Cortisol and skin: bruising, stretch marks, rashes and what the evidence shows

Cortisol has a few documented effects on skin, and they appear in two adrenal conditions. For rashes, eczema and hives, the research links flares to stress, and the studies that measure cortisol itself are small and don’t agree.

Skin changes in Cushing’s syndrome

NIDDK lists easy bruising and wide purple stretch marks, mainly on the abdomen, breasts, hips and under the arms, among the signs of very high cortisol for a long time. Women may have excess hair on the face, neck, chest, abdomen and thighs. These come with other signs: weight gain, thin arms and legs, a round face, a fatty hump between the shoulders and weak muscles.

Not everyone with Cushing’s syndrome has these signs, and NIDDK says that can make it hard to detect.

In a 2019 questionnaire of 320 people with Cushing’s syndrome, 64.7 percent said skin problems and 76.3 percent said hirsutism or acne were among the symptoms they first noticed. After treatment, 16.6 percent still reported skin problems (Endocrine Connections, 2022). The survey was online, mostly women, and based on recall, so treat the figures as rough. They describe people who already have the condition, not the odds that your skin problem comes from it.

Skin changes in Addison’s disease

NIDDK says people with Addison’s disease may have darkening of the skin, most visible on scars, skin folds, pressure points such as the elbows, knees, knuckles and toes, the lips and the lining of the cheek. That comes with the more common signs: long-lasting fatigue, muscle weakness, loss of appetite and weight loss. See low cortisol symptoms.

Cortisol, stress and rashes, eczema and hives

This is where the evidence is weakest. None of the NIDDK or MedlinePlus symptom lists for Cushing’s syndrome or adrenal insufficiency name a rash, eczema or hives.

What the research does say is about stress, not cortisol alone.

• Stress and flares. A 2025 narrative review says stress can make acne, psoriasis and atopic dermatitis (eczema) worse, and lists urticaria (hives) among the conditions influenced by stress. It points to prospective studies linking higher stress with worse acne. It also admits real limits: the experimental (mostly animal) models of stress and skin mainly reflect short-term stress, and they are hard to reproduce (2025 narrative review).
• Eczema. In a small study, 30 adults with atopic dermatitis had higher saliva cortisol than 42 healthy people, and cortisol rose with disease severity on a scoring scale (BioMed Res Int, 2013). The authors read this as a sign of stress, and it can’t show that cortisol causes the rash.
• Hives. In a 2026 study of 67 people with chronic hives and 33 without, hive severity tracked with perceived stress. It did not track with saliva cortisol. In one subgroup, lower cortisol went with longer disease duration (Front Immunol, 2026). The findings point in different directions.

So, can cortisol cause a rash? The sources we use don’t say so. Stress-linked flares are reported in the research, and the cortisol link in them is unresolved.

Steroid creams, tablets and injections

Cortisol helps reduce inflammation, according to NIDDK. Cortisol-like medicines, called glucocorticoids, are used for conditions such as asthma, rheumatoid arthritis and lupus. MedlinePlus says that when checking for Cushing’s syndrome, a provider will ask whether you take glucocorticoids in any form, including pills, shots, inhalers or creams. It also says to tell your provider about all the medicines you use, including skin creams, before a cortisol test. It says not to stop any medicine without talking to your provider first.

Acne and hair

Acne is linked to stress in the review above. MedlinePlus also lists acne among the signs of high levels of DHEAS, an adrenal androgen, in women and girls, along with excess body and facial hair and menstrual irregularities. See the DHEA-S test. Hair thinning has its own page: cortisol and hair loss. This page doesn’t cover treatment.

When to see a clinician

• Easy bruising without injury, or wide purple stretch marks, especially with weight gain, a round face, weak muscles or high blood pressure. See effects of high cortisol.
• Skin darkening that spreads, especially with long-lasting fatigue, weight loss or dizziness on standing.
• A rash that isn’t clearing, or keeps coming back. Skin conditions have many causes, and a clinician can tell what you have.
• You take a steroid medicine. Tell the prescriber about skin changes. See prednisone and cortisol.

A cortisol blood test can’t diagnose a skin condition. MedlinePlus says a cortisol test alone can’t diagnose the cause of an abnormal level. Vomiting you can’t stop, fainting or severe weakness need urgent care. See adrenal crisis.

Keep reading

• Cortisol and hair loss

  What is known about hair thinning, stress and cortisol.

• Effects of high cortisol

  What long-term high cortisol can do and how it is worked up.

• Low cortisol symptoms

  What each symptom can mean, and what doesn't point to cortisol.

• Prednisone and cortisol

  How steroid medicines affect cortisol and its tests.