Red, itchy rashes on the neck can sometimes be triggered by expensive perfume or jewelry – a fact that I can personally attest to.
If you’ve ever had to deal with these itchy uncomfortable allergic skin reactions, you know how miserable they can be. I once bought a lovely gold-tone necklace, and wore it for the first time at a conference. Two days into the conference, my neck was seriously inflamed and itchy.
That’s what happens when you’re allergic to nickel: if you come into contact with it, you can develop a rash 2 to 3 days later (on average).
In fact, the fragrance additives in perfume, and the nickel that’s often used in jewelry, are two of the most common triggers of 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. In this post, I’ll outline some of the top triggers of allergic contact dermatitis on the neck. I’ll also include links to some of my handouts that provide alternate product suggestions.
Why do I have a rash on my neck?
There are many potential causes for rashes on the neck.
Sometimes rashes can develop due to skin irritation, such as irritation from heat, sweating, and rubbing of the skin.
Sometimes neck rashes are due to certain inflammatory skin conditions.
Neck rashes may also be due to allergic reactions.
To make an accurate diagnosis, your dermatologist will ask you questions about the rash and will examine the area. Sometimes they'll need to perform further testing.
If your doctor has diagnosed you with contact 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 skin 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
When poison ivy brushes against your skin, it doesn't burn or bother you right away
Instead, a rash appears about 2-3 days later
BUT it could be shorter or longer than that
In fact, the rash may appear just a few hours later, or as long as a week later
This delay is what makes ACD so hard to figure out
There are many other substances and objects that can trigger similar reactions, such as perfume, jewelry, clothing, and many others.
One other important point about allergic skin reactions due to ACD.
Once the rash occurs, it may last for weeks, and sometimes up to 8 weeks
Let me repeat that: allergic skin reactions can sometimes last 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. My handout on fragrance allergy has more information.
For patients with a rash on the neck, I always tell them not to apply any perfume directly to the skin. Instead, if you really want to use perfume, it's best to use a small amount on the outside of your clothing. Do NOT spray the perfume into the air and do not apply it directly to your skin.
2. Skin care products, such as soap or moisturizer. The options listed in my handout 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 I am SO specific when providing product recommendations.)
3. Jewelry. If you're dealing with a rash on the neck, it's important to pay close attention to your jewelry. The most common culprit is metal jewelry, because it often contains nickel. This may be an issue with a metal chain, a metal locket, or a metal pendant. It may also be an issue with other types of jewelry, since metal may be used in the connections or fasteners.
Nickel is used in many different types of jewelry, and it doesn't matter whether it's expensive. That's because nickel is a strong metal. Because it's strong and inexpensive, it's often mixed with other metals. See my 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 in my list of products that have fewer allergens.
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. My handout provides options for truly fragrance-free hair care products.
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've been 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 may be 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, 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.
The Bottom Line
If you're dealing with rashes on the neck, and your dermatologist suspects that allergic reactions might be to blame, this post lists some of the top triggers. For skin care products that contain fewer allergens, please see this list of products for options.
Dr. Rajani Katta is the author of Glow: The Dermatologist's Guide to a Whole Foods Younger Skin Diet. To receive future updates on preventive dermatology and the role of diet, sign up here.