Can Stress Cause Rashes, Hives, and Breakouts?
Stress can wreak havoc on the body and the skin is no exception. Stress can cause rashes and hives and make skin conditions worse in people who already have them. These are called flare-ups and can occur with acne, rosacea, eczema, and psoriasis.
During periods of stress, the body produces cortisol, a stress hormone. Cortisol prepares the body to help fight stress, but it also leads to skin inflammation and rashes.
Stress can also trigger a type of hair loss, called telogen effluvium. Several weeks to months after a stressful life event, your hair may start falling out in clumps. Stress not only triggers these conditions, but having these conditions can also cause stress, creating a vicious cycle.
I get asked every day about stress causing or worsening a skin disease—and my answer is always yes! Stress can affect the body and your general health, and the skin is no exception. Patients are often surprised to hear this. —Dr. Lauren Levy
What are flare-up symptoms?
If you have a skin condition, there may be times when the condition becomes significantly worse. You may suddenly break out with acne or develop itchy patches of eczema. Alternatively, your skin may seem to be healed and then the condition returns. This is called a flare-up.
Flare-ups can be very frustrating, especially if your skin condition was under relative control. But your doctor can treat flare-ups with topical or oral medications.
Skin conditions worsened by stress
Acne, eczema, rosacea, and psoriasis can all worsen during periods of stress or anxiety. It may trigger your body to release high levels of cortisol.
Cortisol can disrupt the skin barrier (the part of the skin that prevents water loss), leading to dry and flaky skin. At the same time, it can lead to an increase in sebum, a skin oil that contributes to acne.
Stress also causes increased inflammation in your body and skin. This inflammation can lead to acne, hives, and skin rashes like psoriasis or eczema.
In addition to the effects of stress itself, stress can lead to poor food choices and poor sleep, which affect the skin and prevent healing. Eating a diet high in sugar and high-glycemic index foods, like pasta and white bread, can eventually cause acne outbreaks.
Some people also respond to stress and anxiety by picking or scratching their skin. This can lead to sores and cuts.
Even though stress can make many rashes and skin conditions worse, there are effective treatments for these conditions. If you have a rash or a skin condition worsened by stress or anxiety, see a dermatologist. They can prescribe topical (applied to the skin) or oral medications. A mental health professional can help you manage your stress and anxiety.
Acne starts when hair follicles get clogged. Bacteria, keratin, and white cells get caught in the follicle, causing inflammation, which leads to a bump on the skin.
When you are under stress, cortisol causes an increase in sebum in the skin, which can make acne worse.
Extremely common: Acne affects 50 million Americans a year.
- Red painful bumps or cysts on the face, chest, or back
- Painful cysts
- Pus-filled bumps
- Blackheads or whiteheads (comedones)
Your doctor may prescribe topical or oral medications, depending on how severe your acne is. These include:
- Over-the-counter (OTC) washes with benzoyl peroxide and salicylic acid
- Adapalene (Differin), an OTC retinoid
- Topical prescription medications like clindamycin or retinoids (tretinoin)
- Oral antibiotics (such as minocycline or doxycycline), oral contraceptives, and oral isotretinoin (Accutane) for moderate or severe acne
It usually takes at least 4 to 6 weeks to see an improvement with an acne regimen. I have seen many patients call or come back from other physicians after a few days of treatment saying there is no improvement. The medications need time to work! —Dr. Levy
In people with eczema, the skin barrier—the wall that protects and keeps the skin moist and hydrated—doesn’t work well and water or moisture can seep through. This causes dry, scaly, and inflamed skin and can lead to itching and burning.
Stress can exacerbate the skin barrier issues, increasing the loss of moisture. Stress also increases inflammation in the skin.
Common: Eczema affects about 25% of children and 2% to 3% of adults.
- Scaly, red patches—often on the creases of the arm or behind the knee
- Keep skin hydrated by moisturizing frequently, even when you don’t have an active rash.
- Use fragrance-free and hypoallergenic products on your skin and for your laundry.
- Take short lukewarm (not hot) showers.
Your doctor may prescribe:
- Steroid creams or ointments
- Oral or injectable medications that block parts of the immune system to decrease inflammation
- Ultraviolet light therapy
Psoriasis is an inflammatory skin disease that causes itchy, red, scaly patches on any part of the body, including the face or genitals or behind the ears. People who also experience arthritis or joint pain may have psoriatic arthritis.
During periods of stress, there is an increase in inflammatory molecules (cytokines) that can worsen psoriasis. Having psoriasis can be a stressor, leading to an ongoing cycle of stress and worsening skin.
