Allergic Skin Reactions on the Neck
If your dermatologist or allergist has diagnosed you with allergic skin reactions on the neck, the information below will provide more guidance on what items to avoid.
There are many causes for rashes on the neck. Some may be due to irritation, such as irritation from heat, sweating, and rubbing of the skin. Sometimes these rashes are due to certain inflammatory skin conditions. Diagnosis will require an exam of the area, and may even require further testing. If your doctor has diagnosed you with dermatitis of the neck (which is a specific type of skin inflammation), the recommendations below will help.
What is allergic contact dermatitis (ACD)? Why is it so hard to diagnose?
ACD is a type of allergic reaction. In this type of allergy, a substance contacts the skin, and later results in a rash. The rash from poison ivy is one example. The rash classically occurs 2-3 days later, but it may happen just a few hours later, or one week later. This delay is what makes ACD so hard to figure out.
Once the rash occurs, it may last for weeks, and sometimes up to 8 weeks. People may stop using the triggering product for 1-2 weeks, but that’s usually not long enough to see results.
What kinds of substances can trigger ACD of the neck?
1. Skin care products that contact the skin directly, such as perfume, soap, or moisturizer.
2. Objects that touch the skin directly, such as jewelry or badge holders.
3. Substances that are used close by (and that may occasionally contact the neck), such as chemicals used in hair care products [especially leave-in hair care products].
4. Topical medications, including OTC, prescription, and home remedy medications.
5. Substances in clothing, such as fragrance from laundry detergent or chemicals or dyes used in the clothing itself.
What are some of the most common substances that trigger ACD of the neck? How can I avoid them?
1. Perfume. Although you may have used the same perfume for years, it doesn't matter when it comes to allergies: you can actually develop an allergic reaction to any product at any point in time. Perfume is a common trigger since it contains dozens of different fragrance additives. Our handout on fragrance allergy has more information. For patients with a rash on the neck, I advise against applying perfume directly to the skin. A small amount may instead be used on the outside of your clothing.
2. Skin care products, such as soap or moisturizer. The options listed below do not contain fragrance additives or certain preservatives. (It's a little-known fact that products that are labeled as fragrance-free may still legally contain some fragrance additives. This is why we are very specific when providing product recommendations.)
3. Jewelry. The most common culprit is metal jewelry, due to the presence of nickel. Nickel is a metal, and since it's strong and inexpensive, it's often mixed with other metals. See our handout on nickel in jewelry for more information.
4. Badge holders, lanyards, or stethoscopes. These items may trigger rashes on the neck in those who are allergic to metal, rubber, or dark dyes.
5. Fragrance in laundry detergent. Fragrance additives in laundry detergents are a common trigger, and this includes both natural fragrances and synthetic fragrance additives. Even organic detergents and baby detergents may contain fragrance additives. Dryer sheets and fabric softeners may also serve as triggers. I have also seen cases due to fragrance additives [such as Unstoppables], which are designed to last in clothing through multiple washes. Some truly fragrance-free options are listed below.
6. Hair care products. I'm seeing more and more reactions to hair care products over the last few years, due to fragrances, essential oils, and preservatives. These are found in almost all hair care products, and this can be an issue for the neck since these substances can rub onto the neck. This is especially a concern with leave-in hair care products, such as hair serum, hair gel, mousse, and hairspray.
7. Topical medications. Some OTC and even some prescription medications can trigger allergic reactions. This includes antibiotic ointments such as neomycin (found in Neosporin or triple antibiotic ointment) and bacitracin (found in Polysporin). It may also include numbing creams such as benzocaine (found in Solarcaine and Lanacaine). Recently, I am seeing many reactions to home remedies such as tea tree oil and other essential oils.
