Can stress cause rashes? Experts reveal the link between anxiety and skin

Sometimes stress leaves a 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 that she has seen an increase in young patients coming to her with stress-related skin problems, including stress rashes.

“It’s very unfortunate because they’ve tried many times to try TikTok solutions, such as elimination diets,” says Hu, an associate professor in the department of dermatology and cutaneous surgery at the University of Miami School of Medicine. “But then, of course, we need traditional medicine and other approaches to address the underlying problem.”

Can stress cause rashes?

Stress can lead to rashes, such as hives, and can make other rash-like skin conditions worse, 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, Evan Reeder, MD, a board-certified dermatologist and psychiatrist in New York, tells

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 breakouts of conditions such as hives, rosacea, psoriasis and eczema.

When it comes to stress rashes, Hu says, “Cortisol triggers the whole immune cascade and that gives people the clinical manifestation.”

Additionally, during times of stress, various factors can affect your skin, Reeder explains. If you’re commuting, for example, your work-related stress can be exacerbated by a lack of good sleep, changes in your diet, or even a cold you catch along the way. Together, all these factors can cause the skin condition to worsen.

“Whenever your sleep is dysregulated, your entire HPA axis becomes dysregulated and that directly feeds into the skin,” Reeder 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 to form one large bump.

“A rash develops when your blood vessels dilate and leak,” Dr. Joshua Zeichner, an associate professor of dermatology at Mount Sinai Hospital, tells “Blood cells leak through the blood vessels to cause this red, itchy bump on the skin.”

In other cases, a stress rash may come with redness. “People are embarrassed or stressed,” says Zeichner, “and some individuals have more reactive blood vessels and may flush or blush.

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

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

Dermatography isn’t harmful, but it can be a sign of an underlying hypersensitivity, making you more likely to develop a stress rash, Hu explains.

How to prevent stress rash:

If stress or anxiety is causing your rash, it’s important to find stress management techniques that work for you.

“Proactively, you want to do things to reduce stress in your life as much as possible, while understanding that it’s not realistic to get rid of stress completely,” Reeder says.

These may include massage therapy, breathing exercises, physical activity, a balanced diet, prioritizing quality sleep, meditation and mindfulness practices, or more formal mental health treatment, experts say.

Even a regular skin care routine can be part of a calming, consistent mindfulness practice that reduces stress and promotes overall health, Reeder says. “These moments of self-care lower your heart rate, can lower your blood pressure, and can be a moment of respite in times of high stress.”

How to treat a stress rash:

Although stress-relief practices are helpful, they are not a treatment for stress rash by themselves, says Hu. Patients usually need more traditional medicine. And the right way to treat a stress rash depends on the condition you’re dealing with.

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

But if you can, it’s better to incorporate stress management techniques into your life to prevent stress rashes.

Conditions associated with stress rash:

Stress can cause or worsen many skin conditions, including:

  • Acne

  • Rosacea

  • eczema

  • Psoriasis

  • Hair loss

  • Dry goat

“It turns out that the same hormones that prepare our body to deal with a stressful environment, the hormones involved in that flight or fight response, stimulate your sebaceous glands,” says Zeichner.

Corticotropin-releasing hormone, which tells your body to release the “stress hormone” cortisol, also affects the oil glands, also known as sebaceous glands, in your skin, which can lead to breakouts, he explains.

Increased stress is also linked to premature aging, skin barrier dysfunction and dryness, as well as impaired wound healing, Ziechner says.

When to See a Doctor for Stress Rashes:

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

“If you keep getting them no matter what the rash looks like and it’s affecting your quality of life or your ability to function socially or at work, then it might be time to talk to a doctor,” Reeder 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 rash, says Zeichner. For example, in rare cases, your rash could be a sign of a more serious immune system problem called mastocytosis, says Hu. Or it could be related to lupus, Ziechner adds.

A medical professional can also refer you to mental health counseling to help you manage some of the stress. This can be “through cognitive behavioral therapies or just relaxation techniques that can be very helpful,” Reeder says.

“Rashes happen to everyone. Sometimes we can explain them, sometimes we can’t,” says Zeichner. “But if they’re recurring and interfering with your quality of life, it’s time to see a board-certified dermatologist for an evaluation.”

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