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Stress affects every aspect of our lives and how you cope has a big impact on your overall health, including your skin. If you have hives, stress can cause a flare-up of hives. Such "stress rash," the sudden appearance of swollen, red, or skin-colored bumps, most often on the face, neck, chest, or arms, may resemble mosquito bites and itch, tingle, or even hurt.

Stress can also make other, pre-existing skin conditions worse, including psoriasis, eczema, dandruff, and acne. If you have allergies, stress can increase your sensitivity to allergens, including tree pollen, animal dander, certain foods, and fabrics. As for the reasons, for now at least, it is not known why stress causes hives.

Today, the identical fight-or-flight response can be triggered by situations at work, home, or school. Perhaps you're feeling overwhelmed in your new job, or you're worried about final exams. Maybe you're losing sleep over credit card debt or an argument with your best friend. This ancient stress response, instead of helping you fight for your life or run for the hills, could be causing you to gain weight, have frequent headaches, or make your blood pressure and cholesterol rise.

Fortunately, most stress-induced rashes go away on their own within a few days. However, if the rash is itchy, try to resist the urge to scratch, since that can further inflame the skin and cause micro-tears that increase the risk of infection.

A cool compress or an ice pack may help relieve redness and itch, and the use of an over-the-counter, non-sedating antihistamine (like loratadine) can also help relieve symptoms. If stress-induced hives last longer than a week, or symptoms return, see your doctor. Together, you can prevent stress rash from becoming a vicious cycle.

It's important to recognize that stress-induced hives may be a sign that you need to reduce the stress in your life. You're not alone. A recent survey shows that long-term stress caused by the COVID-19 pandemic is affecting the health of many Americans. Researchers say that between 2019 and 2023, the rates of chronic illness such as heart disease and arthritis rose by 10% among people ages 35 to 44. Post-pandemic, ongoing global conflict, racial injustice, inflation, and climate-related disasters are also increasing the impact of everyday stressors such as work, finances, and relationships.

While it may not be possible to prevent stressful situations, you can take back some control by learning how to reduce the impact.

At the top of the list: Move your body. Schedule some form of exercise into your day. Go for a walk, a jog, a bike ride, or a swim. Play pickleball or go paddle boarding. Relaxation and mindfulness activities such as yoga and meditation are also highly effective at counteracting the effects of stress.

You'll feel better and look better, and you'll sleep better too.

Additional Resources:

Read previous installments in this series:

For Your Patients: All About Hives

For Your Patients: Understanding the Many Different Types of Hives

For Your Patients: How Will My Doctor Diagnose Hives?

For Your Patients: What's the Best Treatment for Hives?

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.