Stress is on the rise, and it gets worse every year. Everyone is feeling it due to supply chain issues, COVID, inflation, and global conflicts. Not only does it take its toll on work productivity, but also on many people's physical and mental well-being. For many, stress manifests itself in the form of headaches, stomach ulcers, or high blood pressure, while others suffer from skin rashes.
Stress can cause internal medical problems, as well as rashes and hives.
Hives appear as small or large, itchy welts on the body.
There are over-the-counter treatment options for mild cases and prescription medications for severe cases.
Stress-relieving activities may help prevent or treat stress-related rashes.
A stress rash is a common rash that may appear when a person is overwhelmed with anxiety or stress. The rash typically presents as small hives and, most commonly, appears on the face, chest, neck, and hands. However, stress rash hives can occur anywhere on the body.
Stress-related skin rashes explained
When you become stressed, your body releases various chemicals and hormones. Many of these hormones, such as cortisol, can cause skin hyperreactivity and inflammation. Stress also activates the immune system, which leads to the release of certain chemicals (cytokines) that cause skin inflammation. As a result, neurotransmitters are released, which directly act on skin cells to cause inflammation and itch. All these play a role in the development of stress-related skin rashes.
Types of stress rashes
Stress can cause two different types of skin rashes: hives or a flare-up of pre-existing rashes. Hives, also called urticaria, can be caused by stress, as well as internal medical problems, medications, or viral illnesses. Since stress makes your skin hyperreactive and inflamed, this can trigger a flare-up of any pre-existing skin conditions, such as eczema, psoriasis, acne, rosacea, and cold sores.
What does a stress rash look like?
Hives can present as small pink-red round welts, which may coalesce into larger welts or appear in clusters. The lesions are not scaly or crusty unless scratched. Typically, there are no blisters or pus bumps. Hives may itch, burn, or cause a tingling sensation. However, they usually disappear in less than 24 hours but may re-appear elsewhere on the skin. In most cases, the rash will disappear completely in a few days. If you are unsure if this is a stress rash, see your doctor right away.
Ways to treat rashes at home
There are several effective over-the-counter treatments for hives. For example, cool compresses, cool showers, or ice packs can help relieve itching. Also, warm, not hot, oatmeal baths can soothe the skin. Hot water may irritate the skin and cause dehydration and dryness. Additionally, antihistamine pills and hydrocortisone cream can help calm the inflammation and itch. However, some antihistamines can make you drowsy, so do not operate machinery or drive while taking them. Furthermore, cortisone creams, like hydrocortisone, are only meant to be used for a short time since long-term use can cause permanent skin damage.
It is important to keep your skin free of irritation during an outbreak of hives. Hydrate your skin with a dye and fragrance-free moisturizing cream twice a day. Also, only use mild, moisturizing soaps without dyes and fragrances to cleanse your skin. Avoid any skin products, fabric softeners, or laundry detergents containing dyes and fragrances since they further irritate the skin. Finally, avoid scratching the affected areas, which may lead to infection, bleeding, and scarring.
Can I get stress rash prescriptions?
If over-the-counter treatments are not helping, your doctor can prescribe stronger medications. For example, there are prescription-strength antihistamines pills and cortisone creams to calm the inflammation in your skin and lessen the itch. In severe cases, oral steroids, immunosuppressants (cyclosporin or methotrexate), or immunomodulators (Xolair or Dupixent) might be needed. These meds are reserved for severe cases because of the possible side effects, such as infection, cancers, and immunosuppression. Sometimes, the rash might get infected from scratching and require oral antibiotics.
When to see a dermatologist
Most cases of hives resolve on their own quickly with minimal amounts of over-the-counter medications. However, some severe outbreaks may require a doctor's help. If you are unsure if you are suffering from a stress rash, see your doctor immediately. Here are some warning signs to look for:
- Rash involving the inside of the nose, mouth, or eyes
- Rash persisting longer than six weeks
- Blisters or pus
- Peeling skin
- Rash covering your entire body
- Swollen lymph nodes
If you have difficulty breathing or swallowing or have swollen tongue or lips, CALL 911 — it's an emergency!
Tips to manage stress and rashes
It is always better to prevent a medical problem than to treat one. However, there are some ways to help relieve stress that may prevent a rash from appearing. Stress-relieving activities may also alleviate the internal damage stress causes to your body. Some useful examples include the following:
- Group therapy sessions
- Proper diet
- Eight hours of restful sleep
- Fun activities with your friends and family
Stress is harmful to our physical, mental, and emotional well-being. Some activities may help prevent the damage that stress does to the body. However, they may not work in all cases. If you do break out in a minor stress rash, some over-the-counter treatments can help. If you develop a severe rash, see your doctor immediately. If you have difficulty breathing or swallowing or get swollen lips or tongue, call 911 immediately.
- Saudi Medical Journal. Association of psychological stress with skin symptoms among medical students.
- Journal of the Danish Medical Association. Work-related stress urticaria.
- Clinical Therapeutics. Stress-induced Interaction of Skin Immune Cells, Hormones, and Neurotransmitters.
- American College of Allergy Asthma & Immunology. Perceived stress links income loss and urticaria activity during the coronavirus disease 2019 pandemic.