Can Stress Cause Hives?

Hair loss. Muscle tension. Stomach problems.

Stress can cause a lot of weird things to happen to your body. But can it cause hives, too?

The answer is complicated. While it’s possible for stress to trigger hives, experts say it probably isn’t to blame in most cases.

“For most individuals, stress isn’t an independent risk factor for hives — or else wouldn’t we all have hives?” says Adam Friedman, MD, a professor and the chair of dermatology at The George Washington University School of Medicine & Health Sciences in Washington, DC.

It’s much more likely that stress can trigger hives in people who are already susceptible to getting them, he says.

For instance, there is some evidence that hives may be more common in people who have an autoimmune disease.

Hives also tend to be common in people who have other allergic reactions, too. And stress can make their hives worse.

If you fall into one of those groups, stress may trigger hives. But for other people, stress alone may not be enough to trigger hives.

An exception to the rule is one form of chronic hives: cholinergic urticaria (where the hives are triggered by elevated body temperature), in which emotional stress can induce the rash, says Anthony M. Rossi, MD, an assistant attending dermatologist at Memorial Sloan Kettering Cancer Center in New York City. And that condition tends to be more common in people who have other conditions, such as asthma, eczema, and allergic rhinitis.

Stress may influence hives in another way, too, if that stress causes you to pick or scratch your skin (a common habit, Dr. Friedman says). Friction or pressure on the skin is a risk factor for hives, and the act of scratching skin can cause the release of the chemical histamine, he says. When that happens, your body reacts by producing hives.

Another mechanism by which stress affects hives is in people who have a condition called dermatographia, Dr. Rossi says. When people who have dermatographia scratch their skin, even lightly, those scratches result in a raised welt that looks like a hive. The skin mistakenly releases histamine, not because it’s come into contact with an allergen, but because something — exercise, heat, or (you guessed it) stress — has aggravated it.

Doctors aren’t entirely sure what causes dermatographia, but it’s estimated to affect 2 to 5 percent of the population.

Whether or not stress helps trigger hives, the opposite is certainly true: Hives can cause a lot of stress in people who are prone to them.

“When somebody has chronic hives, the effect on their mental health and well-being can be dramatic,” says Sarina Elmariah, MD, PhD, a board-certified dermatologist at the University of California in San Francisco. If someone is prone to scratching themselves because they’re itching, they may choose to avoid certain social situations to avoid feeling embarrassed, says Dr. Elmariah.

You also often don’t sleep well with discomfort, which can cause irritability and fatigue. “At that point, it becomes a real challenge, not only for patients, but often their families, who have to learn to deal with the dynamics of somebody who’s chronically uncomfortable,” Elmariah says. This dynamic can create more issues at home and in the workplace.

The first step in managing stress-related hives is managing stress, so it isn’t triggering the reaction to begin with.

Managing stress is easier said than done, of course. While there’s not much data on stress-relieving activities to help hives specifically, there is evidence that things such as yoga, meditation, and exercise can help people with psoriasis.

There’s evidence that the same stress-relieving activities can help with eczema, too.

“And if those activities can help those skin conditions, it’s safe to assume they may also help with hives, too,” Friedman says.

Other scientifically proven ways to relieve stress include getting enough sleep, eating a healthy diet, maintaining a strong social network and work-life balance, adopting an attitude of gratitude, embracing spirituality, thinking positively, and smiling.

Many times, hives go away on their own, but some people may need to take medications called antihistamines, which can help prevent hives by blocking the effects of histamine in the body. Antihistamines may also be an option for chronic hives — meaning, those that last longer than six weeks — but there are other treatments available for that, including steroids (temporarily), biologics, and immunosuppressants.

If stress is contributing to hives for you, then controlling stress can help. Not only does managing stress lessen the frequency or severity of hives, but you’ll also reap all the other physical, mental, and emotional benefits of coping with stress, Elmariah says.

Stress alone usually isn’t enough to trigger hives, but stress may cause the condition in people who are already prone to hives.
If stress causes you to scratch your skin, you may develop a hive. Scratching causes the release of the chemical histamine, which can cause a hive.
Yoga, meditation, and exercise may all help ease stress.

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