Stress Rash and Stress Hives: What They Look Like

Can stress cause a rash?

Yes. Stress is a recognised trigger for hives, along with infections, foods, medicines, insect bites and heat.^1,2 It can also set off flare-ups of skin conditions you already have, including eczema and psoriasis.^3,4

What does a stress rash look like?

Most stress rashes are hives, also called urticaria, welts or wheals.¹

• Raised, itchy swellings, usually pink or red, that can look like mosquito bites¹
• They range from small spots to large blotches, in different shapes, and can appear anywhere on the body¹
• They come up in batches. Each welt lasts a few hours, and as one batch fades another may appear somewhere else²
• They leave no mark when they go²

A welt that stays in exactly the same spot for more than 24 hours may be a different condition and is worth showing to a doctor.²

How common are hives?

Very. Around one in six people have a bout of hives at some point in their lives.² The international guideline puts the lifetime figure at about 20 per cent.⁵ In about 80 per cent of cases, no cause is found.²

Why does stress affect the skin?

Hives appear when cells in the skin called mast cells release histamine and other chemicals. Fluid leaks from small blood vessels and the skin swells and itches.²

The skin and the nervous system are closely linked. A review of the research on stress and long-lasting hives describes a loop between nerves, stress hormones, immune cells and the skin. People with chronic hives report high stress levels, though the review could not say whether stress starts the hives or the other way around.⁶

Stress also weakens the skin’s outer barrier. In a study that followed students through exam periods and holidays, their skin was slower to repair itself during high-stress weeks, and the students whose stress rose the most showed the biggest change.⁷

Other rashes that stress can flare

• Eczema. Symptoms come and go, and stress is one of the known triggers, along with heat and skin irritants³
• Psoriasis. Stress can trigger flare-ups.⁴ In a review of 39 studies, 46 per cent of people with psoriasis said their skin reacted to stress, although studies that tried to confirm the link gave mixed results⁸
• Acne. In a study of university students, acne was worse during exams, and the change tracked closely with how stressed each student felt⁹

How long does a stress rash last?

Individual hives usually fade within 24 hours.¹ A bout can come and go for a few days or weeks. When hives keep appearing for more than six weeks, they are called chronic hives. That is uncommon, and it can last months or years.²

How to treat a stress rash

• Cool it down. A cool compress or a cool bath relieves the itch¹
• Avoid heat. Hot showers, sunshine and heat make hives worse²
• Ask a pharmacist. Hives can usually be treated with allergy medicines available without a prescription. A pharmacist can suggest one that won’t make you drowsy^1,2
• Try not to scratch. Scratching makes skin itchier and can disturb your sleep^1,3
• Work on the stress. If stress is the trigger, the rash is likely to return until the pressure eases. See stress and how to calm anxiety

Almost one in three people with chronic hives also has a mental health condition such as anxiety or depression.¹⁰ If that sounds familiar, it is worth raising both with your doctor.

When to get urgent help

Call triple zero (000) and ask for an ambulance if a rash comes with:¹

• Trouble breathing
• Swelling of the face, lips, neck or throat
• Dizziness

These can be signs of a severe allergic reaction.

When to see a doctor

• Hives that don’t go away or keep coming back¹
• Pharmacy treatment isn’t controlling the itch¹
• You aren’t sure the rash is hives
• The rash is painful, blistering, or you also have a fever

References

1. healthdirect. Hives (urticaria).
2. Better Health Channel (Victorian Government). Hives.
3. healthdirect. Eczema.
4. healthdirect. Psoriasis.
5. Zuberbier T, Abdul Latiff AH, Abuzakouk M, et al. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy. 2022;77(3):734-766.
6. Konstantinou GN, Konstantinou GN. Psychological Stress and Chronic Urticaria: A Neuro-immuno-cutaneous Crosstalk. A Systematic Review of the Existing Evidence. Clin Ther. 2020;42(5):771-782.
7. Garg A, Chren MM, Sands LP, et al. Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders. Arch Dermatol. 2001;137(1):53-9.
8. Snast I, Reiter O, Atzmony L, et al. Psychological stress and psoriasis: a systematic review and meta-analysis. Br J Dermatol. 2018;178(5):1044-1055.
9. Chiu A, Chon SY, Kimball AB. The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Arch Dermatol. 2003;139(7):897-900.
10. Konstantinou GN, Konstantinou GN. Psychiatric comorbidity in chronic urticaria patients: a systematic review and meta-analysis. Clin Transl Allergy. 2019;9:42.