Significant stress can cause several, unique symptoms. For example, some people noticed that when working through the COVID-19 pandemic, their skin seemed to flare up as their stress levels increased.
Sometimes people may notice scratching their chest more than usual, and then a rash shows up. Splotches can appear from the neck to the navel (belly button), and they may have a red color if you have a lighter skin tone. People who have experienced skin conditions such as eczema before tend to describe this redness and itchiness as different.
These splotches shouldn't last long and shouldn't be a cause for concern. However, they may be annoying and you may be wondering what exactly caused them, as well as how to prevent them.
There is a good chance that stress rashes may be to blame. So, if you've experienced bumpy, itchy skin when stressed (and let's face it, everyone goes through stressful periods in life), here's everything you need to know.
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“A stress rash is any skin flare-up that stress can trigger,” Debra Jaliman, MD, a New York-based dermatologist, said to 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 American 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 said to 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.”
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A study published in the journal Dermatology Practical and Conceptual in 2021 explained how stress can affect the endocrine, immune, and neurological systems. For example, stress can induce inflammation on the skin and result in a stress-induced psoriasis or eczema outbreak.
But whatever type of stress rash you’re experiencing, you’re not alone; everyone experiences stress, and stress rashes and hives may be more common than you think. For example, a study published in 2018 in the journal Advances in Dermatology and Allergology examined the connection between stress and itch in a group of female participants.
The study discussed how stress can play a role in chronic hives. Not only can stress exacerbate the condition, emotional distress can also lower the threshold for itchiness. In other words, severe stress can make you feel itchiness more intensely.
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When stressed, your body has a chemical response that may contribute to skin inflammation. The 2021 study published in the journal Dermatology Practical and Conceptual explained that when you are stressed, a pathway called the hypothalamus-pituitary-adrenal (HPA) axis is triggered. This process leads to the release of cortisol, other stress hormones, and mast cells.
Mast cells are a key component behind itchy, irritated skin as they make the chemical histamine, per the American Academy of Family Physicians.
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Unfortunately, how that histamine response results in a rash or flare-up of your other skin conditions is still unclear. "We don't know how or why the skin responds to your stress hormones, but it's not a direct relationship," Dr. Nazarian said. "We may not know exactly why the trigger happens, but we know how to fix it."
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Luckily, Dr. Nazarian said stress rashes are completely transient, meaning 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 bother you, Dr. Nazarian and Dr. Jaliman recommend over-the-counter treatments. These treatments include antihistamines like Benadryl or Zyrtec, or cortisone cream to decrease the inflammation that results in itchy skin.
Dr. Nazarian also suggested 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 said.
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If you don't see any improvements after trying over-the-counter remedies, Dr. Nazarian and Dr. Jaliman recommended taking the time to see a dermatologist. The reason is that the rash could signify something else is going on. "The average person can totally misdiagnose, so don't be afraid to seek out a dermatologist," Dr. Jaliman said.
Treatment 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 said. "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 nonprescription treatments aren't working, don't fret. Your dermatologist will help you get to the bottom of it. A telehealth visit may even be an option so you don't have to take time out of your day to go to a clinic.
Also worth noting: You can work to prevent a stress rash by relieving stress. Methods you could try include limiting screen time and social media use, practicing mindfulness, or taking a walk outside. Your skin (and mind) will thank you.
A Quick Review
If you find yourself feeling itchy during periods of stress, know you are not alone and that stress may be contributing to your hives or general itchiness. Consider self-care strategies to reduce stress, such as meditating or exercising.
If self-care isn't working or you are concerned about your symptoms, reach out to a healthcare provider for advice. Healthcare providers can work with you to determine an effective treatment plan to reduce your itchiness and help calm your skin.