What do anxiety rashes look like? Causes & treatment

Everyone feels anxious at times, but the lingering effects of the pandemic, global strife, and the stress of daily life have contributed to an anxiety epidemic. According to a KFF/CNN Mental Health in America Survey published in 2022, 90% of U.S. adults believe the country is facing a mental health crisis, with 32% of adults and 49.9% of people ages 18–24 reporting signs of anxiety. Some people respond to stress or anxiety by developing a rash. 

Anxiety rashes can be unsightly, itchy, and uncomfortable and often look like raised bumps, welts, or hives (urticaria). Hives vary in size, shape, and color. They can appear almost anywhere on the body, but most commonly on the neck, chest, torso, face, and arms. Anxiety rashes are one way the body responds to stress, but people with existing skin conditions are often more at risk, and it is important to be sure a rash is not an allergic reaction or an infection. Anxiety rashes typically resolve spontaneously without treatment. Some people want to try to speed up the resolution by using topical treatments. See a healthcare provider if rashes last more than six weeks. 

What causes anxiety rashes? 

To understand why people develop anxiety rashes, it is important to appreciate how skin—the body’s largest organ—responds to stress. When people feel stress, cortisol spikes. Cortisol is a steroid hormone produced by the adrenal glands that helps regulate the body’s response to stress. Rising cortisol levels trigger the body’s histamine response, a chemical the immune system releases that can cause inflammation, itching, and hives. 

“Psychological stress and underlying anxiety can be a significant factor for many who suffer from unexplained, and often, episodic hives,” says Clifford W. Bassett, MD, founder and medical director of Allergy & Asthma Care of New York, part of the Schweiger Dermatology Group, and author of The New Allergy Solution. “The ‘stress response’ may lead to histamine release and onset of hives or an itchy rash. Other variables, such as alcohol, heat, and exercise, may further worsen those affected.” 

Itchy skin may be due to various causes, including allergies, skin conditions, infections, and neurological disorders. Sometimes, rashes or hives are triggered by foods, medications, or other allergens. People with existing skin conditions, such as eczema, rosacea, and acne, are more susceptible, and stress can trigger flare-ups in people with Crohn’s disease, colitis, and fibromyalgia. 

“Anyone can get an anxiety rash,” says Anna Chacon, MD, of Miami Derm, “but people with a history of skin conditions, women, young people, and those with a predisposition to anxiety may be more susceptible. In our practice, I have observed an increase in stress-related conditions, and today’s fast-paced, high-pressure society has increased the number of anxiety rashes seen in our office.” 

Before deciding whether a rash is caused by stress or anxiety, look at other probable causes: 

• New foods 
• New soap or detergents 
• New medications 
• Insect bites 
• Existing skin conditions such as eczema, rosacea, and acne 

What does an anxiety rash look like? 

Anxiety rashes may appear as an inflammation or irritation of the skin or as hives—puffy raised welts that vary in size, shape, and itchiness. They can be red, pink, white, or flesh-colored, ranging in size from tiny dots, bumps, or splotches as large as a dinner plate. Scratching can cause the rash to spread and lead to infection. 

It is not always possible to tell the difference between an anxiety rash and a rash caused by something else. 

“Distinguishing an anxiety rash from other types of rashes can be challenging, as the physical appearance may be similar,” Dr. Chacon says. “However, the correlation between the onset of the rash and periods of increased stress or anxiety can provide a clue.” 

Who is most susceptible to anxiety rashes? 

Studies have shown that women in their 30s and 40s are most at risk for anxiety rashes. Women are almost twice as likely to experience anxiety as men, according to the Anxiety & Depression Association of America. Family history can also be a factor. Feeling stress, getting too little sleep, and unhealthy eating habits create ideal conditions for anxiety and the development of an anxiety rash. 

Should you be worried about an anxiety rash? 

In most cases, an anxiety rash is not cause for concern. “Anxiety rashes often resolve on their own once an individual manages to calm down and reduce his or her stress levels,” Dr. Chacon says. “However, if the rash persists for more than a few days, becomes increasingly uncomfortable, or is accompanied by other symptoms, it’s advisable to seek medical attention.” 

