What is Hashimoto's Rash?
Hashimoto’s rash is technically called chronic urticaria and can pop up on people with Hashimoto’s thyroiditis, a condition that triggers the body’s immune system to attack the thyroid gland.
Hives, or raised patches of itchy skin, is a frequently reported rash presented by people with Hashimoto’s thyroiditis. Rashes or areas of discolouration can form in the creases of your skin. The skin can also thicken or resemble the surface of a ‘cork’. Some areas of skin affected can feel woody and firm to the touch. Not everyone with Hashimoto’s thyroiditis will have a rash. However, a rash doesn’t confirm you have Hashimoto’s disease [1, 2].
Causes of Hashimoto's Rash
Hashimoto’s rash does not have a clear cause, except that it’s always associated with Hashimoto’s thyroiditis, the autoimmune attack on the thyroid.
High iodine intake from supplements, medications, beans and some other foods, or nicotine, may sometimes trigger the rash for someone with thyroid disease. In some studies, there has been a link between autoimmune thyroid disease and the development of hives [1, 3].
Further, medications used in the treatment of hyperthyroidism (high thyroid) – a parasympathetic, sympathetic imbalance similar to Hashimoto’s thyroiditis – might also cause a rash.
At the same time, chronic urticaria is associated with Hashimoto’s thyroiditis, a syndrome in which the immune system produces anti-thyroid antibodies that can destroy the thyroid gland. Thus, some patients with both conditions might also develop a rash [4].
Moreover, some infections, such as those caused by Herpes simplex virus, Blastocystis hominis, and others, are known to stimulate autoimmune reactions that might pave the way to autoimmune diseases like Hashimoto’s thyroiditis and hence indirectly to the rash [5, 6].
What are the Symptoms of Hashimotos Rash?
Hashimoto’s disease can present with skin symptoms such as a rash or bodily hives. Although these rashes or hives may appear differently in various people, many refer to them as Hashimoto’s rash or hives.
One of the most telling signs of his Hashimoto’s rash was that it manifested as red, elevated bumps called welts (known medically as hives) that were often intensely itchy and could come and go rapidly [7].
The hives are often intermittent, flaring up one day and vanishing the next (typically within 24 hours) only to re-emerge elsewhere on the body a few days later. Hashimotos is considered chronic if the hives last more than six weeks [7].
A rash associated with Hashimoto’s, particularly in the red or purple variety, could be noticeable in light-skinned individuals, while brown rashes are more commonly seen in dark-skinned people [1]. It is often raised, similar to hives, is red, purple or brown, and itchy and painful. The skin overlying the rash is frequently warm to the touch [1].
Hashimoto’s rash, which sometimes develops intense redness of the palms and soles, can also trigger sweating in those areas. The skin-related conditions also include hair loss and thinning skin [7].
A rash or hives, however, can be a clue of Hashimoto’s disease, especially if one has other symptoms such as:
- rapid heart rate,
- insomnia,
- fatigue,
- nervousness,
- irritability,
- hand tremors,
- increased appetite with unintentional weight loss,
- increased thirst,
- muscle weakness,
- heat intolerance,
- increased urination and bowel movements,
- diarrhoea,
- decreased libido,
- bulging in one or both eyes
- or swelling in the front of the neck (goitre).
If you have any of these symptoms, you should review them with a physician to determine if your physician should make a thyroid evaluation of you [1].
Treatment methods for Hashimotos Rash
Hashimoto’s autoimmune thyroiditis, for example, can occasionally have skin manifestations, such as hives or rashes. The treatment options are numerous and can be highly personalised.
Standard treatment for hives includes antihistamines – prescription or over-the-counter oral medications – that block the production of histamine, a substance in the body that results in allergic symptoms, or cold compresses for skin cooling and decreased inflammation [7].
These medications can reduce inflammation and alleviate symptoms of the condition. Corticosteroids, such as prednisone, suppress the immune system and can be helpful in some cases [1, 7]. Other immune-altering medications, such as omalizumab (Xolair), used to treat allergies, or cyclosporine, usually used only for severe cases [7, 8].
Hydroxychloroquine, a once-a-week pill developed for malaria prevention, has been proven in many trials to improve hives over time or even disappear altogether by the third month in 83% of people [7].
Levothyroxine, an often prescribed drug for thyroid disease, has been shown to treat the classic symptoms of hives. Coupled with the findings that those with more persistently raised antithyroid antibodies are more likely to benefit [2, 7], these findings make the case that treating the thyroid issue could even benefit skincare.
Topical In the most severe cases, surgery (thyroidectomy) [1] is used to remove some or all of the thyroid gland, such as steroids for rashes or antihistamines to counteract itch and treat skin problems at their site [1]. Removal of some or all of the thyroid gland via surgery (thyroidectomy) [1] is used in the most severe cases.
Additional therapy aids include lifestyle changes, such as a wholesome diet, regular exercise, and stress management, to enhance mental function or reduce symptoms [3].
Remember that the list might not include all the treatments that work for a given person. If therapy is left out, it doesn’t mean it isn’t practical for you or that it’s the wrong one for your symptom profile and overall health status. It’s always best to consult a healthcare provider to develop the best treatment plan.