Hives on The Breast: Causes, Identification, and Treatment

Hives (urticaria) may appear as pink-red bumps, or patches on your skin, and are very itchy. They are often signs of an allergic reaction but can also be idiopathic, meaning the cause is unknown.

While hives tend to disappear within hours, they may reoccur. They can show up anywhere on the body that has come into contact with irritating substances, including the breast area.

It’s important to have a doctor check any rashes on the breasts or the areola, and to not quickly assume it’s just hives.

Aside from hives, other possible rashes or skin conditions that can occur around the breasts include:

  • eczema (atopic dermatitis)
  • psoriasis
  • Candida (yeast infection)
  • contact dermatitis
  • Hailey-Hailey disease (very rare)
  • as symptom of autoimmune conditions, like Hashimoto’s thyroiditis
  • inflammatory breast cancer (IBC)
  • mastitis (inflammation or infection of breast tissue)
  • bug bites
    • acne

Let’s go over how to evaluate whether your rash is due to hives or another possible cause, and when you should see a doctor for further evaluation.

Causes

Hives are primarily caused by our body’s release of the chemical histamine, which is also generated in allergic reactions. According to the American Academy of Dermatology (AAD), here are some common allergens and environmental factors that can trigger hives:

  • animal dander
  • bug bites or stings
  • pollen
  • foods
  • medications
  • latex

Inflamed bumps may appear if your skin comes into contact with irritating substances, such as perfumes or detergents. Hives can also be a symptom of an autoimmune disease, and less commonly, may be caused by viral infections. Hives and other rashes have been a reported symptom of some people with COVID-19.

Other possible causes and contributors of hives may include:

  • exercise
  • extreme weather conditions
  • stress
  • thyroid disease
  • lupus
  • vasculitis
  • pressure on skin (ex: tight clothing or gear)
  • water (temperature, chemicals)
  • lymphoma
  • mastocytosis
  • infections

If you’re experiencing hives in the breast area, you may also have them on other areas of the body, especially in the case of an allergic reaction. Check to see if you have hives on other areas of your skin.

Some people find it helpful to take notes or photos of their skin irritation to try and trace the cause, and to show to their doctor to aid in diagnosis.

Appearance

Symptoms of hives include raised welts on the skin that are pink or red in color. They’re often extremely itchy. Hives tend to occur in multiples and can range significantly in size. Sometimes smaller hives can grow larger to form one big one — up to the size of a dinner plate.

A hallmark of hives is that they appear suddenly and don’t last long, typically disappearing in less than 24 hours. However, hives can reoccur in cycles, depending on the cause.

Pictures

Hives have characteristic symptoms, such as being raised and itchy, but this condition may be confused with other types of rashes. Explore the images below, which show what hives, eczema, and rashes from inflammatory breast cancer may look like.

Similar rashes

Other rashes and forms of skin irritation may mimic the appearance of hives. However, there are often unique defining factors that will help you tell the difference.

Bug bites

Some hive-like irritations can develop because of a reaction to a bug bite, but the two aren’t the same. While bug bites tend to be more common on the arms and legs, it’s possible for them to occur in the breast area and other parts of the torso.

Bug bites that may mimic the appearance of hives commonly come from:

  • mosquitos
  • bedbugs
  • scabies
  • gnats

An allergic reaction to a bug — such as a bee sting or flea bite allergy — can also cause hives.

Eczema

Another condition that causes a rash that looks similar to hives is eczema, which has several different types. Like hives, eczema is red and extremely itchy; although, it looks slightly different depending on the melanin in a person’s skin. The eczema rash itself does not cause welts.

If you have atopic eczema, you may notice that this rash comes and goes. This type of eczema most often begins during infancy or your childhood and requires lifelong management and treatment of flare-ups.

Other types of dermatitis (skin irritation), such as contact dermatitis, can similarly appear as a pink or red scaly rash.

Inflammatory breast cancer

A rare and aggressive form of breast cancer called IBC can also cause rash-like symptoms.

