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Rash on forehead and splotches on neck

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Any time I get emotional, nervous, take a hot shower or sit in hot sun, I get blotchy/ flushing red rash on my forehead, cheeks and splotches on my neck and chest.
It also occurs if I drink alcohol and definitely after too much caffeine.

It seems to occur if I am nervous. The areas affected are really hot to touch but it goes as quickly as it comes. It seems to be tied to anxiety...the more I think about it, the worse it gets.
It usually goes away in about 20mins although the more I think about it the worse it gets!

I suffer from dermographia urticaria, allergies and anxiety. Could this be from my allergies or anxiety? When it goes away, the rash shows no lingering signs. It feels hot and burns a little. It will also go up Into my scalp. I have attached some photos.

Category: Internal Medicine Specialist

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Category: HIV- AIDS Specialist
 32 Doctors Online

Thank you for asking your query.

The symptoms you have mentioned here, getting blotchy, flushing, red rashes, hot to touch ares, dermographism, urticarias - all are part and parcel of same allergy and hypersensitivity phenomenon group called “Physical Urticarias”

This means your skin and body is reacting a bit ‘hyper’ to external stimuli. You could be having specifically having cholinergic urticaria and solar urticaria too. Please do not get alarmed by the names. It just means your skin is a bit hypersensitive. The good thing here is that this is not serious and there will not be any long term complication.
The best treatment would be avoidance of precipitants. That means whatever things are causing symptoms you better avoid them. Anti allergic medications like Cetirizine (H1 anti histamins) can be really helpful. If its really troublesome you may need glucocorticoids after consulting an Allergy specialist.

Hope this helps
Thank you

Patient replied :

Dr. Sebastian,

Thank you so much for your reply, I really appreciate it. Were you able to view the photos I uploaded? Do they look like urticaria? So the "flushing" is caused by my allergies? Can anxiety be a trigger?

I notice that if I am feeling anxious and take a hot shower the blotchy flushing is much worse. If I am feeling calm and take a hot shower, sometimes the blotchy-ness stays away. Any idea why it occurs when I am nervous? Oh also, it disappears after I calm down and/or cool off.

Should I upload the photos again?

Thanks so much,


Yes I did see the pictures. They all looked like different stages and patterns of urticaria (except one, which was not very clear for me).

And YES, anxiety is a know risk factor. Anxiety is another 'trigger' and can produce neuro hormones. So obviously it make sense to stay calm and relaxed as much as possible.

Hope this helps.
Thank you

Patient replied :

Thank you for the reply. My hairline is itchy and there are red patches in my scalp. I am wondering if I have some sort of scalp eczema that flares up down to my forehead? It flared up today, blotches on my forehead but then went away in a few minutes. It felt hot and itchy. My dermatologist appointment isn't for another week.

Can scalp eczema resemble urticaria??



Since this 'eczema' you mention flares up and down - this probably a component in the urticaria group. Cetirizine should give good relief. It is not possible to comment further without direct physical examination.

Thank you
Hope this helps

Patient replied :

Thank you

You are welcome. Regards

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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