Nope, Hives and Eczema Are Not the Same Thing—Here’s How To Tell Them Apart

You’re putting on your body lotion as part of your nightly skin-care routine and you notice a couple of little bumps on your arm. It’s also so itchy and red. You don’t think it’s your skin purging or reacting to the new products you’ve implemented (you did a patch test beforehand, which went well). You’ve narrowed it down to either hives or eczema, but how are you supposed to tell one from the other?

Telling hives vs eczema apart can be tricky. Both are itchy skin conditions that stem from an immune system response. And they can look similar, too. “Hives and eczema can both cause skin to appear red and swollen. As a result, people may mistakenly refer to hives as eczema and eczema as hives,” says Brendan Camp, MD, a board-certified dermatologist based in New York City.

That said, each have different underlying causes, and there are ways to tell them apart by looking at them. Here’s how to tell what you’re dealing with and how to find relief.

Causes of hives and eczema

Hives and eczema are essentially both allergic skin conditions, but each one works a little differently. So let’s break it down.

Causes of hives

Hives (aka, urticaria) are a skin rash that pops up when something irritates your skin. “They can develop in people as part of an allergic reaction to an environmental allergen, medication, food, or underlying medical condition,” Dr. Camp says. They’re super common: Around 20 percent of people will get hives at some point in their lives, according to American Academy of Family Physicians.

That’s because hives can be triggered by so many things. Here’s a list of common culprits from the American College of Allergy, Asthma, & Immunology (ACAAI):

• Foods, especially peanuts, eggs, nuts, and shellfish
• Medications including antibiotics, aspirin, and ibuprofen
• Insect stings and bites
• Physical stimuli including heat, cold, pressure, exercise, or sun exposure
• Latex
• Bacterial or viral infections
• Pet dander
• Pollen
• Some plants
• Blood transfusions

Hives are usually short-lived, coming on quickly after you’ve been exposed to an irritant and dissipating soon after. “Hives by definition do not last more than 24 hours on the skin. They may disappear in one area and show up in another, but a single hives lesion will usually resolve within minutes to hours without leaving any mark,” Dr. Camp says.

Causes of eczema

Eczema is a condition that causes dry, itchy skin. It’s thought to be caused by an overactive immune system that prompts the skin to launch an inflammatory response when it comes in contact with an allergen or irritant, per the National Eczema Association. “Eczema can occur in people with a genetic predisposition, characterized by impaired skin moisture retention and a compromised skin barrier,” says Dr. Camp.

Eczema is a chronic skin issue, but said allergens or irritants can trigger a flare. Again, there are a ton of possible culprits, but the National Eczema Association says some of the most likely offenders include:

• Dry air
• Extreme heat or cold
• Soaps, body washes, bubble bath, and other personal-care products
• Harsh laundry detergents or cleaning products
• Wool or polyester fabric
• Added fragrances, like in scented candles
• Metals like nickel, often found in jewelry or utensils
• Dust mites
• Stress

Eczema flares last longer than hives. According to the National Eczema Association, it typically takes days or weeks for eczema-inflamed skin to calm back down. There are also different types of eczema, with the most common being atopic dermatitis, per the American Academy of Dermatology (AAD).

Symptoms of hives vs eczema

Both hives and eczema make your skin red and itchy. But the similarities kind of end there.

According to the ACAAI, hives:

• Are marked by reddish bumps that appear and fade suddenly. (An individual bump will disappear within 24 hours.) They might look pinkish on fair skin or purplish on darker skin. They can also vary great in size, from the size of a pea to a dinner plate, according to the Mayo Clinic.
• Itch
• Feel smooth to the touch
• Can appear anywhere on your body and may fade and show up in different spots
• Turn white when you press on the center

Eczema symptoms are pretty different. Per the Mayo Clinic, it causes:

• Swollen patches that may be red, pinkish, or purplish
• Small raised bumps on darker skin
• Dry, cracked skin that feels rough to the touch
• Itching
• Oozing, crusting, or weeping

Telling psoriasis vs eczema apart can also be tricky. But psoriasis will typically create dry, raised skin patches (called plaques) that look red or white and scaly, per the Mayo Clinic.

Treatment for hives and eczema

Once you’ve figured out which condition you’re dealing with (you can always see your dermatologist or primary-care doc if you’re unsure), you can start looking at proper treatment. Sometimes this will involve home remedies for allergies, too, which may be causing your skin reaction.