Be aware that stress can not only cause rashes but can also trigger flare-ups for people with other conditions such as Crohn’s, colitis, and fibromyalgia. If a rash lasts more than six weeks or becomes chronic, consider seeing a dermatologist or other healthcare provider. 

While an anxiety rash is typically not dangerous, it is important to act if the rash proves to be something more serious, such as an allergic reaction or an infection. Causes for concern include the following: 

• If the rash appears suddenly and spreads rapidly, it could be an infection or an allergic reaction to a food or medication. Some infections that cause rashes include cellulitis, shingles, mononucleosis, and measles. 
• When rashes occur with fever, swelling of the tongue or throat, or cause trouble breathing, call 911 or go to the emergency room. 
• Rashes that start blistering or turn into open sores may also signal an allergic reaction. Get medical attention if blistering appears around the eyes, mouth, or genitals. 
• Scratching can lead to serious infections because we often have staph and strep on our skin and under our fingernails. Signs of infection include yellow or green secretions, swelling or crusting, skin that feels warm or hot to the touch, and red streaks. 
• See a healthcare provider for a rash that becomes painful. 

How are anxiety rashes diagnosed?

Rashes can be diagnosed by a primary care physician, dermatologist, or allergist. Typically, a healthcare provider will begin the diagnosis by taking a thorough history and asking about the onset of the rash, symptoms, and any medications you’re taking. They will examine the rash and may order a blood test, an allergy test, a skin biopsy, or a skin culture. 

“When a patient presents with an anxiety rash, we begin with a physical examination, review the patient’s medical history, and ask about recent stressors,” Dr. Chacon says. “In some scenarios, it is important to perform an allergy test to rule out other potential causes. “ 

Anxiety rash treatment and prevention 

The itchiness, irritation, and inflammation of an anxiety rash can be extremely uncomfortable. Soothing home remedies include cold compresses, ice packs, and oatmeal baths. Anxiety rash treatment includes hydrocortisone cream and OTC antihistamines such as Benadryl, Claritin, Allegra, or Zyrtec. In some cases, rashes may require an oral prescription steroid such as prednisone. 

“OTC calming creams can help alleviate the itching and inflammation,” Dr. Chacon says. “However, it is important to remember that these are temporary solutions. The most effective treatment is to address the underlying anxiety triggering the rash. It is crucial to understand that an anxiety rash is a physical symptom of emotional distress. It is not just about treating the rash but also about addressing underlying anxiety. People who frequently experience anxiety rashes may find it beneficial to seek help from a mental health professional.” 

These days, it can be difficult to avoid anxiety, but some lifestyle changes can help: 

• Take a break from the news. 
• Eat healthily. 
• Get a minimum of seven hours of sleep a night. 
• Make time to unwind. 
• Exercise. 
• Practice mindfulness. 
• Do not self-medicate. 

“Controlling the stress response is not easy and may require a multi-faceted, integrated approach that combines diagnostic testing and medication to break the cycle and improve control of itchy skin and vexing hives,” Dr. Bassett says. 

Most importantly: Anxiety rashes are common and treatable 

Anxiety rashes have become increasingly common due to the many stressors in today’s world. Although they can be itchy and uncomfortable, anxiety rashes generally resolve on their own within a day or two and respond to treatment with OTC antihistamines or hydrocortisone cream. If the rash lasts longer than six weeks, see a healthcare professional. Anxiety rashes are often confused with other underlying causes, such as allergic reactions or infections. People who experience rashes accompanied by fever or have trouble breathing should call 911 or go to an emergency room. People who suffer from chronic anxiety rashes should consider addressing the underlying symptoms of emotional distress by consulting with a mental health professional and incorporating stress relief practices into their lives. 

If an anxiety rash continues, worsens, or is accompanied by pain, swelling, or fever, it could be a sign of an infection, allergic reaction, or an underlying medical condition. Only your healthcare provider can rule out infection or other serious health conditions. Visit your healthcare provider to determine the best treatment for an anxiety rash.