Can stress cause a rash? Experts reveal links between anxiety and skin

Sometimes, stress leaves its mark on us — physically. Stress rashes can take many forms, experts say, and finding ways to effectively manage those feelings can benefit our skin.

Dr. Shasa Hu tells TODAY.com that she's seen an increase in young patients coming to her with stress-related skin conditions, including stress rashes.

"It's very unfortunate because a lot of times they will try have tried TikTok solutions before like elimination diets," says Hu, an associate professor in the department of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine. "But then, of course, we need traditional medicine and other approaches to address the underlying issue."

Can stress cause a rash?

Stress can lead to a rash, such as hives, and it can exacerbate other rash-like skin conditions, Hu says.

The link between stress and skin goes back to the hypothalamic-pituitary-adrenal axis in the brain, which regulates the body's response to stress, Dr. Evan Rieder, a board-certified dermatologist and psychiatrist in New York City, tells TODAY.com.

As part of that role, the HPA axis controls the release of cortisol, sometimes called "the stress hormone." Cortisol also interacts with your immune system, making skin more prone to flare-ups of conditions like hives, rosacea, psoriasis and eczema.

When it comes to stress rashes, Hu says, "Cortisol revs up the whole immune cascade and that gives people the clinical manifestation."

Plus, during times of stress, different factors can combine to affect your skin, Rieder explains. If you're traveling for work, for instance, your work stress might compound with a lack of good sleep, changes in your diet or even a cold you picked up along the way. Together, those factors can all make skin conditions flare.

"Any time that your sleep is dysregulated, your entire HPA axis gets dysregulated and that feeds directly upon onto the skin," Rieder says.

What does a stress rash look like?

When a stress rash manifests as hives, it looks like raised, itchy bumps on the skin that may be red or pink. Hives can be a collection of individual bumps or connected, making one large bump.

"Hives develop when your blood vessels dilate and become leaky," Dr. Joshua Zeichner, associate professor of dermatology at Mount Sinai Hospital, tells TODAY.com. "Blood cells leak out through the blood vessels to cause this red, itchy raised welt in the skin."

Other times, a stress rash may come with flushing. "People get embarrassed or stressed," Zeichner says, "and some individuals have more reactive blood vessels and can become flushed or blushed."

Sometimes, stress-related rashes go hand-in-hand with another condition called dermatographism (also called dermatographia), Hu says.

To test for dermatographism, dermatologists will drag something dull, like the eraser of a pencil or the end of a tongue depressor, along an area of skin. Normally, this would leave a red mark that goes away within about 10 minutes, Hu explains. But if someone has dermatographism, it can develop into a longer-lasting raised mark or even hives, she says.

Dermatographia isn't harmful, but it can be a sign of underlying hypersensitivity, which may make you more likely to develop a stress rash, Hu explains.

How to prevent a stress rash:

If stress or anxiety is causing rashes, finding stress-management techniques that work for you is important.

"Proactively, you want to do things to minimize the stress in your life as much as you can while understanding that it's not reality to get rid of stress entirely," Rieder says.

That might include massage therapy, breathing exercises, physical activity, balanced nutrition, prioritizing quality sleep, meditation and mindfulness practices or more formal mental health treatment, the experts say.

Even a regular skin-care routine can be part of a calming, consistent mindfulness practice that reduces stress and promotes overall health, Rieder says. "These self-care moments decrease your heart rate, they can decrease your blood pressure, and they can be a moment of respite during times when you're under a lot of stress."

How to treat a stress rash:

While stress relief practices are helpful, they aren't a treatment for stress rashes on their own, Hu says. Patients typically need more traditional medicine as well. And the right way to treat a stress rash depends on which condition you're dealing with.

If you have hives, over-the-counter antihistamines are usually the first step, Rieder says. You can also use topical steroids as needed, Hu says. Other conditions, like acne, rosacea, psoriasis or eczema may require other specialized treatments.

But, if you can, it's better to build stress-management techniques into your life to prevent stress rashes.

Conditions related to stress rash:

Stress can trigger or exacerbate many skin conditions, including:

• Acne

• Rosacea

• Eczema

• Psoriasis

• Hair loss

• Dry skin

"The same hormones that prepare our body to deal with a stressful environment, the hormones involved in that flight or fight response, have been shown to stimulate your oil glands," Zeichner says.

Corticotropin-releasing hormone, which tells your body to release the "stress hormone" cortisol, also affects the oil glands, aka sebaceous glands, in your skin, which can lead to a breakout, he explains.

Increased stress has also been associated with premature aging, skin barrier dysfunction and dryness, as well as impaired wound healing, Ziechner says.

When to see a doctor for stress rashes:

At a certain point, you may need to talk to a medical professional to find better ways to manage your stress rashes.

"If you're recurrently having these — whatever the rash looks like —and it's getting in the way of your quality of life or your ability to function socially or occupationally, then that would be the time to talk to a doctor," Rieder says.

Your doctor or dermatologist may want to do a skin biopsy or blood test to look for underlying conditions that could be contributing to your stress rashes, Zeichner says. For example, in rare cases, your rash could be a sign of a more serious immune system issue called mastocytosis, Hu says. Or it may be related to lupus, Ziechner adds.

A medical professional may also point you in the direction of mental health counseling to help you manage some of the stress. That may be "through cognitive behavioral therapy or just relaxation techniques that can be really helpful," Rieder says.

"Rashes happen to everybody. Sometimes we can explain them, sometimes we can't," Zeichner says. "But if they're recurring and getting in the way of your quality of life, it's time to visit a board-certified dermatologist for evaluation."

This article was originally published on TODAY.com