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.

1. Acne

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.

Main symptoms

• Red painful bumps or cysts on the face, chest, or back
• Painful cysts
• Pus-filled bumps
• Blackheads or whiteheads (comedones)

Treating acne

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

2. Eczema

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.

Main symptoms

• Scaly, red patches—often on the creases of the arm or behind the knee
• Dryness
• Itchiness

Treating eczema

• 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

3. Psoriasis

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.

Main symptoms

• Red, pink, or silver scaly plaques on the elbows, knees, or scalp
• Yellow or brittle nails
• Joint pain (arthritis) or back pain

Treating psoriasis

• Topical steroids
• Ultraviolet light therapy (for moderate to severe or widespread disease)
• Injectable or oral immunosuppressant medications (for more severe cases)

4. Rosacea

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.

Main symptoms

• Red pimples or pus-filled bumps on the cheeks and forehead
• Flushing
• 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.

Treating rosacea

• 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

5. Hives

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.

Main symptoms

• Welts
• Red, swollen bumps on the skin
• Itchiness

Treating hives

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.