What are the other names for this Condition? (Also known as/Synonyms)

• Stress Bumps
• Stress Hives
• Stress Rash

What is Stress-Induced Hives? (Definition/Background Information)

• Stress-Induced Hives is an itchy skin condition that develops due to longstanding physical, psychological and emotional stress. It is also known as Stress Hives and Stress Urticaria
• Any region of body skin may be affected, but usually the chest, back, head and neck area are involved. Intense itching may rarely lead to breathing difficulties, skin ulceration, and scarring
• The stresses causing hives may include job loss, financial troubles, death in the family, or major illnesses. The influencing factors for Stress-Induced Hives may also include strenuous exercising and intense sports activities
• Acute Stress-Induced Hives may not need treatment and the condition may resolve on its own, in some individuals, when the stress is removed
• In individuals requiring treatment, the condition is treated using topical ointments, creams, and oral antihistamines. The prognosis of Stress-Induced Hives with adequate treatment is usually good

Who gets Stress-Induced Hives? (Age and Sex Distribution)

• Stress-Induced Hives is generally observed in adults
• There is no gender, race, or ethnic preference observed

What are the Risk Factors for Stress-Induced Hives? (Predisposing Factors)

The risk factors for Stress-Induced Hives include any condition causing physical, emotional and psychological stress. These may include:

• Bereavement or death of a loved one
• Trauma due to physical or sexual abuse
• Major illness, accident, or injury
• Poverty and malnutrition
• Social phobia
• Depression and loneliness
• Divorce
• Financial stress or financial loss
• Office-related stress; loss of job
• Change of residence
• Exposure to heat or cold
• Individuals affected by natural disasters such as earthquakes, tornadoes, floods, etc.
• Some of the physical stressors may also include excessive physical activities, participation in sports activities, intense workout, thrill-seeking behavior, sky diving, roller-coaster ride, etc.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Stress-Induced Hives? (Etiology)

Stress-Induced Hives is caused by chronic stress that comes about due to a variety of factors.

• The stress triggering the skin rashes or hives may be physical, psychological or emotional
• The stress may be negative, such as loss of job, death in the family, or depression, or positive, which may include strenuous physical work-out or exhilarating rides
• The condition develops due to the release of chemical substances, such as histamines, platelet activating factor, and cytokines (example bradykinin), from inflammatory cells called mast cells and basophils in the body

When chronic hives are observed that persists for over 6 weeks, it is unlikely due to stress. In such cases, other factors that commonly cause hives, such as infections (bacterial, viral, or fungal), metabolic disorders, kidney and liver diseases, pancreatic diseases, thyroid diseases, and use of certain medications, should be excluded.

What are the Signs and Symptoms of Stress-Induced Hives?

The signs and symptoms of Stress-Induced Hives may vary from one individual to another and may be mild or severe. It may include:

• Itching of skin that may be localized or widespread; the skin may appear swollen
• Formation of skin rashes/weals that are associated with redness and intense itching
• The onset of hives may be sudden
• The skin surrounding the affected area may be normal skin color or appear red (erythema)
• The rashes may be irregular and change in shape and size
• Any part of the body area may be involved, but commonly the head, neck, and torso are affected
• In some individuals, there may be a burning sensation accompanying the itching
• Numerous weals covering a large area of the body skin may be observed
• Scratching can result in worsening of the symptoms
• In some individuals, fever from hives may be noted
• Pain is usually not be observed
• Symptom episodes come and go during periods of stress
• A decrease in stress consequently tends to bring about a reduction in the symptoms

How is Stress-Induced Hives Diagnosed?

A diagnosis of Stress-Induced Hives may involve the following tests and examinations:

• Physical examination of the skin and medical history evaluation including assessment of the stressors
• Skin allergy test
• Blood test to detect various antibodies against allergens including:
  • Complete blood count (CBC) test
  • Antinuclear antibody (ANA) test
  • Erythrocyte sedimentation rate (ESR) test
  • Serum level of complement
  • Serum C-reactive protein blood test
• Tests to rule-out other underlying conditions causing chronic hives, such as infections, autoimmune disorders, metabolic conditions, etc.
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• A differential diagnosis may be considered to eliminate certain skin conditions, prior to arriving at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Stress-Induced Hives?

The following complications of Stress-Induced Hives may be noted:

• Scrattching can lead to ulceration of skin, causing superimposed bacterial and fungal skin infections
• This may result in scarring of skin
• The condition may be accompanied by breathing difficulty and change in blood pressure. In such cases, if there is severe difficulty in breathing, then one should seek emergency healthcare
• Sleep disruption
• Cosmetic concerns in some individuals leading to stress
• The acute condition may become chronic, if it last over 6 weeks
• Frequent episodes of Stress Hives can affect the quality of life, which can result in severe stress. This severe stress can in-turn be a trigger for further worsening of the condition

Generally, acute Stress Hives is self-resolving and no major complications are usually noted.

How is Stress-Induced Hives Treated?

In many cases, Stress-Induced Hives is self-limiting when the stressors (factors causing stress) are addressed and resolved. The treatment also depends upon the severity of the signs and symptoms. The treatment measures for Stress-Induced Hives include:

• Individuals with mild symptoms can be treated using over-the-counter medications
• Cooling the skin using moist towels
• Topical steroid treatment that may include moisturizing creams to soothe the condition
• Anti-histamine therapy: Over-the-counter oral antihistamines may be prescribed; although they help with the symptoms, the symptoms may return in the presence of stress
• In individuals with severe signs and symptoms, immunosuppressive medication may be administered
• Patient education in understanding the condition is beneficial
• Stress management for severe and chronic conditions

How can Stress-Induced Hives be Prevented?

Although Stress-Induced Hives may not be prevented, further and future flare-ups may be avoided, if the triggers that cause the condition are known and recognized. In such cases, the following may be considered:

• Addressing issues that cause stress early, when possible
• Garnering support of family members and friends in case of emotional stress or depression
• One may potentially control flare-ups or severe symptoms by undertaking milder exercises or performing any physical activity in a controlled fashion

What is the Prognosis of Stress-Induced Hives? (Outcomes/Resolutions)

• The prognosis of Stress-Induced Hives is usually good-to-excellent
• Often, the condition is self-limiting; it goes away when stress decreases. However, it can recur when the factors causing hives return

Additional and Relevant Useful Information for Stress-Induced Hives:

Please visit our Skin Care Health Center for more physician-approved health information:

https://www.dovemed.com/healthy-living/skin-disorders/