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A woman holding her neck: Cortisol rash: Related causes and treatment
Health Education

What causes a cortisol rash? Related conditions and treatments

Also called hives, cortisol rashes are often caused by emotional stress
Leandra Beabout
By | Feb. 9, 2024 Medically reviewed by Josephine Bawab, Pharm.D.

Key takeaways

  • Cortisol rashes are common and may be caused by medications, stressful situations, infections, allergies, and more.

  • Typically, a cortisol rash does not require immediate medical attention.

  • If caused by stress, cortisol rashes usually resolve without treatment within a day or two.

  • Treatment of a cortisol rash may include oral antihistamines or topical corticosteroids. Read more about treatments for hives here.

  • Cortisol rashes can be managed with cold compresses, anti-itch cream, and avoiding triggers.

  • Use coupons for cortisol rash treatments, like Benadryl (diphenhydramine) and Claritin (loratadine), to save up to 80%.

Stress-induced rashes can develop anywhere on the body, but stress hives are especially common on the neck, chest, face, and belly. Cortisol is known as the stress hormone. Anyone who has experienced a cortisol rash knows the signs of an outbreak: itchy bumps that appear red on lighter skin tones or flesh-colored on darker skin tones.

“When someone refers to a cortisol or stress rash, they are usually referring to urticaria or hives,” says Charu Sawhney, DO, internal medicine physician at Harbor Health in Austin, Texas. “Urticaria is a skin reaction that starts as itchy, red skin that turns into swollen, red welts. A unique characteristic of hives is that the rash blanches or turns white when the center is pressed.”

Acute urticaria is typically temporary and harmless. It is not an inflammatory skin disease like eczema or psoriasis. Triggers vary, but the underlying cause is a sudden increase in histamines, natural substances that the immune system releases in response to allergens and stress, according to Christopher Bunick, MD, a board-certified dermatologist and associate professor at Yale School of Medicine: Department of Dermatology. Treatment focuses on removing triggers and calming the itch.

What causes a cortisol rash?

“Cortisol rash, also known as urticaria, can be triggered by various factors, and stress is a common culprit,” says Casey Kelley, MD, founder and medical director of Case Integrative Health. 

For many people, the exact cause of a cortisol rash may never be identified. However, causes are typically environmental, emotional, or physical.

Environmental causes

  • Changes in temperature 
  • Sun exposure
  • Sweating
  • Friction

Emotional causes

  • Emotional distress from work or personal issues
  • Stress or pressure during major life events
  • Grief
  • Anxiety

Other physical causes

  • Allergies
  • Infections
  • Insect bites
  • Changes in lotion, detergent, perfume, or other personal care items
  • Medications 
  • Consumption of high-histamine foods, such as avocados, eggplants, tomatoes, and sardines

Should I be worried about a cortisol rash?

Stress hives are not uncommon. About 1 in 5 people will experience urticaria at some point in their lives. This type of skin rash is rarely a serious threat, but it can be a sign of an underlying medical condition or a warning of a severe allergy.

It’s a good idea to call your doctor if any skin condition, including stress hives, becomes itchy, widespread, or uncomfortable enough to interfere with everyday activities. Also, make an appointment to see a healthcare provider if hives last more than six weeks or are accompanied by a fever, joint pain, or fatigue.

“If a person suspects a medication reaction, this should be discussed with a medical provider since a medication change may be necessary,” Dr. Bunick says. 

Seek emergency medical attention if your cortisol rash is accompanied by these symptoms of a severe allergic reaction:

  • Trouble breathing
  • Facial swelling
  • Throat swelling or constriction

How is the cause of a cortisol rash diagnosed?

When a patient seeks help for cortisol rash, doctors are tasked with figuring out the underlying cause. Sometimes, a medical history and physical examination are enough to make a diagnosis. 

Your doctor may also ask about your lifestyle, stress levels, and any recent life events in order to assess the potential impact of stress on your symptoms. For example, they may ask:

  • When did you first notice the skin rash?
  • Have you recently started using new skincare products?
  • Have you recently started taking a new medication?
  • What is your current stress level?
  • Have you recently experienced any major life events?

In other cases, diagnostic testing may be necessary. “There is no specific universal test that informs doctors exactly what stressor is triggering a rash or hives,” Dr. Bunick says. 

Possible tests may include:

  • Complete blood count (CBC) test
  • Thyroid function test
  • Cortisol level test
  • Skin prick allergy test
  • Food allergen blood test
  • Urinalysis or urine culture if infection is suspected
  • Aerobic wound culture if there is also a wound present
  • Sputum culture if a respiratory illness is suspected

How long does a cortisol rash last?

Stress hives may be a temporary or chronic medical condition, depending on the cause. If a cortisol rash has developed in response to acute stress, then the rash may subside as soon as the stressor goes away. In other cases, chronic stress can cause recurrent or persistent hives, Dr. Kelley says.

“Symptoms for stress hives usually last for minutes to hours. However, they can be intermittent for weeks to months to years,” Dr. Sawhney explains. “It is necessary to avoid the substance or situation to prevent the hives from being present over a longer period of time.”

Cortisol rash treatment and prevention

In many cases, cortisol rashes go away without treatment. However, over-the-counter (OTC) treatments can help soothe itchy skin and reduce inflammation in the meantime.

“The two most common treatments are oral antihistamines and a topical corticosteroid,” Dr. Bunick says.

OTC antihistamines used to treat a cortisol rash include:

Topical steroids used to treat a cortisol rash include:

Sometimes, cortisol rash symptoms can be soothed with home remedies. For example, a cold compress can calm skin inflammation from an outbreak of hives. 

Prevention

Not all stress hives can be prevented, especially if you are unable to identify what typically triggers your outbreaks in the affected area. However, emotional stress is often a factor. Taking good care of your mental health may help protect against a cortisol rash.

“While antihistamines can help relieve symptoms, addressing the underlying stress or triggering factors is crucial for long-term management,” Dr. Kelley says. “Stress management techniques, such as relaxation exercises, mindfulness, and lifestyle adjustments, may be beneficial in preventing recurrent episodes of stress hives.”

Most importantly, get help if your cortisol rash is accompanied by swelling or shortness of breath

Cortisol rash causes may include emotional or physical stressors. The cause of a cortisol rash may resolve on its own without treatment. However, if a cortisol rash continues, worsens, or is accompanied by facial swelling, throat constriction, or shortness of breath, it could be a sign of anaphylaxis (severe allergy) and require emergency medical attention. Only your healthcare provider can rule out infections or other serious health conditions. Visit your doctor to determine the best treatment for a cortisol rash.

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