Anxiety rash: What is it and how to manage it

While everyone gets stressed, some people suffer from an anxiety disorder. Anxiety is a feeling of nervousness, unease or worry that can be a normal response to stress or feeling threatened. It can also elevate the release of certain chemicals in the body, which can trigger physical reactions, such as a rash. The rash usually happens without the presence of an external allergen and can take up to days to clear up. If this sounds familiar, you need to start treatment to get rid of it. Identifying triggers, reducing stress levels and several medications can help you address these symptoms.

What is an anxiety rash?

Anxiety rash is a skin reaction—often presenting as hives, redness, or small itchy bumps that occur in response to emotional or psychological stress. It is not caused by external allergens or infections but is closely linked to the body’s physiological response to anxiety and stress, explains psychiatrist and mental health expert Dr Ajit Dandekar. It can manifest in many ways. A study, published in the Saudi Medical Journal observed that highly stressed medical students had a higher prevalence of oily, waxy patches on their scalp, dandruff, dry and sore rash and itchy skin.

Symptoms of an anxiety rash

Here is what an anxiety rash looks and feels like:

• Hives: Raised, itchy bumps on the skin.
• Redness: Red, inflamed patches of skin.
• Dry, itchy skin: Similar to eczema

Causes of anxiety rash

An anxiety rash can be caused by many reasons. The most common ones are listed below:

1. Histamine release triggered by stress and anxiety

Anxiety and stress activate the body’s stress response, which can trigger the release of chemicals such as histamines that mediate allergic-like reactions as well as an anxiety rash, found a study published in Biomedicine & Pharmacotherapy. Histamines are responsible for the appearance of hives, red patches, or small itchy bumps. This mechanism occurs even in the absence of an allergen. Some patients complain of itchy rashes that appeared during panic attacks, subsiding within 24 hours, explains Dr Dandekar. He suggests that itchiness mostly can be resolved with diphenhydramine, a known antihistamine.

2. Body temperature fluctuations

Anxiety can cause fluctuations in body temperature, such as increased warmth, without adequate sweating to cool the body. A study published in the journal Temperature states that some patients develop extremely high core body temperature (Tc) (up to 41°C) when they are exposed to emotional events. This may be a result of medications or autonomic nervous system dysregulation, a condition where the autonomic nervous system which is responsible for well-being and maintaining balance, does not regulate in the right way.

Some patients experience an increased body temperature and warmth during panic attacks but they rarely sweat, explains Dr Dandekar. He adds that this is due to the medication topiramate’s effect on our bodies. This leads to an impaired cooling mechanism, which may contribute to the development of a rash in response to psychological stress.

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3. Itch-anxiety cycle

Chronic itch and anxiety can create a vicious cycle that aggravates symptoms, resulting in an anxiety rash. Psychological stress aggravates itch perception, which is a sensation that makes you want to scratch. A chronic itch is often associated with heightened anxiety and mood disturbances, states this study, published in the journal Neuroscience Biobehavioral Rev. The central nervous system plays a key role in this process, as it regulates both stress responses and the sensation of itch.

4. Psychogenic Urticaria

Stress and anxiety can trigger psychogenic urticaria, a condition where hives or welts develop without a physical allergen. Emotional stress aggravates conditions like chronic urticaria and atopic dermatitis, leading to visible rashes. A study, published in the British Journal of Dermatology, states that a high prevalence of psychiatric comorbidities was seen in patients with urticaria.

How to treat an anxiety rash

The treatment of anxiety rash focuses on alleviating the rash itself while addressing the underlying anxiety that triggers or worsens it.

• Antihistamines: Antihistamines remain the first line of defence to reduce itching and inflammation caused by histamine release. Diphenhydramine, for instance, effectively relieve itching in anxiety-induced hives. Other antihistamines, such as cetirizine or loratadine, may also be used, says Dr Dandekar. However, these medicines should only be taken after consulting a doctor.
• Anxiety management: It is important to manage your anxiety levels. This plays a critical role in reducing the frequency and severity of anxiety rashes. Pharmacological treatments like SSRIs (Selective serotonin reuptake inhibitors to treat depression) have shown dual benefits in managing both anxiety and associated skin symptoms. These medications help regulate mood and may indirectly reduce stress-induced histamine responses.
• Cool the body: Cooling measures can help soothe the skin and provide immediate relief. Applying cold compresses or using cooling agents can reduce inflammation and discomfort, particularly in cases where warmth contributes to the rash.
• Non-pharmacological treatments: Treatments such as stress management techniques, including cognitive-behavioural therapy (CBT is a therapy that makes you aware of the way you think), mindfulness, and relaxation practices, are essential to break the itch-anxiety cycle. Psychological stress aggravates itch perception; therefore, reducing stress can improve both anxiety and skin symptoms.

How to prevent an anxiety rash?

Preventing anxiety rashes involves controlling both stress levels and the body’s physical response to anxiety.

1. Keep stress at bay

Managing psychological stress is key. Techniques like mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can help regulate the body’s stress response, reducing the likelihood of triggering an anxiety rash. Stress is a significant factor in aggravating itch perception and chronic skin conditions.

2. Manage anxiety with medication

In patients with persistent anxiety, medications such as SSRIs can help stabilise mood and reduce anxiety-induced skin reactions. For acute episodes of anxiety, short-term use of benzodiazepines, a medication to slow down brain activity, may also be considered, although their role in anxiety rashes is less well-studied. However, all medicines should only be taken after consulting a doctor.

3. Identify and avoid triggers

Monitoring patterns of stress, anxiety episodes, and rash development can help identify specific triggers. Patients are encouraged to maintain a journal to track when symptoms occur and address potential emotional or environmental factors, explains Dr Dandekar.

4. Address temperature dysregulation

For people with impaired sweating, staying cool, hydrating, and avoiding overheating can help prevent rashes. This is particularly important for patients on medications that may disrupt body temperature regulation.

Break the itch-anxiety cycle

Since anxiety can heighten itch perception and scratching worsens skin symptoms, it’s important to adopt behavioural strategies to reduce scratching. Distraction techniques, such as engaging in relaxing activities or cognitive interventions, can help break this cycle.

Anxiety rash is a skin condition that is triggered by high levels of stress and anxiety. When you’re stressed, your body releases hormones like cortisol and adrenaline. These can often leave you with rash-like symptoms. However, maintaining your stress levels, and learning coping strategies can help you.

Note: While these strategies may help some people, please contact your doctor if the symptoms persist or if you suffer from any underlying conditions.