When your skin is red, itchy, and irritated, it could be a rash or it might be hives. We spoke with experts to learn how to tell the difference and the best ways to manage them.
Is It Hives or a Rash? Here’s How to Tell the Difference
Updated on Mar. 17, 2025
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Easily confused when it comes to hives vs. rashes? You’re not alone. Considering how similar they look, it’s common to get them mixed up.
“The term ‘rash’ generally applies to an inflammatory skin condition, so hives are a type of rash,” says Jennifer Segal, MD, founder of Metropolitan Dermatology Institute, in Houston, Texas.
However, not all rashes are hives. “Hives are a very common skin condition that results from the allergic immune response to a wide variety of triggers, including medicines, illnesses, allergies, foods, heat, cold, and even stress,” says Dr. Segal.
We spoke with skin experts to get the scoop on how to differentiate between hives versus rashes, as well as how to treat them—and, hopefully, how to prevent them from coming back.
What are hives?
Medically known as urticaria, “the term hives is used to describe an itchy, raised rash that can look like welts and often has redness,” explains Monica Kraft, MD, an allergist/immunologist at The Ohio State University Wexner Medical Center.
Unlike other types of rashes, which can last for days, weeks, months, or even years, hives typically last no more than 24 hours.
However, hives can sometimes last longer—sticking around for days, weeks, or months as well. This is known as chronic urticaria, explains Rebecca Dufner MD, MBA, FAAD, dermatologist and Director of Digital Health and Clinical Innovation at Tufts Medical Center. But even in these cases, “each individual lesion is transient and should disappear within a day, in contrast to other rashes which typically last longer and are more persistent.”
If you see raised areas or have especially itchy patches on the skin, you’re probably dealing with hives. “Hives are a very distinctive type of rash with raised, welt-like lesions,” says Dr. Segal.
By contrast, rashes aren’t always itchy, depending on what type of rash it is.
What is a rash?
“’Rash’ is the general term describing inflammation on the skin,” Dr. Kraft explains. Hives are just one form of rash—and there are many other types of rashes that can stem from a range of causes.
One of the most common rashes is eczema, a group of conditions otherwise known by their various names—including atopic dermatitis, contact dermatitis, and seborrheic dermatitis. Eczema affects more than 31 million Americans, according to the National Eczema Association. When the skin’s barrier (the outermost layer of your epidermis) isn’t functioning properly, your skin can flake and become scaly, which can result in an eczema rash.
Psoriasis is another common skin condition—affecting more than 8 million Americans, per the National Psoriasis Foundation. It often appears as a rash and is frequently caused by an infection or stress.
Meanwhile, rosacea affects more than 14 million Americans, according to the American Academy of Dermatology. It can cause redness on your face, as well as red spots or bumps and flushing of the skin.
What’s the difference between hives and a rash?
“Hives typically appear as transient, raised areas on the skin—and the color can range from bright red to more subtle variations, depending on a patient’s underlying skin tone,” Dr. Dufner explains. “Hives can be very itchy, but they should not be painful, leave bruising, or cause bloody blisters.”
“In comparison, rashes from eczema or psoriasis are usually fixed in the same place for several days or weeks and may be dry, red, or scaly,” Dr. Kraft says.
In addition, hives are not contagious, Dr. Dufner says. Not all rashes can spread from person to person, but some—like those caused by bacteria, fungi, or viruses—are contagious.
Hives vs. rash: Symptoms
“Hives have a very characteristic appearance and behavior on the skin,” says Dr. Dufner. They’re usually very itchy and come and go—often getting better on their own—and they do not stay in the same location for long periods of time, adds Dr. Kraft.
Symptoms of hives
Hives are distinguishable by their telltale appearance, says Dr. Segal. Expect them to feel itchy and to look red and raised.
“Hives are typically raised pink or red welt-like lesions that are either localized in one area or generalized over the whole body,” she explains. “They are typically itchy and occasionally warm—generally uncomfortable.”