IBC can manifest as a scaly orange or pinkish rash on the areola or breast, and may include swelling or itchiness. This cancer is a type of invasive ductal carcinoma, and the inflammation is caused by cancer cells blocking lymph vessels. If not detected early, IBC can quickly spread to the lymph nodes.

But unlike hives, IBC also causes:

  • swelling and tenderness in the affected breast
  • the breast to feel warm or heavy
  • dilated pores
  • pitted-looking skin, similar to an orange peel
  • inverted nipples
  • dimpling or flattening of the nipples
  • skin on the breast to turn a red or purple color

Certain breast cancer treatments, such as chemotherapy, targeted therapies, and hormonal therapy, may cause breast rashes in some people. It’s important to report these symptoms to your doctor to rule out medication allergies.

Researchers in one 2017 study found it was common for dermatitis to develop several weeks or months after breast reconstruction surgery following a mastectomy. This may be due to a loss of skin barrier integrity, which may be corrected with a combination of antibiotics and topical corticosteroids.

Radiation therapy in cancer treatment can also cause a red scaly rash known as radiation dermatitis.

Diagnosis

To diagnose a rash on the breasts or chest area, your doctor will need to conduct a physical exam. They may be able to tell that the rash is allergy- related right away based on the symptoms, as well as your medical history. They may also order lab tests.

If your doctor determines your rash is hives due to an allergy or irritant, they’ll likely prescribe a topical steroid ointment. You’ll then schedule a follow-up within a month to check your progress.

Your doctor may refer you to an allergist and recommend allergy testing. This helps to determine which allergens your body reacts to help you in avoiding them.

If a rash does not resolve after a month, or if IBC or Paget’s disease is suspected, a skin biopsy will usually be done to determine the cause. Your doctor will refer you to an oncologist (cancer specialist) for further medical evaluations, including imaging.

Treatment

Treatment for hives on the breast depends on the underlying cause. If your hives are related to allergies, your doctor may recommend:

  • avoiding your triggers, such as scented soaps, certain laundry detergents, pollen, and certain foods
  • wearing looser clothing
  • taking over-the-counter or prescription antihistamines to help stop your body from reacting to allergens
  • having corticosteroid (oral or to pical) treatment, used on a short- term basis to reduce severe inflammation
  • receiving allergy shots to help gradually decrease your sensitivity to certain allergens
  • receiving omalizumab (Xolair) injections for the treatment of chronic idiopathic hives only
  • taking immunomodulators or immunosuppressive drugs
  • taking leukotriene receptor antagonists (often used for asthma and allergies), a more recent treatment option

If it’s determined that a bug is responsible for your rash, some culprits (like bedbugs and scabies) may require you to clean or hire a professional to treat your environment to get rid of an infestation. You may also need to take an oral or topical medication.

If your hives continue to recur despite treatment, your doctor may refer you to an internal medicine specialist. They may help rule out any other possible underlying medical conditions that could be causing hives.

When to seek care

A doctor should evaluate any unusual rash on the breast. This is especially true if your hives continue to return after several weeks despite treatment. You may benefit from seeing a specialist, such as an allergist, dermatologist, immunologist, or internist, which your doctor can refer you to.

Seek emergency medical care right away if your hives are accompanied by other severe symptoms, such as facial swelling and breathing difficulties. These may be signs of anaphylaxis, a potentially life threatening allergic reaction.

You should also see a doctor if you’re experiencing nipple discharge or pus from any welts or rashes on your breast. These may be signs of an infection.

Takeaway

Finding a rash on your breast can be concerning, but it’s important to know there are a variety of possible causes. Try not to jump to conclusions without all the information. Consider documenting the rash via a diary or photos to aid in diagnosis, and schedule an appointment with a healthcare professional.

Hives are just one potential cause of a breast rash. This is most often an allergic reaction that results in raised, red welts that become very itchy. Bug bites, eczema, IBC, and other conditions can also cause hive-like rashes or bumps on your chest.

Reach out to your doctor if a rash on your breast worsens, or if it does not resolve within a few days. They can help provide proper testing and an accurate diagnosis so you can receive effective treatment.

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