Treatment for hives

First things first: If you can figure out what’s causing your hives, do what you can to avoid it, Dr. Camp recommends. (If it’s a medication, check with your doctor before stopping it.)

For fast relief, you can apply a cold compress, slather on an anti-itch lotion (like calamine lotion), or take an over-the-counter (OTC) antihistamine like Zyrtec, Claritin, or Benadryl. They’ll take down the inflammation to relieve the redness, swelling, and itching, says the AAD.

If your symptoms are severe or they keep coming back, your doctor might recommend a corticosteroid like prednisone or a prescription antihistamine. If those aren’t cutting it, an injectable biologic like omalizumab can help, the AAD notes.

Treatment for eczema

Prevention is the best medicine when it comes to eczema. That starts with keeping your skin from getting too dry, which can lead to irritation. “Maintaining a simple skin-care routine focused on providing adequate skin moisture is essential,” Dr. Camp says. That includes taking short showers or baths (long ones dry out your skin) and following up with a thick ointment or cream (slather on more throughout the day any time you feel dry), the National Eczema Association recommends.

You’ll need more help when you’re flaring. Cold compresses can calm mild symptoms, but in general, “flares may be treated with topical steroids or oral medications like steroids or antibiotics,” Dr. Camp says. If your eczema is severe, your doctor might prescribe an injectable biologic or an oral immunosuppressant (like a JAK inhibitor) to keep your symptoms under control, per the American Academy of Allergy Asthma & Immunology.

Preventing hives and eczema

You can’t always stop hives or an eczema flare, TBH. But being nice to your skin and avoiding triggers as much as possible makes a big difference for both.

According to the ACAAI, ADA, and Cleveland Clinic, these things can help:

• Wear loose, comfortable cotton clothing: Tight clothes make it harder for your skin to breathe. For eczema especially, steer clear of irritating fabrics like wool or polyester.
• Watch the temp: Try to stay cool and shaded on warm, sticky days—overheating and too much sun can trigger eczema or hives. Keep your skin covered if you’ll be out in cold or windy conditions, too.
• Don’t let your skin dry out: This one’s mostly for eczema. Again, keep those showers or baths warm (not hot) and short (think five to 10 minutes max), and be religious about moisturizing.
• Resist the urge to rub or scratch: Both irritate your skin and can make the problem worse.
• Identify your triggers and avoid them: Everyone’s skin responds differently to different triggers. Keep a journal of your symptoms and the details around how they happened (Did your hives start after eating shrimp? Did your eczema flare up after a day at the beach?) to figure out what sets your skin off so you can limit your exposure as much as possible.

When to see a doctor

There’s typically no need to stress about a one-off case of hives that goes away quickly. But if your symptoms keep showing up and get worse over time, definitely seek help. See a dermatologist if your skin isn’t responding to at-home or OTC treatments, or your rash is negatively affecting your quality of life, Dr. Camp recommends. Together, you can come up with a plan to control the itch and feel better.

FAQ

Can stress cause hives or eczema?

Absolutely. “Stress can exacerbate symptoms associated with hives and eczema, especially itching. Stress may also trigger the itch-scratch cycle, which can worsen symptoms and put skin at increased risk for infection,” Dr. Camp says.

On the other hand, finding ways to tame your tension can help keep your skin calm. You’ll typically be able to differentiate stress hives vs eczema if the rash completely goes away once you’re relaxed/once the trigger is gone.

How can you tell the difference between hives and atopic dermatitis?

Skin rash differences can be tough to pinpoint. Two key things to look for? First, pay attention to the texture. Hives are smooth, while eczema is rough and scratchy. Second, see how long your symptoms last. While a case of hives can last for a couple days or longer, a single hive will disappear within 24 hours, Dr. Camp says. (Circle it with a marker so you can keep track!) Eczema flares usually last for days or weeks. It’s also possible to get hives that aren’t itchy, whereas atopic dermatitis will likely always itch.

Can you develop eczema or hives as an adult?

Eczema often strikes in childhood, but it can also develop in adulthood, particularly in your 50s. Adult-onset eczema is more likely to happen on the backs of your knees, elbow crooks, back of the neck, face, or around the eyes, notes the AAD.

—reviewed by Jennifer Gilbert, MD, MPH