They may also be the same color as your skin, unlike rashes (which will generally be only red).
Symptoms of hives may include:
- Red or skin-colored bumps that may blend together in clusters
- Patchy red skin in the area where the bumps present
- Bumps that look like mosquito bites, “and may welt up more when scratched,” says Dr. Kraft
- Itchiness
Symptoms of a rash
Rashes vary depending on the type of underlying skin condition. For example, a shingles rash will probably not look the same as, say, a psoriasis rash.
Still, rashes do tend to have certain identifiable characteristics. “Rashes are usually defined by changes in color or texture of the skin,” says John J. Shaff, PA-C, DFAAPA, a board-certified physician assistant at Stockton Dermatology in Phoenix, Arizona. “Rashes don’t always itch either, unlike hives.”
On the other hand, similarly to hives, certain types of rashes may itch excessively, especially if the rash stems from something irritating such as poison ivy. Other rashes, such as shingles—also known as herpes zoster—may even be painful.
Rash symptoms may include:
- Changes in skin texture, such as scaly, bumpy, rough, or raw-looking skin
- Redness
- Pain
- Swelling
- Skin that’s warm to the touch
- Blistering
- Itchiness
Hives vs. rash: Causes
“Dermatologists study and learn to differentiate over 3,000 types of skin conditions,” Dr. Dufner explains. “Clues to what is causing your rash [including hives] can range from subtle physical findings to the distribution of the rash, clinical history, or how it responds to treatment. Often, there are tests we can do that can be helpful in differentiating rashes and finding the best treatment options.”
Cause of hives
“Hives are caused by activation of the allergy cells in the skin (mast cells) releasing their contents (histamine) but it does not mean it has to be an allergic reaction causing it,” Dr. Kraft explains. “In fact, it is very common for people to get hives due to a viral illness or spontaneously.”
So, while it’s possible that hives erupt out of the blue and have no clear cause, Dr. Kraft and Dr. Dufner say that some common triggers of hives include:
- Infections
- Medications
- Environmental changes
- Intense sunlight
- Insect bites
- Physical stimuli, such as friction or pressure from tight clothing
- Allergies to food, medication, pets, pollen, dust, or mold
- Underlying health conditions
- Stress and anxiety
“Sometimes, physical triggers like heat, cold, pressure, or vibration may cause hives in some people,” Dr. Kraft adds.
Causes of a rash
The most common cause of a rash is dermatitis, which is when your skin reacts to allergens or irritants, such as fragrances, harsh soaps, or cleaning products, per the Cleveland Clinic. A food allergy or allergic rhinitis (hay fever) can cause a rash as well.
Brushing up against a plant like poison ivy, stinging nettles, or ragweed often triggers an allergic rash, too—and some people can even get a rash from plants like orchids, daffodils, tomato leaves, and some herbs.
In addition to allergic dermatitis, the experts say that a rash could also occur due to:
- Chronic skin conditions, such as eczema, psoriasis, or rosacea
- Drug reactions
- A fungal infection, such as ringworm, athlete’s foot, or yeast infection (Candidiasis)
- A bacterial infection, such as cellulitis
- A viral infection, such as chickenpox or shingles, fifth disease, and hand, foot and mouth disease
- Autoimmune diseases, such as lupus
- Bug bites
- Extreme heat
- Stress
Hives vs. rash: Treatment
Although both hives and rashes generally require similar treatment, there are subtle differences in how you treat hives vs. rashes, according to dermatologists.
Treatment for hives
“Hives often get better on their own, but using long-acting antihistamines can help with the itch,” Dr. Kraft says. These medications—such as Benadryl, Zyrtec, or Claritin—are most effective when continuously taken, adds Dr. Segal. (Here are other ways to treat hives at home.)
