Chronic spontaneous urticaria (CSU) is the medical term for hives that appear for over 6 weeks. Stress, along with allergens and anxiety, can trigger it. Lowering stress can help reduce flares.
Chronic spontaneous urticaria (CSU) is the term for hives that don’t have an identifiable cause. Physical triggers, such as a virus or allergens, can lead to hives in many people. But for some, stress and anxiety can cause a CSU flare.
The relationship between CSU and stress isn’t clear, but research suggests that the symptoms of CSU, such as constant itching, can also increase stress. As a result, CSU symptoms may last longer, creating an uncomfortable cycle.
What is chronic spontaneous urticaria?
Also known as chronic idiopathic urticaria , the condition is characterized by hives on the skin that come and go.
The raised red bumps are often called welts, lesions, or wheals and typically appear at least twice a week. Urticaria changes from acute to chronic when hives continue to appear for longer than 6 weeks.
CSU hives are itchy and can appear anywhere on the body.
“Urticaria is driven by a chemical called histamine,” explained Jocelyn Lieb, a board certified dermatologist. “Histamine is made by the body in response to a trigger and packaged into water balloons. These water balloons sit in your skin, waiting to pop. When they pop, they cause a hive or urticarial lesion.”
Acute hives typically develop because of contact with an allergen, such as a certain food or type of medication. Scratching the hives causes more to appear, but they go away once you remove or avoid the allergen.
However, for many people with CSU, the cause of their hives is unknown. Some research suggests that autoimmune dysfunction can be a risk factor for CSU, but the underlying cause is still unclear.
Despite the unknown root cause, people with CSU typically find that certain triggers set off a flare-up of hives. Potential triggers for CSU include physical stimulation, like rapid temperature changes or tight clothing, as well as psychological factors, such as stress and anxiety.
How stress can trigger an outbreak
While it’s still unclear how exactly CSU and stress are related, scientists believe their connection is bidirectional. This means that one factor can affect the other and vice versa.
Mental or emotional stress may trigger hives. Lieb notes that stress can play a role in multiple skin conditions and that the skin can reflect what the mind is feeling.
Besides CSU, she cites a similar common skin condition called holinergic urticaria, which causes blotchiness or hives that develop when someone is nervous.
Research indicates that this could be true, but further study is needed to produce more evidence. Stress can also affect other inflammatory diseases, like acne and psoriasis.
Dr. Kiran Dintyala, a board certified internal medicine physician, notes that not only can the skin perceive the stress of the mind, but it may also be a target for stress response. He says that skin with chronic inflammatory problems like urticaria is especially prone to overreact when a person is stressed.
Dintyala explains that the skin of a person with CSU has a lower tolerance for stress than healthy skin, probably due to a constant accumulation and arousal of immune cells, proinflammatory cytokines, and chemokines.
These cells, molecules, and hormones are part of the hypothalamic-pituitary-adrenal (HPA) axis, which regulates bodily functions and processes.
Chronic stress can cause this system to become dysregulated and overactive. Inflammatory markers and molecules can accumulate on the skin, similar to the water balloon imagery used by Lieb. As a result, the overactivity can cause the skin to become more reactive and sensitive to triggers.
People who have oversensitive skin often experience hives due to even the slightest trigger. This can lead to more stress.
As Dintyala explained, “Having any skin condition (including CSU) is a big stressor as it affects your appearance, which can impact your self-confidence. People with CSU are known to have a higher incidence of stress , anxiety, and depression, which further exacerbates CSU.”
Reducing stress and anxiety may be the key to stopping the cycle.
Tips on managing stress
Keeping stress levels in check may help reduce CSU flares. Dintyala notes that it’s a multifaceted approach. He says that the first step is to get the necessary treatment for your specific skin condition.
While there isn’t a cure for CSU, your doctor may help determine your triggers. Additionally, research shows that continuous administration of antihistamines, sometimes at higher doses, can effectively manage CSU.
Once you’ve addressed the skin condition, managing stress may help further ease flares. Lieb suggests complementary treatments such as yoga, acupuncture, and meditation. Relaxing exercises can help you stay calm, reducing the chances of hives.
“Under stressful circumstances, keep your focus within. Remember, you are more than your body,” said Dintyala.
A mindfulness practice may help you take the focus off of a potential flare-up, which can help you de-stress.
That said, flare-ups only last about a year for around 50% of individuals with chronic hives, according to the American Academy of Dermatology Association .
Additionally, while you’re experiencing CSU, there are treatment options and lifestyle changes that can help you better manage your hives.
Takeaway
CIU are hives that appear and disappear periodically. While it may be caused by physical factors like a virus or allergen, stress can also play a role.
The relationship between stress and CIU is bidirectional, meaning one can trigger the other and vice versa. Seeking out treatment, identifying your triggers, and finding ways to lower stress levels can help prevent flares.
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