Israelis get this rash all the time - this is why

Although stress is a natural part of life, when it becomes chronic or prolonged, it can have a negative effect on our physical and mental health. 

Stress can cause the body to release hormones such as cortisol, which can affect the immune system and increase inflammation in the body. This inflammation can trigger or worsen skin conditions such as psoriasis and seborrhea.

Besides these conditions, stress can also contribute to acne as a result of increased lipid production, and may cause vitiligo, known for a long time as a disease that breaks out in many patients following a traumatic event such as a car accident, injury to a relative or mental stress experienced for a long period.

Urticaria (hives) is also one of the physical ailments that can erupt from stress, and in Israel, hundreds of thousands of patients develop hives, but for varying reasons it's less known and not always correctly diagnosed.

Hives are when red and itchy lesions on the skin's surface appear and disappear unexpectedly in different areas of the body. The itching is extremely severe and the lesions come and go on their own and affect the patient's quality of life, from concentration in daily activities, even to waking up.

The trigger is hard to identify

There's often a confusion of terms between hives, allergies and other skin problems, so public awareness is very important. If someone has an itchy rash that doesn't go away after several days, they must see a dermatologist or allergist for an exam, especially if one is in a risk group, i.e. people with a family history of asthma, allergic rhinitis, allergic eye inflammation, atopic dermatitis (asthma of the skin), etc.

There are two types of urticaria: acute and chronic. Acute urticaria is more common, in which lesions appear suddenly and disappear within a few days, but there's a possibility of repeated flare-ups for months or years, which are usually short. Chronic urticaria lasts six weeks or more without respite.

Other factors, besides stress and anxiety, that may cause outbreaks are infectious diseases, certain medications, contact with various substances, contact with plants and animals, internal diseases hidden from view, and more. 

In most cases, however, it's very difficult to identify the trigger, so it's important to do blood tests to rule out any internal medical problems, and if nothing unusual is found, drug treatment should be started.

Warning signs

Urticaria isn't considered a life-threatening phenomenon when it appears in places such as the arms, legs, chest and abdomen, but in some people urticaria can be accompanied by swelling of the soft tissues under the skin. 

This swelling called angioedema may appear on the face, eyelids, lips, ears, mouth, hands, legs or genitals, and is sometimes accompanied by pain.

When urticaria manifests itself in the respiratory tract or the tongue, it can be life-threatening, as it can block the respiratory tract, and this warning sign requires one to see a doctor urgently at a health fund, an urgent care center, or the emergency room.

Treatment Methods

The first step of drug treatment is using antihistamines that reduce the activity of the mediator of inflammation (histamine), a molecule found inside the body, which causes blood vessels to dilate and smooth muscle tissues to contract.

The first generation of antihistamines have a sedative effect, so taking them should be calculated and activities such as driving must be avoided. The second generation of antihistamines are non-sedating, so they can be given in higher doses (up to 4 pills a day) if one pill doesn't help.

Instead, there's now an advanced biological drug that opposes the activity of the IGE antibodies which are secreted from the mast cells and releases histamine. This is a very effective medicine that is taken once every four weeks, works very well and really improves the quality of life for patients.

So if you've been diagnosed with urticaria and despite treatment, there is no relief, see a dermatologist who knows how to prescribe advanced medications that will prevent much suffering. 

In any case, if it's really a skin disease that broke out as a result of mental stress, first it's important to identify the source and find healthy ways to deal with it mentally as well.

The writer is a dermatologist and coordinator of dermatological services at Clalit Health Services, South District.