Equally important: identifying the root cause of the hives in order to potentially eliminate any triggers. It may take some trial and error, but take note of when you’re experiencing hives—like if it’s after wearing clothing that’s too tight, during sun exposure, when coming into contact with an allergen, or if hives pop up when you’re under stress.
By pinpointing what’s causing the hives, you can prevent future outbreaks. This may include wearing looser, more breathable clothing, in the case of friction-based hives, or by avoiding sunlight and staying in the shade, if you have sun-induced hives.
Another common cause of hives has to do with extreme temperature changes, in particular, the cold—known as cold urticaria. Antihistamines also can be used to block cold urticaria, as they’re triggered by histamine release, explains Dr. Segal.
Finally, studies have pointed to a link between stress, exacerbated skin conditions, and inflammation, so attempts to lessen stress certainly can’t hurt—and might even help.
Treatment for a rash
“Rashes can be treated in many ways but differ depending on the cause,” says Shaff. “Most often, a topical steroid is used to help, but this isn’t always the case. If the rash is caused by something the person came in contact with, then that needs to be removed.”
But if a rash is caused by an illness or infection, it won’t go away until the underlying issue is identified. “The illness or infection needs to be treated and the rash will usually resolve with that,” says Shaff.
Treating a rash is best done under the care of an experienced medical provider, says Dr. Segal. “The rash must be correctly identified and diagnosed in order to treat it appropriately,” says Dr. Segal. “Treatments can vary from as simple as avoidance of triggers to systemic medications and even more intensive testing.”
She emphasizes that a correct diagnosis is essential to finding your best treatment option. “Inappropriate treatment can worsen certain conditions rather than improving them,” she says.
Can hives be dangerous?
Hives are extremely common, but severe hive reactions that tend to have a hereditary or genetic source are rare, says Dr. Segal. Still, in some cases, hives can be dangerous and can lead to swollen lips or a swollen tongue, which can affect breathing and require immediate medical attention.
Chronic hives aren’t as dangerous, but they’re still troubling, explains Dr. Segal. “Some people are more prone to hives and have a lower threshold for reacting to environmental stimuli. The hives can either be fairly continuous or wax and wane—such as worsening or improving seasonally or based on location,” she says.
If you have chronic hives, see your doctor to diagnose the underlying cause: likely allergies or an autoimmune disorder, although stress is another common trigger.
When to see a doctor
Dr. Dufner says that “if you’re having trouble managing your symptoms at home, if you are uncertain of your diagnosis, or if your symptoms are not improving, you should make an appointment with a dermatologist—we are here to help you!”
A medical professional can help distinguish the cause of a rash based on the timing of onset, appearance, and description, then direct the right course of treatment, like a medication or topical dream, explains Dr. Kraft. “It can be very helpful to take pictures of the rash in case it is not present by the time you are seen in the office.”
But if you have a rash that is spreading rapidly or is associated with systemic symptoms such as fever, chills, nausea, vomiting, or joint pain, you should seek urgent medical attention, says Dr. Dufner.
You should also seek immediate medical care if your rash involves your face, lips, or tongue and you’re having difficulty breathing. “Hives can be associated with a condition called angioedema, where the swelling occurs deeper in the skin and can involve the airway,” she says.
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Sources
- Jennifer Segal, MD, founder of Metropolitan Dermatology Institute, Houston
- Kelly Bickle, MD, board-certified dermatologist in Santa Monica, California
- Sheilagh Maguiness, MD, pediatric dermatologist, an associate professor in the department of dermatology at the University of Minnesota Medical School, and co-founder of Stryke Club
- Papri Sarkar, MD, board-certified dermatologist in Newton, Massachusetts
- Jeffrey Fromowitz, MD, board-certified dermatologist in Boca Raton, Florida
- Inflammation & Allergy Drug Targets: "Brain-Skin Connection: Stress, Inflammation and Skin Aging"
- John Shaff, PA-C, DFAAPA, Stockton Dermatology, Phoenix
Medically reviewed by 