8. Chemicals in clothing. While many people are aware that laundry detergent can be a problem, it's less well-known that items of clothing themselves may trigger allergic reactions. This may be due to the dyes that are used to color the clothing, or maybe due to other chemicals [formaldehyde finishes] that are sometimes added to clothing to make it wrinkle-free. While you should always wash clothing before wearing it, some of these chemicals stay in clothing despite washing. I've seen more reactions in recent years from some of the dark clothing dyes (especially blue dyes that are found in blue, black, and other dark-colored items). These dyes are released more easily when exposed to sweat and when used in synthetic materials, such as workout clothing. If this is a concern, I recommend using only lighter-colored shirts. Note that the labels on clothing do NOT indicate what color dyes have been used.
What products should I stop using? What are examples of products that contain less of the substances that commonly trigger ACD?
The products below are examples (there are multiple other options) of products that do not contain some of the common triggers of ACD. They do not contain any synthetic fragrance additives, natural fragrance additives, botanicals, formaldehyde, methylisothiazolinone, or lanolin. Some are available at major retailers, and others must be ordered via phone or website.
Note that every product must contain some additives, and some people are allergic to less common triggers. Therefore, if these recommendations do not help, you may require further testing. It can take up to 8 weeks of allergen avoidance for your skin to recover.
Your physician will recommend or prescribe a medicated ointment to use during this time to help with the inflammation. Stop using any and all over-the-counter medications, including numbing creams, antibiotic creams, Benadryl cream, tea tree oil, or others.
These recommendations only apply for the exact products listed. Products with a similar name may not be a safe choice. We make every effort to provide up-to-date information, but product formulations frequently change, so read labels and use caution.
NOTE: All products contain some potential allergens.BCL=benzalkonium chloride/CPB=cocamidopropyl betaine/IPBC=iodopropinyl butylcarbamate/ P=parabens/ PG=propylene glycol/TR=trolamine
Facial and Body Cleansers:
Eyelid cleansers: Albolene gentle cleanser [to remove make-up]
Liquid cleansers: Aveeno baby cleansing therapy wash fragrance-free, Cetaphil gentle skin cleanser [liquid only][P,PG], Cerave hydrating cleanser [P] and foaming cleanser [P,PG], Free and Clear liquid cleanser, Neutrogena ultra gentle hydrating cleanser (creamy formula only), Vanicream gentle facial cleanser
Bar soaps: Aveeno fragrance-free bar soap, Neutrogena fragrance-free bar soap [TR], Vanicream bar soap [1-800-325-8232][PG]
Moisturizers (from less to more greasy):
Cerave cream [P], Aveeno Eczema Therapy cream [BCL], Theraplex eczema therapy with oatmeal (theraplex.com), Neutrogena Norwegian Formula Hand Cream fragrance-free [P], Vanicream cream [PG], Cerave healing ointment, Theraplex emollient for severely dry skin, Vaniply, pure Vaseline petroleum jelly [no added fragrance]
Free and Clear shampoo/ conditioner [PG]/ styling gel/hairspray soft or firm hold
[available at some drugstores or 1-800-325-8232 or vanicream.com]
Neutrogena T-sal shampoo for dandruff [CPB]
DHS Sal with 3% salicylic acid for dandruff [CPB] and DHS conditioner
Available online: see below for Cleure, Magick Botanicals, VMV Hypoallergenics options
Product Lines Available Online
Avene Hypersensitive Skin Care: Tolerance Extreme Cleansing Lotion and Cream
Cleure Sensitive Skin: Glycerin face/body bar soap, face/body wash, face wash, shampoo hypoallergenic, conditioner for sensitive skin, crystal stone deodorant
Magick Botanicals Fragrance-Free Hair Care line: Shampoo Oil-Free [CPB,P], Conditioner [P], Spray-on Detangler and Conditioner, Hairspray, Styling gel [P,PG,TR]
VMV Hypoallergenics: Can customize products based on allergen results, or choose from post-patch testing product line free of top 109 allergens: Essence skin-saving superwash hair and body shampoo/ skin-saving clark wash hair and body shampoo
Branch Basics, Tide Free, All Free and Clear, or Cheer Free
For more product recommendations, please see this page on hypoallergenic skin care products