:
   

   • Sit in a comfortable position (or lie on your back with your knees bent, pointed upward).
     
   • Place one hand on your lower stomach (just below your belly button) and one hand on your chest.
     
   • On the count of three, breathe deeply through your nose. The hand on your stomach should rise, and the hand on your chest should remain relatively still. If your chest moves but your stomach does not, focus on gently pulling more air into your stomach.
     
   • Release your breath from your lips gently on the count of three.
     
   • Repeat this 3-5 times.
     
     

3. Biofeedback: Biofeedback therapy is a noninvasive process for controlling one's body’s response to stress and discomfort. During a biofeedback session, a provider connects one to a piece of monitoring equipment through electrical pads. The equipment measures involuntary functions like breathing patterns, heart rate, and muscle tension. Providers use the feedback from the machine to get an understanding of how your body responds to stress. Biofeedback can help with:
   

   • Breathing patterns: Your provider can help you improve your breathing to alleviate stress and lower your heart rate.
     
   • Muscle tension: Your provider can offer different sitting, standing, and moving patterns to ease muscle tension caused by stress.
     
   • Mindfulness: Your provider can suggest different mindfulness practices to slow your breathing, which can lower stress levels and heart rate.
     
     

Biofeedback sessions often take about 30-60 minutes. You can undergo biofeedback therapy in physical therapy clinics, medical centers, hospitals, or at home. Biofeedback sessions usually start at $35 for one session. The exact cost of your session will depend on the clinic.

4. Practice healthy habits: A healthy lifestyle maintains your general wellness. These methods are also proven to help reduce stress. Healthy lifestyle habits include:
   
   
   • Exercise regularly
     
   • Eat a healthy diet (rich in fruits, vegetables, whole grains, and lean proteins)
     
   • Stay hydrated
     
   • Avoid alcohol, recreational drugs, and tobacco (these substances can make rashes even worse)
     
   • Prioritize getting 7-8 hours of sleep every night
     
   • Limit social media time
     
     

While you are working to reduce your stress, it’s also helpful to address physical triggers for skin irritation. You can avoid further irritation with simple steps like:

• Use gentle, unscented skincare products and soaps
  
• Use fragrance-free moisturizer to keep your skin hydrated and healthy
  
• Avoid using very hot water for showers, baths, or face rinses
  
• Wear breathable, loose-fitting clothing
  
• Use sunscreen with SPF when going outdoors
  
  

When to see a doctor

Most stress rashes will go away within a day or two. Chronic rashes or chronic hives, however, may require more advanced treatment. Try using the stress management and treatment options listed above to see if you can get rid of the rash on your own. If you experience a rash that lasts longer than a few days, seek medical advice from a healthcare provider.

How Sesame can help

If you’ve had a skin rash for too long, book an online dermatology appointment right away. There is no need to wait for a referral. Sesame connects you with licensed dermatologists without a referral so you can get targeted skin care right away. Providers on Sesame will discuss your symptoms with you, offer treatment options, and prescribe medication if appropriate. Get rid of your stress rash today.

Sources:

• (2022). Feeling stressed? It can show in your skin, hair, and nails. American Academy of Dermatology.
  
• Bin Saif, G. A., Alotaibi, H. M., Alzolibani, A. A., Almodihesh, N. A., Albraidi, H. F., Alotaibi, N. M., & Yosipovitch, G. (2018). Association of psychological stress with skin symptoms among medical students. Saudi medical journal.
  
• Graubard, R., Perez-Sanchez, A., & Katta, R. (2021). Stress and Skin: An Overview of Mind Body Therapies as a Treatment Strategy in Dermatology. Dermatology practical & conceptual.
  
• Hall, J. M., Cruser, D., Podawiltz, A., Mummert, D. I., Jones, H., & Mummert, M. E. (2012). Psychological Stress and the Cutaneous Immune Response: Roles of the HPA Axis and the Sympathetic Nervous System in Atopic Dermatitis and Psoriasis. Dermatology research and practice.
  
• Kayiran, M. A., & Akdeniz, N. (2019). Diagnosis and treatment of urticaria in primary care. Northern clinics of Istanbul.
  
• Niazi, A. K., & Niazi, S. K. (2011). Mindfulness-based stress reduction: a non-pharmacological approach for chronic illnesses. North American journal of medical sciences.
  
• Ograczyk-Piotrowska, A., Gerlicz-Kowalczuk, Z., Pietrzak, A., & Zalewska-Janowska, A. M. (2018). Stress, itch and quality of life in chronic urticaria females. Postepy dermatologii i alergologii.
  
• Worthen, M., & Cash, E. (2023). Stress Management. NIH.