You’ve had a rough day. Your to-do list is getting longer by the minute. And to make matters worse, your skin suddenly looks how you feel — stressed! But is it a stress rash or something else?

Summit Health dermatologist Elizabeth Ghazi, MD, helps answer this question and offers tips to help you deal with outbreaks of hives, acne, and itchy or dry skin.

1.  Stress rash is a term that doesn’t tell the whole story.

“There really isn’t a stress rash, per se,” says Dr. Ghazi. “But stress can definitely flare pre-existing skin conditions.” These include:

• Psoriasis, commonly seen as dry, thick, or raised patches that can itch. Patches can have a thin, silvery-white coating called scales and typically appear on the elbows and knees.
• Acne or the redness and acne-like breakouts associated with rosacea. These conditions tend to affect the face, chest, and back.
• Dandruff, or flaking, itchy skin that can appear on the scalp or folds of the face.
• Eczema. Atopic dermatitis, the most common type of eczema, can cause dry, itchy skin and a rash anywhere on the body.

Dr. Ghazi notes these conditions can look different across skin tones. “Darker skin tones may have less redness to their rash but more skin lightening or darkening where the rashes would typically appear,” she says.

2.  Stress triggers an inflammatory response that can affect your skin.  

So how does stress trigger these flare-ups? Dr. Ghazi explains it has to do with cortisol, a hormone that plays many important roles in the body, including regulating your body’s stress response.

“Cortisol is being produced by our adrenal glands as part of the ‘fight or flight’ response. This powerful hormone increases inflammation in the body, so inflammatory skin diseases such as psoriasis will worsen,” she explains.

“Cortisol also triggers our skin oil production, which makes conditions like acne and dandruff worse,” Dr. Ghazi continues. “This is often why students get pimples or worsening dandruff before exams.”

3.  Some say stress rash when referring to hives.

A skin reaction called hives causes smooth, raised bumps or welts to suddenly appear. Also known as urticaria, hives can show up anywhere on the body — alone or in a group — in various shapes and sizes. They can look red or pink on lighter skin tones or roughly the same color as the skin on darker complexions. Hives can itch, burn, or tingle.

Hives develop when your body releases histamine. Normally, the immune system releases this chemical and others to protect you when it recognizes a threat, such as an injury or infection. Sometimes, though, the immune system can overreact to harmless substances and release histamine.

Dr. Ghazi says that while stress can trigger hives, it’s usually not the only culprit. Often, hives are caused by:

• An allergic reaction to certain foods, chemicals, insect bites and stings, medications, pet dander, or pollen
• Viral or bacterial infections
• A reaction to cold, heat, or sweat
• Pressure or friction on the skin, such as with tight clothing or a shoulder strap

4.  Stress rash and hives are treatable.

Psoriasis, acne, rosacea, dandruff, and eczema can be long-lasting conditions, but they can be controlled with oral and topical medications and other therapies. Learning to recognize and avoid triggers also helps. A dermatologist can evaluate your skin issues and recommend a treatment plan to meet your needs.

“Don’t hesitate to ask your provider anytime you have a question,” says Dr. Ghazi. “Sometimes, a rash isn’t related to stress and can be something else entirely.”   

When it comes to hives, most cases clear up in 24 hours. But be aware that new ones can form. Still, mild cases of hives tend to go away in a few days. In the meantime, over-the-counter and home remedies can help with discomfort. These include:

• Antihistamine medication (note that some can make you drowsy)
• A cool compress, such as a wet washcloth
• Using lukewarm water and mild soap when bathing
• Wearing loose-fitting, 100% cotton clothes
• Not scratching your hives

Talk to your provider if your hives last longer than a few days. And seek immediate medical care if you ever get hives and feel your lips, mouth, tongue, or throat swelling or have trouble breathing.

5.  Stress management can help control flare-ups.

According to recent surveys, Americans are among the most stressed people in the world. And chronic stress can have serious effects on the body, including skin health.

Although you can’t always prevent stressful situations from happening, you can manage how you respond to them. Dr. Ghazi suggests some ways to cope:

• Relaxing exercises, such as yoga and walking
• Mindfulness activities, including breathing exercises and meditation
• Calling or getting together with a friend
• Getting enough sleep at night

She also recommends talking to a behavioral health specialist if you need additional support.

A stress-induced rash or hives can be physically and emotionally uncomfortable. However, managing your condition and triggers can help prevent a vicious cycle. “Stressing about your skin makes most skin conditions worse, so don’t hesitate to seek help from a dermatologist or mental health professional,” says Dr. Ghazi.