Common: Psoriasis is most common in adults at midlife, but children can also have it. It affects 2% of the adult population.
- Red, pink, or silver scaly plaques on the elbows, knees, or scalp
- Yellow or brittle nails
- Joint pain (arthritis) or back pain
- Topical steroids
- Ultraviolet light therapy (for moderate to severe or widespread disease)
- Injectable or oral immunosuppressant medications (for more severe cases)
Rosacea causes red pimples and pus-filled bumps on the face, especially the cheeks and forehead. There is a background of redness and flushing or burning of the skin. With severe cases, the glands of the nose may grow, which increases the size of the nose.
In a survey from the National Rosacea Society, nearly 80% of people said that emotional stress was a trigger for their flare-ups. Stress triggers the inflammatory system, causing blood vessels to open up, or dilate. This makes the skin red and inflamed. Stress hormones also trigger inflammation that leads to pimples.
Very common: About 16 million Americans have rosacea, which is more common in fair-skinned people.
- Red pimples or pus-filled bumps on the cheeks and forehead
- Burning skin
- Burning eyes, impaired vision
- Enlarged nose (rhinophyma)
Rosacea flare-ups can be triggered by certain foods (red wine, spicy foods), irritating skin products (like glycolic acid), or stress. It affects 16 million Americans.
- Use gentle, non-irritating skin products.
- Avoid acidic products (like glycolic acid).
- Reduce alcohol, spicy foods, chocolate, and mint.
- Use OTC or prescription sulfur-based washes.
Your dermatologist may prescribe:
- Topical antiinflammatory medication (metronidazole, ivermectin)
- Oral antibiotics (like doxycycline)
- Laser treatments for redness
Hives are red, itchy welts on your skin that usually last for less than 24 hours. They can be a reaction to a medication, food, something you came in contact with, or a virus. While minor hives are not an emergency, sometimes hives can be part of a serious allergic reaction.
Hives are one of the more common skin diseases that are triggered by stress. The stress hormone adrenaline can release certain molecules in the skin that cause hives. The release of cortisol also causes blood vessels to leak, making skin red and blotchy.
Common: About a quarter of all adults experience hives at some point in their lifetime.
- Red, swollen bumps on the skin
Go to the ER if you notice swelling of your lips or tongue, have trouble breathing, or have diarrhea with an itchy rash.
Otherwise, hives can be treated with OTC oral antihistamines. If your skin doesn’t get better in about a week or symptoms interfere with your daily life, see your doctor. They can help figure out the cause and prescribe other medications to help the hives go away.
Reducing stress can also minimize hive flare-ups.
Lowering stress levels—try meditation and exercise—can be helpful for making a skin disease like acne, rosacea, eczema, and psoriasis better, but it will not cure the disease. You should still use the mediations your dermatologist prescribed. —Dr. Levy
Risk factors & preventative tips
Some conditions are genetic and you may have no control over whether you get them. Since these skin conditions are worsened by stress and anxiety, it’s important to reduce the amount of stress in your day-to-day life. You can try meditation, exercise, yoga, and getting enough sleep.
Seeing a therapist or psychiatrist can help.
A dermatologist can help you get your skin condition under control. You may need gentle creams to keep skin hydrated. Use fragrance-free and hypoallergenic products to maintain the skin barrier and reduce flare-ups.
Dr. Levy is a board certified dermatologist specializing in medical derm with expertise in acne, rosacea, skin cancer, psoriasis, and skin manifestations of rheumatologic disease. Her undergraduate education was completed at the University of Pennsylvania where she graduated summa cum laude and was inducted into the Phi Beta Kappa honors society. She graduated with a distinction in research from the Icahn School of Medicine at Mount Sinai and was inducted into the Alpha Omega Alpha Honor Medical Society. During medical school, she received a one year Doris Duke Clinical Research Fellowship Award. During that time, she investigated imaging techniques for early diagnosis of head and neck cancer. Her training continued with a medical internship at Memorial Sloane Kettering Cancer Center followed by dermatology residency in the Department of Dermatology at Yale University, one of the most prestigious dermatology departments in the country. Following her residency, she worked as a clinical Instructor at Yale School of Medicine. She currently sees patients in New York City and Westport Connecticut and is a Clinical Instructor in the Department of Dermatology at Mount Sinai School of Medicine. She is a Fellow of the American Academy of Dermatology.
Dr. Levy is well published in the field of dermatology having written articles on atopic dermatitis, psoriasis, acne, and skin manifestations of systemic disease. She is an avid lecturer and has been invited to lecture at state wide dermatology meetings. She is the editor of a board review Dermatology textbook.