Stress-induced urticaria

Urticaria is characterized by transient wheals on the skin, oral mucosa, or genital mucosa, caused by the temporary leakage of plasma from small blood vessels into the surrounding connective tissue. Edema in the dermis produces wheals, while edema involving the deeper dermis and/or submucosal tissue is known as angioedema.

These wheals are usually itchy and pale in the center before developing into superficial pink patches. They typically disappear within 2–24 hours without leaving any marks on the skin, except for scratches caused by scratching. In contrast to urticaria, angioedema may be more painful than itchy and usually lasts longer. Urticaria occurring at least twice a week for six consecutive weeks is classified as chronic urticaria. Diagnosis is primarily based on clinical examination.

1. What is stress-induced urticaria?

The cause of urticaria is unknown in approximately 70%–79% of cases, and neurological factors play an important role in 35.5%–48% of cases. Czubalski and Rudzki studied psychosomatic factors in 48 patients with different forms of urticaria. Their findings showed that emotional triggers were associated with outbreaks in 77% of cases of cholinergic urticaria and 82% of cases of dermatographism.

Emotional factors do not trigger cold-induced urticaria. Some reported cases linking vasculitis with neurological symptoms suggest that both the central and peripheral nervous systems may be involved, at systemic and local levels.

The role of psychoneurological factors is extremely difficult to assess. Urticaria and atopic dermatitis are two skin conditions considered to have a substantial psychological impact.

Many authors worldwide also classify urticaria as a skin disease in which psychosomatic factors play an important role. In other words, emotional factors may contribute to susceptibility to the disease, its onset, and its persistence.

Some authors describe two forms of psychologically induced urticaria: an acute emotional form, which typically follows specific events with a clear cause-and-effect relationship, and a chronic, recurrent form that “appears to be based primarily on neurodynamic mechanisms associated with a psychosomatic disorder.”

Some cases have been documented in which patients developed urticarial lesions in response to food or medication allergens during periods of stress. However, when the same patients had resolved their stress, consuming the same foods or taking the same medications no longer triggered urticaria.

Thus, in these cases, psychological stress may be associated with the immune response.

Some people develop stress-induced urticaria as an unconditioned response to stress. For example, eating a particular food while experiencing psychological stress may lead to the development of hives when the person eats that same food again, representing a form of conditioned response.

2. What factors cause stress-related rashes?

Allergic reactions that may cause stress-related rashes can have various triggers, commonly including foods such as milk, eggs, peanuts, tree nuts, and shellfish; medications; animal-related allergens; and environmental allergens such as pollen, latex, and animal fur.

Other potential triggers or associated factors include bacterial or fungal infections; conditions such as lupus, vasculitis, or thyroid disorders; physical activity and exercise; exposure to chemicals, sunlight, heat, cold, or water; severe skin abrasions; and prolonged pressure on the skin, such as from sitting for extended periods.

3. Treatment

Antihistamines are highly effective in treating urticaria. However, they should be prescribed at appropriate doses and for an appropriate duration to ensure treatment effectiveness and reduce recurrence. Certain soothing topical products, such as zinc oxide and calamine, may also be used to provide rapid symptom relief.

In addition, reducing stress plays a role in treatment that is just as important as antihistamine therapy.

Patients should receive psychological support and guidance on stress-reduction strategies. Maintaining a regular daily routine and exercising regularly can help improve physical health and psychological well-being.

Support from family and friends, together with an empathetic approach from the treating physician, are also important factors that can influence treatment outcomes.

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.