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Breaking out in a rash when under emotional stress is not an unusual condition. The underlying reasons that emotional stress triggers that kind of reaction can be totally not what you would expect. Here are some examples.

  • People who have gallbladder problems often break out with a "stress rash" after fast food meals. The liver releases bile to digest the fats in the fast food, gallstones or biliary stasis keep it from flowing to the gut, and the the liver and gallbladder send pain signals to the brain. However, pain signals and allergy signals can be chemically very similar, so your brain tells you skin to break out when you eat.
  • Exercise often tells the brain to release endorphins. These endorphins activate specialized cells in the brain known as mu-opioid receptors, which are also activated by chemicals in wheat, meat (especially rare beef), sweets, and, oddly enough, spinach. In some people, endorphins and "happy chemicals" in food activate redness and itching in the skin.
  • Some people lack the enzymes that break down a byproduct from drinking alcohol called acetaldehyde. They turn red in the face and neck and make get pimply eruptions around the mouth and on the nose about an hour after they drink. The genetics for this condition are particularly common in Korea and Japan.
  • A form of acne known as rosacea can be triggered by stress, or by moving from a cold place to a heated place, drinking a hot beverage, eating unusually hot and/or spicy foods, or exposure to tingly skin care products. This kind of acne is caused by enlarged blood vessels under the skin, not clogged pores, and it can break out in just minutes. The bumps caused by rosacea usually run across the cheeks and on the nose. The more often one has breakouts of rosacea, the more likely the skin changes are to become permanent.

But the most common sort of rash that breaks out when people are under stress is urticaria, better known as hives. You might be more prone to hives if you have been sick lately. You can get sudden outbreaks of hives in response to heat, cold, pressure, new body care products, exposure to new pets, exposure to new houseplants, molds, dust, exercise, travel, contact with nickel, latex, industrial chemicals,or nail polish, going out into the sun, coming in from the sun, exercise, pregnancy (most commonly in the third trimester), drinking alcoholic beverages, or taking certain medications. 

Hives erupt as round wheals, which an coalesce into a single red mass as the breakout progresses. These wheals are usually blanchable, that is, if you press the skin, they turn white. They tend to be itchy, and if they occur inside the mouth or throat, they can cut off breathing and even cause fatality.

If you're having trouble breathing when you break out in hives, you must get to an emergency room right away. However, if you are just dealing with a skin rash, you may be able to get some relief just by taking Diphenhydramine (Benadryl). Ranitidine (Zantac) is better known for treating heartburn, but it's also a potent antihistamine that can relieve hives and other skin rashes. Cimetidine (Tagamet) and famotidine (Pepcid) also help relieve some cases of skin rash. 

None of these rashes is related to any specific kind of food other than "new" or "spicy" food. You don't need to get food allergy testing. You may need to avoid whole classes of foods, like any food that contains chili peppers, but you won't need to be on the lookout  for any particular food. It can also help to avoid Aspirin and any kind of red or yellow food dye, which increase the severity the kinds of skin reactions that cause sudden rashes.

What about St. John's wort? If you have a rash reaction to sun, St. John's wort can make it worse. If your rashes occur in response to emotional stress, it can help. Be sure to let your doctor know you are taking St. John's wort. It's incompatible with many prescription drugs.

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