Can Stress Cause Hives? The Answer Is Complicated

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Stress can trigger hives or make hives worse in people who are already prone to them. But stress tends not to be an independent risk factor for hives.
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Stress can cause a lot of weird things to happen in your body. The experience of emotional stress can trigger hair loss, mess up your bowel habits, and even make your eyes twitch. Can it cause your hives, too? There’s definitely a connection between emotional stress and hives, but experts say stress may be blamed as a bigger culprit when it comes to hives than is actually the case.

Stress Can Make Hives Worse in Those Who Are Already Prone to Getting Them

“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 of dermatology at the George Washington University School of Medicine & Health Sciences in Washington, DC.

It’s much more likely that stress plays a role in the development of hives in those who are already susceptible to getting hives, he adds.

RELATED: All About the Physical Toll Stress Takes on Our Bodies

For instance, there is some evidence that hives may affect women more than men.  Hives are also more common in people with autoimmune diseases. And hives also tend to be common in people who have other allergic reactions, too — and when they do, stress can make those hives worse.

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

There is one form of chronic hives, cholinergic urticaria (wherein 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 with conditions like asthma, eczema, and allergic rhinitis.

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

Another mechanism by which stress affects hives is in people who have a condition called dermatographia, Dr. Rossi says. When people who have this condition scratch their skin, even lightly, those scratches result in a raised welt that looks like a hive. The skin has erroneously released histamine because it’s not been triggered by a response from the body’s immune system, but rather by an external stimulus, like exercise, heat, stress, vibration, or exposure to the cold

Doctors aren’t entirely sure what causes this condition, but it’s estimated to affect 2 to 5 percent of the population. (3)